Background The treatment of brain arteriovenous malformations (AVMs) has been studied extensively. With the use of the Spetzler-Martin (S-M) grading system, patients can be informed appropriately about their possible surgical risks. This does not hold true for their neuropsychological sequelae, which have not been studied widely. We evaluated the neuropsychological outcome of our patients treated for brain AVMs. Methods Of 113 patients treated for a brain AVM between 2001 and 2009, 66 patients were enrolled in the study. All patients underwent treatment at our institution and neuropsychological testing 2 years later using a test battery constructed specifically for this study. A control group consisted of 10 subjects without any neurologic disease. Results When the whole cohort was analyzed, no significant differences were found between the groups distinguished by hemorrhage, gender, or hemispheric dominance. Patients with S-M IV and V scores fared significantly worse than patients with S-M I to III. Patients who presented with epilepsy scored lower than patients presenting with other symptomatology, but the difference had only borderline significance. When we analyzed patients according to the presence or absence of obliteration after treatment and compared these with the control group, we found no significant differences. When the patients with an obliterated AVM after treatment were subdivided according to treatment modality, there were no significant differences in their S-M groups compared with the control group. Similarly, those patients with nonobliterated AVMs analyzed according to their S-M grade showed a borderline significant difference, with S-M IV and V having a worse neuropsychological outcome compared with the other groups. Conclusions Patients harboring nonobliterated high-grade AVMs (S-M IV and V) scored worse than patients with nonobliterated AVM S-M grades I to III. This could be explained by the steal phenomenon. No differences in neuropsychological testing were found when comparing results according to nidus location. This study lends support to an active treatment policy for cerebral AVMs. Those patients in whom complete obliteration was achieved with treatment scored similarly to the background population, implying active AVM treatment does not cause deterioration in neuropsychological performance. This, together with a > 90% AVM obliteration rate, favors microsurgery as the treatment modality of choice whenever the AVM can be safely resected.
- MeSH
- dospělí MeSH
- intrakraniální arteriovenózní malformace komplikace chirurgie MeSH
- kognitivní poruchy diagnóza etiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrochirurgie škodlivé účinky MeSH
- mladý dospělý MeSH
- neuropsychologické testy * MeSH
- retrospektivní studie MeSH
- terapeutická embolizace škodlivé účinky MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
V článku jsou stručně popsány základní neuromodulační metody v léčení chronické bolesti s důrazem na invazivní neurostimulační metody a role psychologa při výběru pacientů vhodných pro tento způsob léčby a v následné péči o pacienty podstupující neuromodulační zákrok. Psychologické vyšetření je zaměřeno na vyloučení psychopatologie, zhodnocení míry adaptace na chronickou bolest, zmapování psychosociálního prostředí pacienta a odhad jeho compliance v případě implantace neurostimulátoru. Autorka vychází ze zkušeností z dlouhodobé spolupráce Neuropsychologické poradny Ústřední vojenské nemocnice Praha (ÚVN) a Ambulance pro léčbu chronické bolesti při Neurochirurgické a Neuroonkologické klinice ÚVN.
The article describes the main neuromodulatory methods in treatment of chronic pain with a concern to invasive neurostimulation methods and a role of a psychologist in an identification of favourable candidates for this type of treatment and further extensive psychological care. Psychological assesment is aimed to exclude psychopathology, evaluate the adaptation on chronic pain and to map a psychosocial environment of a patient to predict his/her complience in the case of implantation of a neurostimulation device. Author draws from long-term cooperation of a Neuropsychological unit at Central Military Hospital (UVN) in Prague and a Department for chronic pain treatment at Neurosurgery a Neurooncology Clinic UVN.
- Klíčová slova
- neuromodulace, neurostimulace,
- MeSH
- analgezie metody MeSH
- chronická bolest * psychologie terapie MeSH
- elektrostimulační terapie * kontraindikace psychologie MeSH
- lidé MeSH
- neuralgie psychologie terapie MeSH
- výběr pacientů MeSH
- Check Tag
- lidé MeSH
- MeSH
- mentální anorexie psychologie MeSH
- stravovací zvyklosti fyziologie psychologie MeSH
- výsledek terapie MeSH
- Publikační typ
- kongresy MeSH
