Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article - Vascular
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

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

Objective

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.

Methods

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.

Results

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.

Conclusions

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

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Al-Shahi Salman R, White PM, Counsell CE, du Plessis J, van Beijnum J, Josephson CB, Wilkinson T, Wedderburn CJ, Chandy Z, St George EJ, Sellar RJ, Warlow CP, Scottish Audit of Intracranial Vascular Malformations Collaborators (2014) Outcome after conservative management or intervention for unruptured brain arteriovenous malformations. JAMA 311:1661–1669

    Article  PubMed  Google Scholar 

  2. Bayliss EA, Bayliss MS, Ware JE (2004) Predicting declines in physical function in persons with multiple chronic medical conditions: what we can learn from the medical problem list. Health Qual Life Outcomes 2:47. https://doi.org/10.1186/1477-7525-2-47

    Article  PubMed  PubMed Central  Google Scholar 

  3. Bervini D, Morgan MK, Ritson EA, Heller G (2014) Surgery for unruptured arteriovenous malformations of the brain is better than conservative management for selected cases: a prospective cohort study. J Neurosurg 121:878–890

    Article  PubMed  Google Scholar 

  4. Davidson AS, Morgan MK (2010) How safe is arteriovenous malformation surgery? A prospective, observational study of surgery as first-line treatment for brain arteriovenous malformations. Neurosurgery 66:498–504

    Article  PubMed  Google Scholar 

  5. Della Puppa A, Rustemi O, Scienza R (2015) Quality of life of patients affected by unruptured brain AVMs. J Neurosurg 122:984–985

    Article  PubMed  Google Scholar 

  6. Iansek R, Elstein AS, Balla JI (1983) Application of decision analysis to management of cerebral arteriovenous malformation. Lancet 1(8334):1132–1135

    Article  CAS  PubMed  Google Scholar 

  7. Lai EHP, Lun SLC (2002) Impact on the quality of life of patients with arteriovenous malformations during the latent interval between gamma knife radiosurgery and lesion obliteration. J Neurosurg 97(SUPPL. 5):471–473

    PubMed  Google Scholar 

  8. Magro E, Gentric J-C, Darsault TE, Ziegler D, Bojanowski MW, Raymond J (2017) Response to ARUBA: a systematic review and critical analysis for the design of future arteriovenous malformation trials. J Neurosurg 126:486–494

    Article  PubMed  Google Scholar 

  9. Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. Md State Med J 14:61–65

    CAS  PubMed  Google Scholar 

  10. Manuguerra M, Heller GZ (2010) Ordinal regression models for continuous scales. Int J Biostat 6:Article 14

    PubMed  Google Scholar 

  11. Mast H, Young WL, Koennecke HC, Sciacca RR, Osipov A, Pile-Spellman J, Hacein-Bey L, Duong H, Stein BM, Mohr JP (1997) Risk of spontaneous haemorrhage after diagnosis of cerebral arteriovenous malformation. Lancet 350:1065–1068

    Article  CAS  PubMed  Google Scholar 

  12. Mohr JP, Moskowitz AJ, Stapf C, Hartmann A, Lord K, Marshall SM, Mast H, Moquete E, Moy CS, Parides M, Pile-Spellman J, Al-Shahi Salman R, Weinberg A, Young WL, Estevez A, Kureshi I, Brisman JL (2010) The ARUBA trial: current status, future hopes. Stroke 41(8):e537–e540

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Mohr JP, Overby JR, von Kummer R, Stefani MA, Libman R, Stapf C, Parides MK, Pile-Spellman J, Moquete E, Moy CS, Vicaut E, Moskowitz AJ, Harkness K, Cordonnier C, Biondi A, Houdart E, Berkefeld J, CJM K, Barreau X, Kim H, Hartmann A, International ARUBA investigators (2017) Functional impairments for outcomes in a randomized trial of unruptured brain AVMs. Neurology 89(14):1499–1506

    Article  CAS  PubMed  Google Scholar 

  14. Mohr JP, Parides MK, Stapf C, Moquete E, Moy CS, Overbey JR, Al-Shahi Salman R, Vicaut E, Young WL, Houdart E, Cordonnier C, Stefani MA, Hartmann A, von Kummer R, Biondi A, Berkefeld J, Klijn CJ, Harkness K, Libman R, Barreau X, Moskowitz AJ, international ARUBA investigators (2014) Medical management with or without interventional therapy for unruptured brain arteriovenous malformations (ARUBA): a multicentre, non-blinded, randomised trial. Lancet 383:614–621

    Article  CAS  PubMed  Google Scholar 

  15. Moon K, Levitt MR, Nakaji P, Albuquerque FC, Zabramski JM, McDougall CG, Spetzler RF (2015) Safety and efficacy of surgical resection of unruptured low-grade arteriovenous malformations from the modern decade. Neurosurgery 77:948–953

