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Calvanese F, Auricchio AM, Pohjola A, Hafez A, Nurminen V, Korja M, Numminen J, Lehecka M, Raj R, Niemelä M. Changes in treatment of intracranial aneurysms during the last decade in a large European neurovascular center. Acta Neurochir (Wien) 2024; 166:173. [PMID: 38594469 PMCID: PMC11004042 DOI: 10.1007/s00701-024-06064-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 03/26/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE Treatment modality for ruptured and unruptured intracranial aneurysms has shifted during the last two decades from microsurgical treatment towards endovascular treatment. We present how this transition happened in a large European neurovascular center. METHODS We conducted a retrospective observational study consecutive patients treated for an unruptured or ruptured intracranial aneurysm at Helsinki University Hospital during 2012-2022. We used Poisson regression analysis to report age-adjusted treatment trends by aneurysm location and rupture status. RESULTS A total of 2491 patients with intracranial aneurysms were treated (44% ruptured, 56% unruptured): 1421 (57%) surgically and 1070 (43%) endovascularly. A general trend towards fewer treated aneurysms was noted. The proportion of patients treated surgically decreased from 90% in 2012 to 20% in 2022. The age-adjusted decrease of surgical versus endovascular treatment was 6.9%/year for all aneurysms, 6.8% for ruptured aneurysms, and 6.8% for unruptured aneurysms. The decrease of surgical treatment was most evident in unruptured vertebrobasilar aneurysms (10.8%/year), unruptured communicating artery aneurysms (10.1%/year), ruptured communicating artery aneurysms (10.0%/year), and ruptured internal carotid aneurysms (9.0%/year). There was no change in treatment modality for middle cerebral artery aneurysms, of which 85% were still surgically treated in 2022. A trend towards an increasing size for treated ruptured aneurysms was found (p = 0.033). CONCLUSION A significant shift of the treatment modality from surgical to endovascular treatment occurred for all aneurysm locations except for middle cerebral artery aneurysms. Whether this shift has affected long-term safety and patient outcomes should be assessed in the future.
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Affiliation(s)
- Francesco Calvanese
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Anna Maria Auricchio
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Anni Pohjola
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Ahmad Hafez
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Ville Nurminen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Miikka Korja
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Jussi Numminen
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland.
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, Po Box 320, 00029 HUS, Helsinki, Finland
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Vasankari V, Hafez A, Pohjola A, Auricchio AM, Calvanese F, Rossmann T, Veldeman M, Badic I, Netti E, Rautalin I, Nurminen V, Raj R, Niemelä M, Lehecka M. Even short-term training improves the skills of novice exoscope users: a prospective laboratory experiment. Acta Neurochir (Wien) 2024; 166:118. [PMID: 38427127 PMCID: PMC10907429 DOI: 10.1007/s00701-024-05975-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 01/14/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The surgical 3D exoscopes have recently been introduced as an alternative to the surgical microscopes in microneurosurgery. Since the exoscope availability is still limited, it is relevant to know whether even a short-term exoscope training develops the skills needed for performing exoscope-assisted surgeries. METHODS Ten participants (six consultants, four residents) performed two laboratory bypass test tasks with a 3D exoscope (Aesculap Aeos®). Six training sessions (6 h) were performed in between (interval of 2-5 weeks) on artificial models. The participants were divided into two groups: test group (n = 6) trained with the exoscope and control group (n = 4) with a surgical microscope. The test task was an artificial end-to-side microsurgical anastomosis model, using 12 interrupted 9-0 sutures and recorded on video. We compared the individual as well as group performance among the test subjects based on suturing time, anastomosis quality, and manual dexterity. RESULTS Altogether, 20 bypass tasks were performed (baseline n = 10, follow-up n = 10). The median duration decreased by 28 min and 44% in the exoscope training group. The decrease was steeper (29 min, 45%) among the participants with less than 6 years of microneurosurgery experience compared to the more experienced participants (13 min, 24%). After training, the participants with at least 1-year experience of using the exoscope did not improve their task duration. The training with the exoscope led to a greater time reduction than the training with the microscope (44% vs 17%). CONCLUSIONS Even short-term training with the exoscope led to marked improvements in exoscope-assisted bypass suturing among novice microneurosurgeons. For the more experienced participants, a plateau in the initial learning curve was reached quickly. A much longer-term effort might be needed to witness further improvement in this user group.
