ORIGINAL ARTICLE - VASCULAR NEUROSURGERY - ARTERIOVENOUS MALFORMATION Patient functional outcomes and quality of life after surgery for unruptured brain arteriovenous malformation Joan Margaret O’Donnell 1,2 & Michael Kerin Morgan 1 & Maurizio Manuguerra 3 & David Bervini 4 & Nazih Assaad 1 Received: 2 November 2020 /Accepted: 23 March 2021 # Crown 2021 Abstract Background Studies have questioned the effectiveness of surgery for the management of unruptured brain arteriovenous mal- formation (ubAVM). Few studies have examined functional outcomes and quality of life (QOL) prior and 12 months after surgical repair of ubAVM. Objective This study examined the effectiveness of surgical management of ubAVM by measuring patients’ perceived QOL and their ability to perform everyday activities. Methods Between 2011 and 2016, patients diagnosed with an unbAVM were assessed using the Quality Metric Short Form 36 (SF36), the DriveSafe component of the off-road driver screening tool DriveSafeDriveAware (DSDA), the modified Barthel Index (mBI) and the modified Rankin Scale (mRS). Reassessments were conducted at the 6-week post-operative follow-up for surgical patients and at 12-month follow-up for surgical and conservatively managed patients. Results Forty-five patients enrolled in the study, of which 35 (78%) had their ubAVM surgically treated. Patients undergoing surgery had a significantly lower ubAVM Spetzler-Ponce Class (SPC). There was no significant difference 12 months after presentation in function or QOL for either the conservative or surgical group. The surgical group had significantly higher QOL of life scores from pre-surgery to 12 months post-surgery (PCS p < 0.01; MCS p = 0.02). Higher SP grade ubAVM was significantly related to poorer function in the surgical group (SP C compared with SP A; p = 0.04, mean difference - 12.4, 95%CI - 24.3 to - 0.4). Conclusion Function and QOL are not diminished after surgical treatment of low Spetzler-Ponce Class unruptured brain arte- riovenous malformations. QOL is higher 12 months after surgery for ubAVM than for those who do not have treatment for their ubAVM. Keywords Arteriovenous malformation . Brain . Quality of life . Surgery . Functional outcomes Introduction Management options for patients with a brain arteriovenous malformation (bAVM) have broadened due to advances in medical technology over the last two decades. These options include surgical resection, endovascular embolization, fo- cused radiosurgery — alone or combined — and conservative treatment. Patients with bAVM are able to choose whether to have treatment and, in selected cases, what type of treatment option they would prefer. Prior to the introduction of endovascular and radiosurgical management of bAVM, the only treatment option was surgical resection. Questions have been raised of the effectiveness and necessity of the perceived more costly and invasive surgical management for bAVM [27]. Some studies have questioned the effectiveness of any of the bAVM treatment modalities [1, 16, 17, 27]. Patients This article is part of the Topical Collection on Vascular Neurosurgery — Arteriovenous malformation. * Joan Margaret O’Donnell joan.odonnell@sydney.edu.au 1 Department of Clinical Medicine, Macquarie University, Sydney, NSW 2113, Australia 2 Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Camperdown, NSW 2006, Australia 3 Department of Mathematics and Statistics, Macquarie University, Sydney, NSW 2113, Australia 4 Department of Neurosurgery, Bern University Hospital and University of Bern, Freiburgstrasse, 3010 Bern, Switzerland https://doi.org/10.1007/s00701-021-04827-x / Published online: 8 April 2021 Acta Neurochirurgica (2021) 163:2047–2054