    Article  PubMed  Google Scholar 

  16. O’Donnell J, Morgan MK (2015) Response. J Neurosurg 122(4):985–986

    PubMed  Google Scholar 

  17. Potts MB, Lau D, Abla AA, Kim H, Young WL, Lawton MT (2015) Current surgical results with low-grade arteriovenous malformations. J Neurosurg 122:912–920

    Article  PubMed  PubMed Central  Google Scholar 

  18. Quinn TJ, Dawson J, Walters MR, Lees KR (2009) Reliability of the modified Rankin Scale. A systematic review. Stroke 40:3393–3395

    Article  PubMed  Google Scholar 

  19. Reponen E, Tuominen H, Hernesniemi J, Korja M (2016) Modified Rankin Scale and short-term outcome in cranial neurosurgery: a prospective and unselected cohort study. World Neurosurg 91:567–573

    Article  PubMed  Google Scholar 

  20. Rohn B, Haenggi D, Etminan N, Kunz M, Turowski B, Steiger HJ (2014) Epilepsy, headache, and quality of life after resection of cerebral arteriovenous malformations. J Neurol Surg A Cent Eur Neurosurg 75(4):282–288

    Article  PubMed  Google Scholar 

  21. Rohn B, Hänggi D, Etminan N, Turowski B, Steiger HJ (2017) Relief of epilepsy and headache and quality of life after microsurgical treatment of unruptured brain AVM—audit of a single-center series and comprehensive review of the literature. Neurosurg Rev 40(1):59–65

    Article  PubMed  Google Scholar 

  22. Schramm J, Schaller K, Esche J, Bostrom A (2017) Microsurgery for cerebral arteriovenous malformations: subgroup outcomes in a consecutive series of 288 cases. J Neurosurg 125:1056–1063

    Article  Google Scholar 

  23. Shah S, Cooper B (1993) Issues in the choice of activities of daily living assessment. Aust Occup Ther J 40(2):77–82

    Article  Google Scholar 

  24. Spetzler RF, Martin NA (1986) A proposed grading system for arteriovenous malformations. J Neurosurg 65(4):476–483

    Article  CAS  PubMed  Google Scholar 

  25. Spetzler RF, Ponce FA (2011) A 3-tier classification of cerebral arteriovenous malformations. J Neurosurg 114(3):842–849

    Article  PubMed  Google Scholar 

  26. van der Schaaf IC, Brilstra EH, Rinkel GJ, Bossuyt PM, van Gijn J (2002) Quality of life, anxiety, and depression in patients with an untreated intracranial aneurysm or arteriovenous malformation. Stroke 33(2):440–443

    Article  PubMed  Google Scholar 

  27. Van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJA, Van Gijn J (1988) Interobserver agreement for the assessment of handicap in stroke patients. Stroke 19(5):604–607

    Article  PubMed  Google Scholar 

  28. Ware JE Jr, Bayliss MS, Rogers WH, Kosinski M, Tarlov AR (1996) Differences in 4-year health outcomes for elderly and poor, chronically ill patients treated in HMO and fee-for-service systems. Results from the Medical Outcomes Study. JAMA 276:1039–1047

    Article  PubMed  Google Scholar 

  29. Ware JE Jr, Kosinski MA (2002) SF-36 physical and mental health summary scales: a manual for users of version 1, 2nd edn. QualityMetric Incorporated, Lincoln

    Google Scholar 

  30. Ware JE Jr, Sherbourne CD (1992) The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care 30(6):473–483

    Article  PubMed  Google Scholar 

  31. Wedderburn CJ, van Beijnum J, Bhattacharya JJ, Counsell CE, Papanastassiou V, Ritchie V, Roberts RC, Sellar RJ, Warlow CP, Al-Shahi Salman R (2008) Outcome after interventional or conservative management of unruptured brain arteriovenous malformations: a prospective, population-based cohort study. Lancet Neurol 7(3):223–230

    Article  PubMed  Google Scholar 

  32. Wong J, Slomovic A, Ibrahim G, Radovanovic I, Tymianski M (2017) Microsurgery for ARUBA trial (A Randomized Trial of Unruptured Brain Arteriovenous Malformations)-eligible unruptured brain arteriovenous malformations. Stroke 48:136–144

    Article  PubMed  Google Scholar 

Download references

Funding

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.

Author information

Authors and Affiliations

  1. Department of Clinical Medicine, Macquarie University, 2 Technology Place, Sydney, NSW, 2109, Australia

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

  2. Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, Scotland

    Rustam Al-Shahi Salman

  3. Department of Statistics, Macquarie University, Sydney, NSW, Australia

    Maurizio Manuguerra

Authors
  1. Joan Margaret O’Donnell
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rustam Al-Shahi Salman
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maurizio Manuguerra
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nazih Assaad
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Kerin Morgan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael Kerin Morgan.

Ethics declarations

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.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

O’Donnell, J.M., Al-Shahi Salman, R., Manuguerra, M. et al. 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. Acta Neurochir 160, 559–566 (2018). https://doi.org/10.1007/s00701-017-3451-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-017-3451-2

Keywords

Search

Navigation