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Affiliation(s)
- Ville Vasankari
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland.
| | - Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Anni Pohjola
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Anna Maria Auricchio
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
- Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Calvanese
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Tobias Rossmann
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
- Department of Neurosurgery, Neuromed Campus, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Michael Veldeman
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
- Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany
| | - Ines Badic
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
- Sigmund Freud University Vienna, Vienna, Austria
| | - Eliisa Netti
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Ilari Rautalin
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand
| | - Ville Nurminen
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
| | - Martin Lehecka
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, P.O. Box 266, 00029, Helsinki, Finland
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Auricchio AM, Calvanese F, Pohjola A, Laakso A, Niemelä M. Hemangioblastoma and arteriovenous malformation in the same patient: a not random association or two isolated entities? Systematic review starting from a unique case. Neurochirurgie 2024; 70:101537. [PMID: 38324942 DOI: 10.1016/j.neuchi.2024.101537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND The association between intracranial hemangioblastomas and arteriovenous malformations has been documented in very few cases in literature since 1965 and might present in three modalities: "intermixed, adjacent and separated (spatially and temporally)". Often, the pattern of presentation is "intermixed". According to our systematic review, we propose an adjustment of the previous classification, specifically for these entities. We describe the first case of a truly "spatially separated" association between these two lesions. METHODS Our study encompassed all adult patients diagnosed with both intracranial hemangioblastoma and AVM who were evaluated in the last 20-year period, from 2003 to 2023 at Helsinki University Hospital. Cases of this coexistence were retrospectively identified and collected from clinical records. For the systematic review, studies reporting the coexistence of hemangioblastoma and AVM in adult patients (>18 years old) were selected. Given the rarity of this pattern, case reports were also included. RESULTS The combined analysis of our systematic review and institutional retrospective study revealed a total of only seven identified cases. We applied the classification of neoplasms and AVM by Yano, modifying and adapting it into our screened patient series. We systematically reclassified "adjacent" and genuinely "spatially separated" patterns based on the vascular axis supplying both lesions. CONCLUSIONS Hemangioblastomas and AVMs rarely coexist in the same patient. Our study reports the first instance of a truly "spatially separated" sporadic association between these vascular lesions. The rarity of such coexistence underscores the need for a nuanced and systematic classification to guide the management of these infrequent cases.
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Affiliation(s)
- Anna Maria Auricchio
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Neurosurgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Calvanese
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Anni Pohjola
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aki Laakso
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Oulasvirta E, Pohjola A, Koroknay-Pál P, Hafez A, Roine R, Sintonen H, Laakso A. Long-term health-related quality of life in patients with ruptured arteriovenous malformations treated in childhood. J Neurosurg Pediatr 2022; 30:1-9. [PMID: 35901751 DOI: 10.3171/2022.5.peds2284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
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.
