Neurological Deficit Rather than Obliteration Determines Quality of Life in Patients Treated with Radiosurgery for AVMs

摘要

Objective: There is a dearth of literature about the quality of life (QOL) of patients treated for brain arteriovenous malformations (AVMs). This study evaluates the factors that predict the QOL after radiosurgical treatment of patients with AVMs. Method: Between 1989 and 2000, 228 patients were treated at the University of Toronto using a LINAC system. One hundred and eighty-one had a complete radiological and clinical follow-up, including 7 who died. Of the 174 remaining patients, it proved possible to notify 113 by telephone that a three-part questionnaire consisting of questions concerning their neurological status before and after treatment and a Medical Outcomes Study questionnaire (SF-36) would be sent. Results: Of the 113 forms sent, 66 (58.4%) were adequately completed and returned. There were no significant differences in age, AVM location and volume between patients who returned the questionnaires, patients who did not return the questionnaires, and patients who could not be contacted. However, patients who returned the questionnaires had a higher rate of permanent deficit (10.6 vs. 8.1 and 4.4%) and a lower obliteration rate (54.2 vs. 68.8 and 70.3%) than those who did not return the questionnaires, and those who could not be contacted, respectively. In a multivariate analysis, the most important predictor of QOL was permanent deficit. In order of importance, permanent deficit affected the various aspects of QOL as follows: role physical, physical functioning, social functioning and vitality (p = 0.000, 0.006, 0.040, 0.049, respectively). AVM obliteration was not a predictor of QOL, even for the emotional scales. Conclusion: Permanent deficits were associated with a lower QOL and this should be considered a strong end-point in the choice among treatment modalities. Surprisingly, AVM obliteration was not a predictor of the QOL for these patients.