Evaluation of Qualitative Outcomes after Surgical Intervention on Patients Affected by Arteriovenous Malformations.

BACKGROUND: Arteriovenous malformations are abnormal tangles of blood vessels that cause irregular connections between arteries and veins. Rupture of arteriovenous malformations represents a frequent complication associated with a neurological impairment and physical disability. METHODS: We investigated the relationship among coping dimensions and overall quality of life (QoL), and health status after surgical intervention in 20 patients affected by arteriovenous malformations. Each patient was administered a battery of self-report questionnaires (Short Form 12 Health Survey Questionnaire, Brief COPE Inventory, Beck Depression Inventory, and Hamilton Rating Scale for Anxiety). RESULTS: We found that surgical treatment of arteriovenous malformations affected subjective well-being and emotional aspects. Coping ability influenced the QoL and the presence of anxiety and depressive symptoms. We found a significant correlation between depression and humor (r = -.47, P = .03) and between QoL and self-distraction (r = -.48, P = .03) and humor (r = .44, P = .05). In particular, humor was a significant predictor of mental health and physical health. CONCLUSIONS: The presence of anxiety and depression was the cause of deterioration of QoL, even if psychological resources used to deal with the disease significantly modified the subjective perception of well-being. The evaluation of the impact of cerebrovascular disease on QoL should be a basis for planning and evaluating therapeutic and psychological rehabilitative interventions.

Toward a comprehensive assessment of functional outcomes in pediatric patients with brain arteriovenous malformations: the Pediatric Quality of Life Inventory.

OBJECTIVE Brain arteriovenous malformations (bAVMs) are rare in pediatric patients but represent the most common cause of hemorrhagic stroke in this population. Pediatric patients demonstrate superior outcomes in comparison with adult patients with similar lesions and presentations. Most studies of clinical outcomes of pediatric bAVMs use the modified Rankin Scale (mRS), despite a lack of validation in pediatric patients. METHODS The authors interviewed the parents of 26 pediatric patients who underwent multimodality bAVM treatment and administered the Pediatric Quality of Life Inventory (PedsQL)-a well-validated tool for pediatric outcomes that quantifies performance in a physical, emotional, social, and school domains. They also reviewed clinical information from the patients' medical charts. Statistical analysis was performed using a log-transformed t-test, the Mann-Whitney exact test, the Kruskal-Wallis test, and Spearman correlation. In addition, the literature was reviewed for prior reports of clinical outcome of pediatric cases of bAVM. RESULTS The average PedsQL health-related quality of life score was 71 ± 24, with an average age at diagnosis of 12.5 years and an average follow-up period of 6.8 years. Seventeen patients (65%) presented with hemorrhage and 4 (15%) with seizures. PedsQL scores correlated strongly and at a statistically significant level (p < 0.001) with mRS, Pediatric Overall Performance Category (POPC), Pediatric Cerebral Performance Category (PCPC), and Glasgow Outcome Scale scores. Multivariate modeling validated special education, corrective devices, and cure status as significant predictors of PedsQL scores. Statistically significant risk factors for undergoing placement of a ventriculoperitoneal shunt included lower Glasgow Coma Scale motor scores on admission (p = 0.042), cerebellar location (p = 0.046), and nidus volume (p = 0.017). Neither treatment modality nor location statistically affected clinical outcomes at follow-up. CONCLUSIONS There have been few studies of long-term clinical outcomes of bAVM in pediatric patients, and previously published studies have used conventional metrics that have been validated in the adult population, such as the mRS. Although these metrics can serve as reasonable surrogates, an accurate understanding of overall health-related quality of life is contingent on utilizing validated toolsets, such as the PedsQL.

Patient concerns posthaemorrhagic stroke: a study of the Internet narratives of patients with ruptured arteriovenous malformation.

AIMS: To identify and describe the experiences and concerns of a sample of young haemorrhagic stroke patients who experienced a ruptured arteriovenous malformation and determine whether there are gender differences. BACKGROUND: Patients with arteriovenous malformation haemorrhage tend to be young adults, but little is known about their experiences and concerns. Some research suggest that there is a need to take gender into account when investigating their experiences and concerns. DESIGN: A content analysis of a sample of narratives posted by survivors of an arteriovenous malformation haemorrhage on an Internet site, to determine the extent to which writers discuss similar concerns and experiences. METHODS: The sample consists of 83 narratives. The author and a research assistant carefully considered the content of each narrative, created categories based upon this reading and then coded men and women's narratives separately, according to the topic discussed. RESULTS: Five main categories of topics were identified: 'symptoms', 'doctors and hospitals', 'rehabilitation and recovery', 'disabilities' and 'miscellaneous reflections'. The latter category contained the sub-categories 'arteriovenous malformation website', 'thanks', 'life now' and 'feelings'. Narratives varied greatly regarding how much each topic was addressed, but there were few gender differences. Overall, most attention was paid to discussing doctors and hospitals and most writers also paid significant attention to the importance of being able to share experiences with other survivors. CONCLUSIONS: For these narrators, the experience of being evaluated and treated for arteriovenous malformation haemorrhage is traumatic, leaves a lasting impact and men and women share similar concerns and experiences. Narrators show a need to talk about their experiences, especially with others who may share similar experiences. RELEVANCE TO CLINICAL PRACTICE: Knowing the concerns and perspectives of a sample of arteriovenous malformation patients may help nurses anticipate the concerns of their own haemorrhagic stroke patients and help improve patients' psychosocial well-being.

Functional PET scanning in the preoperative assessment of cerebral arteriovenous malformations.

We have evaluated positron emission tomography (PET) scanning during sensory stimulation or during the performance of auditory, visually based or expressive language tasks (activation PET scanning) to determine its reliability in establishing the relationships of cerebral arteriovenous malformations (AVMs) to the ambient cortex in 10 patients. Five patients with a central AVM underwent activation PET scanning combined with three-dimensional MRI during vibrotactile stimulation of the contralateral hand, and 5 patients with AVMs in or around speech areas were similarly scanned during a language task. Vibrotactile stimulation identified the post-central gyrus, establishing the relationship of the AVM to the central region. The results of language activation were specific to the modality (visual, auditory, articulate) on which the task was based. Sensory PET activation scanning is reliable in identifying the pre- and post-central gyri and useful in assessing AVMs in and around the central region. A greater understanding of results in normal controls for specific visual, auditory, and expressive language tasks is necessary before language activation PET scanning can be confidently applied to clinical cases.