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首页> 美国卫生研究院文献>Neurosurgery >Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations Based on Systematic Literature Review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel
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Synopsis of Guidelines for the Clinical Management of Cerebral Cavernous Malformations: Consensus Recommendations Based on Systematic Literature Review by the Angioma Alliance Scientific Advisory Board Clinical Experts Panel

机译：脑海绵状畸形临床治疗指南纲要：基于血管瘤联盟科学咨询委员会临床专家小组系统研究文献的共识性建议

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>BACKGROUND: Despite many publications about cerebral cavernous malformations (CCMs), controversy remains regarding diagnostic and management strategies. >OBJECTIVE: To develop guidelines for CCM management. >METHODS: The Angioma Alliance (), the patient support group in the United States advocating on behalf of patients and research in CCM, convened a multidisciplinary writing group comprising expert CCM clinicians to help summarize the existing literature related to the clinical care of CCM, focusing on 5 topics: (1) epidemiology and natural history, (2) genetic testing and counseling, (3) diagnostic criteria and radiology standards, (4) neurosurgical considerations, and (5) neurological considerations. The group reviewed literature, rated evidence, developed recommendations, and established consensus, controversies, and knowledge gaps according to a prespecified protocol. >RESULTS: Of 1270 publications published between January 1, 1983 and September 31, 2014, we selected 98 based on methodological criteria, and identified 38 additional recent or relevant publications. Topic authors used these publications to summarize current knowledge and arrive at 23 consensus management recommendations, which we rated by class (size of effect) and level (estimate of certainty) according to the American Heart Association/American Stroke Association criteria. No recommendation was level A (because of the absence of randomized controlled trials), 11 (48%) were level B, and 12 (52%) were level C. Recommendations were class I in 8 (35%), class II in 10 (43%), and class III in 5 (22%). >CONCLUSION: Current evidence supports recommendations for the management of CCM, but their generally low levels and classes mandate further research to better inform clinical practice and update these recommendations. The complete recommendations document, including the criteria for selecting reference citations, a more detailed justification of the respective recommendations, and a summary of controversies and knowledge gaps, was similarly peer reviewed and is available on line .
机译：>背景：尽管有许多关于脑海绵状畸形（CCM）的出版物，但有关诊断和治疗策略的争议仍然存在。 >目标：为CCM管理制定指南。 >方法：：美国的患者支持小组（Angiooma Alliance，血管病联盟）代表患者倡导患者并开展CCM研究，召集了一个多学科写作小组，由CCM专业临床医生组成，以帮助总结有关以下方面的现有文献CCM的临床护理，侧重于5个主题：（1）流行病学和自然历史，（2）基因检测和咨询，（3）诊断标准和放射学标准，（4）神经外科方面的考虑，以及（5）神经方面的考虑。该小组根据预定方案审查了文献，对证据进行了评级，提出了建议，并建立了共识，争议和知识鸿沟。 >结果：在1983年1月1日至2014年9月31日之间出版的1270种出版物中，我们根据方法学标准选择了98种出版物，并确定了38种其他近期或相关出版物。主题作者使用这些出版物总结了当前的知识，并得出了23项共识性管理建议，我们根据美国心脏协会/美国中风协会的标准按类别（影响的大小）和水平（确定性的估计）对其进行了评分。没有推荐为A级（因为没有随机对照试验），B级为11（48％），C级为12（52％）。I级为8级（35％），II级为10级（43％），并在5级（22％）中获得III级。 >结论：目前的证据支持有关CCM管理的建议，但是其总体水平和级别较低，需要进一步研究以更好地指导临床实践并更新这些建议。完整的建议文件，包括选择参考文献的标准，对各个建议的更详细的论据以及争议和知识差距的摘要，也经过了同行评审，可在线获得。

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