Relief of epilepsy and headache and quality of life after microsurgical treatment of unruptured brain AVM-audit of a single-center series and comprehensive review of the literature

Although the benefit of intervention for unruptured arteriovenous malformation (AVM) with regard to stroke rates and long-term disability remains unclear, most patients present with symptoms, such as epilepsy, headache, or neurological deficits, compromising their quality of life. Detailed analysis of the long-term effects of microsurgical treatment on quality of life, epilepsy, and headache was the purpose of this audit. A series of 25 microsurgically treated patients were interviewed on average 7 ± 5 years after treatment. Detailed information was obtained regarding frequency and severity of seizures and headaches. Outcome data was compared with the initial complaints and neurological findings. The Short Form (SF)-36 was used to assess health-related quality of life. On average, the SF-36 scores did not differ significantly from the age-matched German norm values. Patients suffering from chronic headache prior to treatment scored worse in most SF-36 subscales than patients without headache at the time of treatment, and the difference was significant in the SF-36 dimensions physical role functioning and emotional role functioning (P = 0.04). In contrast, there was a trend for patients treated for incidental AVM to score somewhat better than the age norm. Twelve patients had been admitted with epilepsy. At the time of follow-up, all patients were seizure free (Engel class I), although 7 of them continued to take antiepileptic medication. Two of 13 patients without epilepsy at the time of treatment experienced seizures sometime during the post treatment course and were under medication at the time of long-term follow-up interview. At the time of the audit, 7 of 11 patients admitted with chronic headache necessitating regular use of pain medication indicated not to use pain medication any longer. Our data suggest that initial symptoms leading to diagnosis and treatment of unruptured AVM may influence long-term quality of life following treatment. Patients admitted with headache as the chief complaint appear to fare worse than patients with epileptogenic or incidental AVMs.