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Patient functional outcomes and quality of life after surgery for unruptured brain arteriovenous malformation

  • Original Article - Vascular Neurosurgery - Arteriovenous malformation
  • Published:
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Abstract

Background

Studies have questioned the effectiveness of surgery for the management of unruptured brain arteriovenous malformation (ubAVM). Few studies have examined functional outcomes and quality of life (QOL) prior and 12 months after surgical repair of ubAVM.

Objective

This study examined the effectiveness of surgical management of ubAVM by measuring patients’ perceived QOL and their ability to perform everyday activities.

Methods

Between 2011 and 2016, patients diagnosed with an unbAVM were assessed using the Quality Metric Short Form 36 (SF36), the DriveSafe component of the off-road driver screening tool DriveSafeDriveAware (DSDA), the modified Barthel Index (mBI) and the modified Rankin Scale (mRS). Reassessments were conducted at the 6-week post-operative follow-up for surgical patients and at 12-month follow-up for surgical and conservatively managed patients.

Results

Forty-five patients enrolled in the study, of which 35 (78%) had their ubAVM surgically treated. Patients undergoing surgery had a significantly lower ubAVM Spetzler-Ponce Class (SPC). There was no significant difference 12 months after presentation in function or QOL for either the conservative or surgical group. The surgical group had significantly higher QOL of life scores from pre-surgery to 12 months post-surgery (PCS p < 0.01; MCS p = 0.02). Higher SP grade ubAVM was significantly related to poorer function in the surgical group (SP C compared with SP A; p = 0.04, mean difference − 12.4, 95%CI − 24.3 to − 0.4).

Conclusion

Function and QOL are not diminished after surgical treatment of low Spetzler-Ponce Class unruptured brain arteriovenous malformations. QOL is higher 12 months after surgery for ubAVM than for those who do not have treatment for their ubAVM.

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Abbreviations

ubAVM:

Unruptured brain arteriovenous

QOL:

Quality of life

SF36:

Quality Metric Short Form 36

PCS:

Physical Component Score

MCS:

Mental Component Score

DSDA:

DriveSafeDriveAware

mBI:

Modified Barthel Index

mRS:

Modified Rankin Scale

SPC:

Spetzler-Ponce Class

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Funding

Macquarie University Post-graduate Research Scholarship and Australian Government Research Training Program Scholarship

Author information

Authors and Affiliations

  1. Department of Clinical Medicine, Macquarie University, Sydney, NSW, 2113, Australia

    Joan Margaret O’Donnell, Michael Kerin Morgan & Nazih Assaad

  2. Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Camperdown, NSW, 2006, Australia

    Joan Margaret O’Donnell

  3. Department of Mathematics and Statistics, Macquarie University, Sydney, NSW, 2113, Australia

    Maurizio Manuguerra

  4. Department of Neurosurgery, Bern University Hospital and University of Bern, Freiburgstrasse, 3010, Bern, Switzerland

    David Bervini

Authors
  1. Joan Margaret O’Donnell
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  2. Michael Kerin Morgan
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  4. David Bervini
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  5. Nazih Assaad
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Contributions

Conception and design: O’Donnell.

Acquisition of data: O’Donnell, Morgan, Assaad.

Analysis and interpretation of data: O’Donnell, Morgan, Manuguerra.

Drafting the article: O’Donnell.

Critically revising the article: Morgan, Manuguerra, Bervini.

Reviewed submitted version of manuscript: all authors.

Statistical analysis: O’Donnell, Manuguerra.

Administrative/technical/material support: O’Donnell.

Study supervision: Morgan.

Corresponding author

Correspondence to Joan Margaret O’Donnell.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Conflict of interest

The authors declare no competing interests.

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This article is part of the Topical Collection on Vascular Neurosurgery — Arteriovenous malformation.

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O’Donnell, J.M., Morgan, M.K., Manuguerra, M. et al. Patient functional outcomes and quality of life after surgery for unruptured brain arteriovenous malformation. Acta Neurochir 163, 2047–2054 (2021). https://doi.org/10.1007/s00701-021-04827-x

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  • DOI: https://doi.org/10.1007/s00701-021-04827-x

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