Acta Neurochirurgica

, Volume 160, Issue 3, pp 559–566 | Cite as

Quality of life and disability 12 months after surgery vs. conservative management for unruptured brain arteriovenous malformations: Scottish population-based and Australian hospital-based studies

  • Joan Margaret O’Donnell
  • Rustam Al-Shahi Salman
  • Maurizio Manuguerra
  • Nazih Assaad
  • Michael Kerin MorganEmail author
Original Article - Vascular



Few data are available on disability and quality of life (QOL) after surgery versus conservative management for unruptured brain arteriovenous malformations (uAVMs).


The aim of this study was to test the hypothesis that QOL and disability are worse after surgery ± preoperative embolisation for uAVM compared with conservative management.


We included consecutive patients diagnosed with uAVM from a prospective population-based study in Scotland (1999–2003; 2006–2010) and a prospective hospital-based series in Australia (2011–2015). We assessed outcomes on the modified Rankin Scale (mRS) and the Short Form (SF)-36 at ~ 12 months after surgery or conservative treatment and compared these groups using continuous ordinal regression in the two cohorts separately.


Surgery was performed for 29% of all uAVM cases diagnosed in Scotland and 84% of all uAVM referred in Australia. There was no statistically significant difference between surgery and conservative management at 12 months among 79 patients in Scotland (mean SF-36 Physical Component Score (PCS) 39 [SD 14] vs. 39 [SD 13]; mean SF-36 Mental Component Score (MCS) 38 [SD 14] vs. 39 [SD 14]; mRS > 1, 24 vs. 9%), nor among 37 patients in Australia (PCS 51 [SD 10] vs. 49 [SD 6]; MCS 48 [SD 12] vs. 49 [SD 10]; mRS > 1, 19 vs. 30%). In the Australian series, there was no statistically significant change in the MCS and PCS between baseline before surgery or conservative management and 12 months.


We did not find a statistically significant difference between surgery ± preoperative embolisation and conservative management in disability or QOL at 12 months.


Arteriovenous malformation Brain Matched-pairs QOL Surgery 


Funding information

The Australian series was funded by the Macquarie University Post-Graduate Research Fund and Australian Government Research Training Program Scholarship. The Scottish study was funded by the Medical Research Council (grants G84/5176, G108/613, and G1002605), the Chief Scientist Office of the Scottish Government (grants K/MRS/50/C2704 and CZB/4/35), and the Stroke Association (grant TSA04/01). The sponsor had no role in the design or conduct of this research.

Compliance with ethical standards

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Conflict of interest

The authors declared that they have no competing interests.


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Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  • Joan Margaret O’Donnell
    • 1
  • Rustam Al-Shahi Salman
    • 2
  • Maurizio Manuguerra
    • 3
  • Nazih Assaad
    • 1
  • Michael Kerin Morgan
    • 1
    Email author
  1. 1.Department of Clinical MedicineMacquarie UniversitySydneyAustralia
  2. 2.Centre for Clinical Brain SciencesUniversity of EdinburghEdinburghScotland
  3. 3.Department of StatisticsMacquarie UniversitySydneyAustralia

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