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Affiliation(s)
- Elias Oulasvirta
- 1Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Anni Pohjola
- 1Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Päivi Koroknay-Pál
- 1Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Ahmad Hafez
- 1Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
| | - Risto Roine
- 2Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland; and
| | - Harri Sintonen
- 3Department of Public Health, Helsinki University Hospital, Helsinki, Finland
| | - Aki Laakso
- 1Department of Neurosurgery, Helsinki University Hospital, Helsinki, Finland
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Pohjola A, Lindbohm JV, Oulasvirta E, Hafez A, Koroknay-Pál P, Laakso A, Niemelä M. Cigarette Smoking Is More Prevalent in Patients With Brain Arteriovenous Malformations Compared to General Population: A Cross-Sectional Population-Based Study. Neurosurgery 2021. [DOI: 10.1093/neuros/nyaa281_s053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pohjola A, Oulasvirta E, Roine RP, Sintonen HP, Hafez A, Koroknay-Pál P, Lehto H, Niemelä M, Laakso A. Comparing health-related quality of life in modified Rankin Scale grades: 15D results from 323 patients with brain arteriovenous malformation and population controls. Acta Neurochir (Wien) 2021; 163:2037-2046. [PMID: 33860377 PMCID: PMC8195799 DOI: 10.1007/s00701-021-04847-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
Background We wanted to understand how patients with different modified Rankin Scale (mRS) grades differ regarding their health-related quality of life (HRQoL) and how this affects the interpretation and dichotomization of the grade. Methods In 2016, all adult patients in our brain arteriovenous malformation (AVM) database (n = 432) were asked to fill in mailed letters including a questionnaire about self-sufficiency and lifestyle and the 15D HRQoL questionnaire. The follow-up mRS was defined in 2016 using the electronic patient registry and the questionnaire data. The 15D profiles of each mRS grade were compared to those of the general population and to each other, using ANCOVA with age and sex standardization. Results Patients in mRS 0 (mean 15D score = 0.954 ± 0.060) had significantly better HRQoL than the general population (mean = 0.927 ± 0.028), p < 0.0001, whereas patients in mRS 1–4 had worse HRQoL than the general population, p < 0.0001. Patients in mRS 1 (mean = 0.844 ± 0.100) and mRS 2 (mean = 0.838 ± 0.107) had a similar HRQoL. In the recently published AVM research, the most commonly used cut points for mRS dichotomization were between mRS 1 and 2 and between mRS 2 and 3. Conclusions Using 15D, we were able to find significant differences in the HRQoL between mRS 0 and mRS 1 AVM patients, against the recent findings on stroke patients using EQ-5D in their analyses. Although the dichotomization cut point is commonly set between mRS 1 and 2, patients in these grades had a similar HRQoL and a decreased ability to continue their premorbid lifestyle, in contrast to patients in mRS 0.
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Affiliation(s)
- Anni Pohjola
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland.
| | - Elias Oulasvirta
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland
| | - Risto P Roine
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Harri P Sintonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland
| | - Päivi Koroknay-Pál
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland
| | - Hanna Lehto
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Hospital, Topeliuksenkatu 5B, 00260, Helsinki, Finland
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Pohjola A, Lindbohm JV, Oulasvirta E, Hafez A, Koroknay-Pál P, Laakso A, Niemelä M. Cigarette Smoking Is More Prevalent in Patients With Brain Arteriovenous Malformations Compared to General Population: A Cross-Sectional Population-Based Study. Neurosurgery 2020; 87:E657-E662. [PMID: 32687572 DOI: 10.1093/neuros/nyaa281] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 04/26/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Research on the prevalence of smokers in patients with brain arteriovenous malformation (AVM) remains nonexistent, even though smoking is a well-known risk factor for intracranial aneurysms. OBJECTIVE To examine the prevalence and smoking habits of AVM patients. METHODS Data on smoking habits were collected with a quality-of-life questionnaire mailed in 2016 to all patients in our large AVM database. These smoking data were supplemented with registry data derived from medical records. The prevalence of smokers was compared to that of the general population, derived from statistics of National Institute for Health and Welfare. Logit transformation of proportions and Students t distribution were used to calculate the 95% CIs for prevalence estimates. RESULTS Of the 384 patients aged over 18 yr on admission, 277 (72.1%) returned the questionnaires in 2016. When compared to age, sex, and admission year matched general population, the proportion of smokers in AVM patients was 48% (CI = 41%-55%) and 19% (CI = 16%-21%) in the general population. The difference increased in older age groups; in those aged 65 to 77 yr, the percentage of smokers reached 73% (CI = 46%-90%), while the corresponding percentage in the general population was 7% (CI = 5%-9%). CONCLUSION We observed considerably higher rates of smoking among AVM patients when compared to age, sex, and admission year matched general population. Our results suggest that in the development of AVMs, the role played by nicotine and other substances in tobacco smoke should be examined. Cigarette smoking could potentially be a common cerebrovascular risk factor.
