Living with a Brain AVM: A Quality of Life Assessment

Abstract

Background and purpose: Brain arteriovenous malformations (AVM) are uncommon vascular lesions with the risk of hemorrhage, epileptic seizures, neurological deficits, and headache. Comparing the risks of the natural history and that of preventive treatment, a recent study has found observation more beneficial than treatment for unruptured AVMs. This study, however, did not consider the long-term impact of carrying a brain AVM on everyday activities. In this study we analyzed the Quality Of Life (QOL) of patients with untreated AVMs, a measure increasingly used in clinical trials to asses this kind of impact.Methods: We enrolled 36 patients with unruptured, untreated brain AVM from our hospital database and measured their QOL retrospectively using the EQ-5D-5L questionnaire. As a control group we used the results of the Research Report, a nationwide study based on the quality of life of 5534 healthy Hungarians in 2002. Due to the low number of cases, statistical analysis could not be made.Results: Headache proved to be the most common AVM-related sign in our cohort (40%, n = 17), with a female predominance; neurological deficit was detected in 33% (n = 14), while epileptic seizures occurred in 26% (n = 11), more commonly affecting male subjects. Anxiety and discomfort seemed to be the most prevalent influencing factors on QOL, especially in the youngest age group (18–34 years). Female subjects showed a greater dependence than men in all age groups, though males had a more significant impairment in their usual activities. Older patients were affected more significantly in their self-care and usual activities compared with the younger population.Conclusions: Untreated AVMs have a significant negative impact on patients carrying unruptured brain AVMs, as proved by QOL assessment. Beside neurological deficits, this impact should also be considered in the therapeutic decision.

State of the Art in the Role of Endovascular Embolization in the Management of Brain Arteriovenous Malformations—A Systematic Review

“…As shown by quality-of-life assessments, patients with untreated unruptured bAVMs have a significantly reduced quality of life. Most commonly, patients demonstrate decreased levels of health, anxiety, depression, pain, and discomfort [ 78 ]. For this reason, in cases of large bAVMs, which may lead to neurological symptoms and decline due to chronic venous hypertension and vascular stealing from surrounding tissues, the endovascular embolization of high-flow fistulae with nidal flow reduction might be an effective tool to improve the quality of life [ 67 , 79 ].…”

Case report: Surgical treatment of combined dural arteriovenous fistula and angiographically occult arteriovenous malformation complicated by intracerebral hemorrhage

“…(2021) провел исследование, на основании которого сделан вывод: сравнение рисков естественного течения и профилактического лечения больных показывает, что наблюдение более предпочтительно, чем какое-либо лечение. Однако в этом исследовании не учитывалось долгосрочное влияние АВМ на качество жизни [40].…”

Shoulder Pain Associated With Multiple Arteriovenous Malformations Successfully Treated With Embolization

“…Peripheral tissues may be affected by hypertrophy, atrophy, necrosis, and ulceration [ 13 ]. Overall, patients with symptomatic AVMs report a lower health-related quality of life [ 14 , 15 ].…”