gms | German Medical Science

Objective: Brain artero-venous malformations (AVMs) frequently involve the parietal-occipital region. In our study we considered AVMs involving this area because neurological deficits following surgical treatment are generally considered acceptable. Artero-venous malformations located in other eloquent areas are frequently excluded from surgical treatment, as responsible for excessively debilitating neurological sequelae. Following the controversy that arouses in favour of conservative treatment after the publication of the Study ARUBA, the aim of this study was to quantify these visual deficits caused by surgical treatment and evaluate the influence and impact of these sequelae on a patient's quality of life.

Method: We enrolled 50 patients with parietal-occipital AVMs: 17 ruptured including 12 AVMs assigned to surgical treatment and 5 to Radio-Surgery Gamma Knife (GK); 33 unruptured including 24 AVMs treated with surgical resection and 9 with GK. After a mean follow-up of at least 6 months after treatment we have subjected patients to "SF-17", a telephone interview created for screening of health status, cognitive impairment and ability to carry out daily activities. To quantify the damage after treatment, we subjected our population to a Visual field test.

Results: Of the 50 patients treated, 16 (32%) reported homonymous hemianopia, 3 (6%) homonymous quadrantanopia, 3 (6%) associated visual impairments, 9 (18%) lower deficits (reduction of retinal sensibility), 19 (38%) were without any visual deficit. 68% of patients with hemianoptic visual field loss, 100% of patients with quadrantanopia, 66% of patients with associated deficits, 100% of the patients with lower deficits and 100% of patients without any visual deficit evaluate their quality of life as good or excellent: 6 patients of the 50 treated described their quality of life sufficient or poor. Of the 36 patients surgically treated (with or without any deficit), 83.5% deemed their quality of life good or excellent; 16.5% (6 patients) considered their quality of life sufficient or poor. Two of these 6 patients, despite leading a normal life, considered their quality of life negatively as they are no longer able to practice extreme sports regularly (free-climbing).

Conclusions: In patients with parietal-occipital AVMs, where visual neurological damage is expected from treatment, deficits after surgery don't have an impact on quality of life such as to preclude the possibility of a treatment.