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Affiliation(s)
- Anni Pohjola
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Joni V Lindbohm
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Elias Oulasvirta
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ahmad Hafez
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Päivi Koroknay-Pál
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Aki Laakso
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Mika Niemelä
- Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Pohjola A, Oulasvirta E, Roine RP, Sintonen HP, Hafez A, Koroknay-Pál P, Lehto H, Niemelä M, Laakso A. Long-term health-related quality of life in 262 patients with brain arteriovenous malformation. Neurology 2019; 93:e1374-e1384. [PMID: 31511351 DOI: 10.1212/wnl.0000000000008196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 05/05/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To discover the health-related quality of life (HRQOL) of patients with treated arteriovenous malformation (AVM), we used the self-applicable HRQOL instrument, the 15D, and analyzed the scores in both in the whole study population and specified cohorts. METHODS The 15D questionnaires were mailed to adult patients with AVM alive in 2016 (n = 432) in our database. Patients with completely eradicated AVM (n = 262) were included in a subsequent analysis. The results were compared with those of the general population standardized for age and sex. Subgroup analyses were conducted for epilepsy, number of bleeding episodes, location of the lesion, modified Rankin Scale score, and Spetzler-Ponce classification (SPC) using independent-samples t test or analysis of covariance. Tobit regression was used to explain the variance in the 15D score. RESULTS Patients had impaired HRQOL compared to the reference population (p < 0.0001). Deep location, multiple bleeding episodes, and refractory epilepsy were associated with impaired HRQOL. Patients in SPC A and B had similar posttreatment 15D scores, whereas those in class C had an impaired HRQOL. Significant explanatory variables in the regression model were age, sex, number of bleeding episodes, refractory epilepsy, and SPC. CONCLUSIONS With careful patient selection, patients in SPC B can reach as favorable HRQOL as those in SPC A provided the operation is successful. Multiple bleeding episodes should be prevented with effective treatment aiming at complete AVM obliteration. The postoperative treatment of patients with AVM should focus on preventing depressive symptoms, anxiety, and epileptic seizures. We encourage other research groups to use HRQOL instruments to fully understand the consequences of neurologic and neurosurgical diseases on patients' HRQOL.
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Affiliation(s)
- Anni Pohjola
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Elias Oulasvirta
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Risto P Roine
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Harri P Sintonen
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Ahmad Hafez
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Päivi Koroknay-Pál
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Hanna Lehto
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Mika Niemelä
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland
| | - Aki Laakso
- From the Department of Neurosurgery (A.P., E.O., A.H. P.K-P., H.L., M.N., A.L.), Helsinki University Hospital; Group Administration (R.P.R.), University of Helsinki and Helsinki University Hospital; Department of Health and Social Management (R.P.R.), University of Eastern Finland, Kuopio; and Department of Public Health (H.P.S.), University of Helsinki, Finland.
