Summary

  • Cerebrovascular embolisation (CVE) is a technique, often used in association with other procedures, in which blood flow in vascular malformations within the brain is reduced or eliminated by introduction of amorphous vascular occluding agents (AVOA's).
  • CVE is a complex procedure, demanding high levels of skill and integration of specialties. Technical development continues to be significant. The Panel accepts that it provides a useful approach to the management of small numbers of patients who are at significant risk of major neurological deficit or death.
  • The Panel has considered a proposal from Western Australia that a national CVE unit be established at Royal Perth Hospital, with an estimated eventual caseload of 80 per year.
  • The Panel notes that the group at     Royal Perth Hospital has developed considerable expertise in CVE, in part based on its own research, and has treated a number of patients from Eastern States as well as from Western Australia.
  • However, the Panel also notes that CVE is being undertaken in Sydney and Melbourne, and that this activity, the additional cost of transporting patients to Perth and a probable increase in workload, provide arguments against a single national unit in Western Australia. The Panel suggests that a more appropriate option is for two units to be recognised as national centres, and that they maintain close liaison.
  • Possible national workload for CVE units might eventually be between 100 and 200 cases a year, at a cost of perhaps $M1 to 2. There would be offsetting savings through avoidance of other medical procedures and hospitalisation which untreated patients would otherwise require.
  • Some additional funding will be required for both the national units. This has not been quantified, but the Panel notes that existing centres evidently have essential equipment and facilities in place.
  • The Panel notes that limited availability of AVOAs has presented a problem to those undertaking CVE in Australia, and that a mechanism is required whereby AVOA's can be made available promptly and without unreasonable conditions of use to national centres.

The Panel recommends that:

  • Two national centres for cerebrovascular embolisation procedures be recognised, one at Royal Perth Hospital and the other on the Eastern Seaboard. Two groups, at the Royal Prince Alfred and Royal North Shore Hospitals in Sydney and at the Royal Melbourne Hospital, have both expressed interest in gaining such recognition.
  • Close contact is maintained between the two centres which should routinely collect and publish data on their cases.
  • Urgent action is taken by the Commonwealth Department of Community Services and Health in consultation with appropriate professional bodies tri.ensure that amorphous vascular occluding agents, catheters and other necessary consumables are readily accessible to the two centres.
  • The need for further CVE facilities be kept under review, bearing in mind the need to concentrate expertise in this area.