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

O'Donnell, Joan Margaret; Morgan, Michael Kerin; Manuguerra, Maurizio; Bervini, David; Assaad, Nazih (2021). Patient functional outcomes and quality of life after surgery for unruptured brain arteriovenous malformation. Acta neurochirurgica, 163(7), pp. 2047-2054. Springer Vienna 10.1007/s00701-021-04827-x

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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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