Factors affecting surgery decision-making in patients with a chronic neurovascular condition.

AIMS AND OBJECTIVES: To explore the factors that affect patient decision-making for an elective surgery. BACKGROUND: Cerebral cavernous malformations are lesions found in the brain and spinal cord comprised of abnormal blood vessels, which bleed sporadically causing serious neurological deficits. Course of treatment for cerebral cavernous malformation is often ultimately left up to the patient, and can include symptom management or surgery. Decision-making for surgery in life-threatening conditions has been well documented in the literature. Less extensive research has focused on elective surgeries, where patients have a choice. There has been no research on the factors that affect decision-making for cavernous malformation patients. DESIGN: Correlational self-report survey. METHODS: In part of a larger online study, participants were asked to rate the importance of six factors on their decision-making about surgery for cavernous malformation. RESULTS: Factors that were rated most important for individuals' decision-making included doctor's opinion regarding surgery, presence of disabling symptoms, fear of symptoms getting worse or developing new symptoms, and availability of an expert surgeon. Results indicated that these were rated as more important than having social support during recovery or having the means to pay for surgery. Additionally, having social support during recovery was rated as significantly more important than having the means to pay for surgery. CONCLUSIONS: Factors that affect decision-making for patients diagnosed with cavernous malformation were similar to those found with other medical conditions requiring elective surgery. This study will assist healthcare workers in understanding the decision-making process of individuals who may choose an elective surgery for potentially disabling conditions with uncertain outcomes. RELEVANCE TO CLINICAL PRACTICE: Understanding the complex factors that affect decision-making in cavernous malformation will assist healthcare professionals to better communicate and support patients in their elective surgery decision-making.

Functional capacity of patients in the early period after the embolization of cerebrovascular malformations: preliminary findings.

Research into outcomes of endovascular intervention for cerebral blood vessel malformations has previously focused on the clinical picture of the disease, death rate, comparison of surgical methods, and the most common postoperative and postbleeding complications. From the nursing standpoint, the crucial elements in assessing postoperative patients are functional outcome defining patients' ability to function in life and recognition of impairments in which patients will be dependent on the nursing staff. The aim of the study was to assess functional capacity of patients before and after the embolization of cerebral blood vessel malformations in the aspect of nursing care. The study included 38 patients after embolization of cerebral blood vessels. The assessment of their condition using the Functional Capacity Scale was performed twice: before and after the surgical procedure. The research shows that on the day of admission to hospital, patients had greatest difficulty performing hygienic activities (p < .0001), satisfying physiological needs (p < .0001), and consuming their meals (p < .004). Headache (p < .002) and poor psychological state (p < .0001) manifesting itself through mild depression constituted other serious problems. After the surgery, vast majority of patients were independent in terms of self-care (p ≤ .03). Headache occurred in the case of 21% of patients, and psychological state improved in 34% of patients, which shows that there is a major demand for care in this sphere.

Cavernous malformations.

Cavernous malformations (CMs) are a subset of neurovascular malformations, which include arteriovenous malformations (AVMs), venous malformations, and capillary telangiectasias. CMs are referred to by many names, which may contribute to their being mistaken for malignant entities such as angiomas or hemangiomas. They are not, however, neoplastic; they are true vascular malformations with their own natural history and treatment. This article describes CMs and their clinical manifestations, methods of diagnosis, and types of treatment. CMs exist in both sporadic and familial forms. Nurses caring for patients with CMs should be aware of the specific characteristics of CMs that differentiate them from other neurovascular lesions.

Arteriovenous malformation in the pregnant patient: a case study.

Subarachnoid hemorrhage (SAH) due to ruptured arteriovenous malformation (AVM) or aneurysm accounts for 4.4% of all maternal deaths. It is the third most common nonobstetric cause of maternal death. Significant differences, such as timing of the initial bleed and rebleeding, exist between aneurysmal and AVM related SAH. Increased risk of AVM related SAH appears to correlate with the augmented cardiac output of pregnancy, as well as with other coagulation, hemodynamic and endocrinological changes. These changes usually occur between 20 weeks gestation and 6 weeks postpartum. All suspicious neurological signs and symptoms in the gravid patient should be thoroughly evaluated. Although the nursing care of the pregnant patient with an AVM is similar to that of nonpregnant patients, there are specific clinical observations that are relevant to these patients.

Endovascular therapy of neurovascular malformations.

The development of microcatheters and newer embolytic agents has made it possible to treat persons with arteriovenous malformations, arteriovenous fistulas and aneurysms. Until recently, endovascular embolization was usually performed to devascularize tumors prior to surgical removal. The growing number of neurovascular conditions that can be treated by endovascular embolization has led to the need for neuroscience nurses to be knowledgeable about indications, materials, methods, risks, patient preparation and nursing implications in the care, education and discharge planning for the embolization patient.

Intracerebral arteriovenous malformations presenting as neonatal congestive heart failure.

Intracerebral arteriovenous malformations (AVM) are a complex medical emergency in neonates. AVMs are congenital communications between the arterial and venous circulation. Occurring early in gestation, they may enlarge over time, promulgating a left-to-right shunt. This volume overload can present as severe congestive heart failure or as pronounced shock. This article discusses the pathophysiology, clinical presentation, diagnostic modalities, treatment regimens, nursing implications, and complications of cerebral AVMs. A case study is also presented.

Radiosurgery: a nursing perspective.

The term radiosurgery, originally applied to three-dimensional stereotactic irradiation of small intracranial targets with low-energy x-rays, has more recently been applied to widely differing techniques and radiation sources. These include gamma units using cobalt-60; beams of protons, helium ions and neutrons; and modified cobalt-60 or linear accelerator units. These techniques allow delivery of a high dose of radiation in a single fraction to a small and well-defined intracranial volume, without delivering significant radiation to adjacent normal tissue. The most usual targets for radiosurgery are arteriovenous malformations. It is occasionally used for acoustic neuromas and primary or metastatic brain malignancies as well. Although radiosurgery is not a new procedure, its use is becoming more widespread. Nurses, as critical members of radiosurgery teams, must be informed about all aspects of the procedures and associated nursing care skills.

Transcatheter arterial embolization of cerebral arteriovenous malformations.

An arteriovenous malformation (AVM) is a tangled mass of arteries and veins. These abnormal dilated vessels shunt blood away from normal brain tissue, resulting in adjacent tissue damage. In the past surgical removal of an AVM was often complicated by hemorrhage. In some cases the location or size of an AVM made it unresectable. The risks of surgical removal have led to the development of alternative approaches for the treatment of AVMs, such as transcatheter arterial embolization therapy. A variety of substances can be introduced via a catheter to occlude the abnormal vessels and obliterate the AVM or to decrease size to ease surgical management. This article discusses patient selection for embolization therapy, the materials and methods used and related nursing care and patient education. A case history is presented.

Arteriovenous malformations: complications of surgical intervention and implications for nursing.

Arteriovenous malformations occur in approximately 4 percent of the population and are frequently seen in young adulthood. Controversy exists in the neurosurgical community as to the management of arteriovenous malformations; the four most common methods are medical management, radiation, embolization, and surgical intervention. Complications occur frequently regardless of the treatment selected. These complications are discussed using a selected patient population and case studies. Nursing diagnosis is used and a plan of care formulated for each problem. A one-year follow-up status will also be given for the selected patient population.