TY - JOUR
T1 - Quality of life and disability 12 months after surgery vs. conservative management for unruptured brain arteriovenous malformations
T2 - Scottish population-based and Australian hospital-based studies
AU - O’Donnell, Joan Margaret
AU - Al-Shahi Salman, Rustam
AU - Manuguerra, Maurizio
AU - Assaad, Nazih
AU - Morgan, Michael Kerin
PY - 2018/3
Y1 - 2018/3
N2 - 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.
AB - 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.
KW - arteriovenous malformation
KW - brain
KW - matched-pairs
KW - QOL
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=85040367385&partnerID=8YFLogxK
U2 - 10.1007/s00701-017-3451-2
DO - 10.1007/s00701-017-3451-2
M3 - Article
C2 - 29327142
AN - SCOPUS:85040367385
VL - 160
SP - 559
EP - 566
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
SN - 0001-6268
IS - 3
ER -