National Institute of Clinical Neurosciences, Budapest, Hungary.
Department of Biophysics and Radiation Biology, Semmelweis University, Budapest, Hungary.
Acta Neurochir Suppl. 2021;132:71-76. doi: 10.1007/978-3-030-63453-7_10.
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.
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.
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.
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.
脑动静脉畸形（AVM）是一种罕见的血管病变，具有出血、癫痫发作、神经功能缺损和头痛的风险。与自然病史的风险相比，最近的一项研究发现，对于未破裂的 AVM，观察比治疗更有益。然而，这项研究并未考虑携带脑 AVM 对日常活动的长期影响。在这项研究中，我们分析了未治疗的 AVM 患者的生活质量（QOL），这是一种越来越多地用于临床试验来评估此类影响的衡量标准。
我们从医院数据库中招募了 36 名未破裂、未治疗的脑 AVM 患者，使用 EQ-5D-5L 问卷回顾性地测量了他们的 QOL。作为对照组，我们使用了 2002 年一项基于 5534 名健康匈牙利人生活质量的全国性研究——研究报告的结果。由于病例数量较少，无法进行统计分析。
头痛是我们队列中最常见的 AVM 相关症状（40%，n=17），女性居多；神经功能缺损占 33%（n=14），而癫痫发作占 26%（n=11），更常见于男性。焦虑和不适似乎是对 QOL 影响最大的因素，尤其是在最年轻的年龄组（18-34 岁）。女性在所有年龄组的依赖性都大于男性，但男性在日常活动中的障碍更为明显。与年轻人群相比，年龄较大的患者在自我护理和日常活动中受到的影响更为显著。
未治疗的 AVM 对携带未破裂脑 AVM 的患者有显著的负面影响，这一点可以通过 QOL 评估来证明。除了神经功能缺损外，在治疗决策中也应该考虑到这种影响。