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Pohjola A, Lehto H, Hafez A, Oulasvirta E, Koroknay-Pál P, Laakso A. Arteriovenous Malformations of the Posterior Fossa: Focus on Surgically Treated Patients Presenting with Hemorrhage. World Neurosurg 2018; 116:e934-e943. [PMID: 29857215 DOI: 10.1016/j.wneu.2018.05.138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/18/2018] [Accepted: 05/19/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Arteriovenous malformations (AVMs) of the posterior fossa are demanding lesions that often present with rupture. Studies including outcome analyses in surgically operated patients with ruptured infratentorial AVMs are scarce. Certain anatomic and demographic features have shown associations with postoperative outcomes. METHODS Eighty-six patients with infratentorial AVM were collected from our AVM database. Fifty-four patients were admitted from 1990 onward, and their demographic, lesion, and treatment characteristics were analyzed. The cohort was further refined to 38 consecutive patients with surgically treated ruptured infratentorial AVM admitted to our center between 1990 and 2014, and statistical analyses of factors influencing outcomes were conducted. RESULTS Twenty-seven patients (69%) had a favorable outcome at early follow-up and 24 (67%) had a favorable outcome at final follow-up. Factors associated with poor outcome in early recovery on univariate analyses were deep venous drainage of the lesion (odds ratio [OR], 5.3; P = 0.037) and high Hunt & Hess score (P = 0.003). In the multivariate model, independent predictors for poor outcome were deep venous drainage (OR, 14.5; P = 0.010) and older age at admission (OR, 1.06; P = 0.028). The sole independent predictor for poor outcome at last follow-up was deep venous drainage (OR, 5.00; P = 0.046). The total follow-up time was 370 person-years. CONCLUSIONS AVMs of the posterior fossa usually present with rupture and thus require prompt clinical treatment. The majority of surgically treated patients recover favorably. Our data show that venous drainage patterns have the greatest influence on the patient's postoperative condition. Other influencing factors include the severity of hemorrhage and patient age at admission.
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Affiliation(s)
- Anni Pohjola
- Department of Neurosurgery, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Hanna Lehto
- Department of Neurosurgery, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Ahmad Hafez
- Department of Neurosurgery, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Elias Oulasvirta
- Department of Neurosurgery, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Päivi Koroknay-Pál
- Department of Neurosurgery, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland
| | - Aki Laakso
- Department of Neurosurgery, Helsinki University Hospital and Clinical Neurosciences, University of Helsinki, Helsinki, Finland.
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Abstract
The article deals with the relation between unemployment and health problems using as a case a local support project for long-term unemployed in northern Finland. Mass unemployment has increased competition on the labor market, and successful job-seekers must have a wider range of qualifications than before. As demands have intensified on the labor market, health has become a salient criterion in the recruitment process. At the same time the incidence of illness among long-term unemployed is surprisingly high. The situations of the project clients strongly indicate that health-related difficulties are one distinct risk factor for the long-term unemployed in finding work. We need new means for health promotion, more extensive psychosocial rehabilitation and local solutions for people who are unemployed.
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Affiliation(s)
- A Pohjola
- University of Lapland, Department of Social Work
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Abstract
Pollen and spore counts from Burkard traps for routine pollen and spore sampling placed at 15 m above ground and at ground level were compared. Daily counts of most pollen types were higher on the ground than at roof level, but the counts were significantly correlated. The ratios of pollen frequencies at high and low levels varied between 1.0 and 11.5. The most prominent differences were recorded for herbaceous pollen (e.g. Artemisia counts 11.5 and Poaccae counts 4.4 times higher at ground level) and in Botrytis and Ustilaginales spores. Tree pollen grains and basidiomycetous spores were more equally distributed. Wind speed did not affect the variation of pollen frequencies at either height. Large spores are not so unevenly distributed as previously supposed. Artemisia and grass pollen was detected 1 to 2 weeks earlier at ground level than on the roof. It is therefore concluded that especially the beginning of flowering should be monitored at a low level.
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Abstract
Occurrence of airborne pollen in Finland has been studied for 10 years in Turku (southern Finland), 8 years in Oulu, 4 years in Kuopio (central Finland) and 7 years at Kevo (northern Lapland). Observations on the pollen seasons of alder, birch, grasses and mugwort are presented. All these pollens occur in south and mid- Finland in quantities capable of causing allergy symptoms. Except for birch pollen, allergenic pollens occur in far lower concentrations than in central Europe. In northern Lapland only birch and pine pollen concentrations are high. Pollens may occur without signs of local flowering when there are southerly winds. This finding suggests that long-distance transport is an essential contributing factor to the occurrence of pollens. There are wide year-to-year variations in the start of pollen seasons and the quantities of pollens. The variations in the start of birch and grass pollen seasons could very much depend on the mean temperature in April. However, a forecasting model based on this and other spring-time temperature parameters often fails to give sufficiently accurate forecasts.
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