Long-term health-related quality of life in patients with ruptured arteriovenous malformations treated in childhood

Elias Oulasvirta MD1, Anni Pohjola MD, PhD1, Päivi Koroknay-Pál MD, PhD1, Ahmad Hafez MD, PhD1, Risto Roine MD, PhD2, Harri Sintonen PhD3, and Aki Laakso MD, PhD1
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  • 1 Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland;
  • | 2 Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland; and
  • | 3 Department of Public Health, Helsinki University Hospital, Helsinki, Finland
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OBJECTIVE

The aim of this study was to reveal the long-term health-related quality of life (HRQOL), educational level, and impact on occupation in 55 patients who experienced ruptured brain arteriovenous malformations (AVMs) that were treated during childhood.

METHODS

In 2016, questionnaires including the 15D instrument were sent to all living patients older than 18 years (n = 432) in the Helsinki AVM database. The cohort was further specified to include only patients with ruptured AVMs who were younger than 20 years at the time of diagnosis (n = 55). Educational level was compared with the age-matched general population of Finland. The mean 15D scores were calculated for independent variables (Spetzler-Ponce classification, admission age, symptomatic epilepsy, and multiple bleeding episodes) and tested using the independent-samples t-test or ANCOVA. Linear regression was used to create a multivariate model. Bonferroni correction was used with multiple comparisons.

RESULTS

The mean follow-up time from diagnosis to survey was 24.2 (SD 14.7) years. The difference in the mean 15D scores between Spetzler-Ponce classes did not reach statistical significance. The youngest age group (< 10 years at the time of diagnosis) performed less well on the dimension of usual activities than the older patients. Symptomatic epilepsy significantly reduced the long-term HRQOL. Multiple hemorrhages significantly reduced the scores on three dimensions: mobility, speech, and sexual activity. In the regression model, symptomatic epilepsy was the only significant predictor for a lower 15D score. The educational level of the cohort was for the most part comparable to that of the general population in the same age group. AVM was the reason for early retirement in 11% of the patients, while lowered performance because of the AVM was reported by 37% of the patients.

CONCLUSIONS

Patients with ruptured AVMs treated in childhood can live an independent and meaningful life, even in the case of the highest-grade lesions. Symptomatic epilepsy significantly reduced the long-term HRQOL, highlighting the need for continuing support for these patients.

ABBREVIATIONS

AVM = arteriovenous malformation; HRQOL = health-related quality of life; mRS = modified Rankin Scale.

Illustration from Cinalli et al. (pp 330–341). Printed with permission from © CC Medical Arts.

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