Quality of Life after Treatment of Unruptured Intracranial Aneurysms by Neurosurgical Clipping or by Embolisation with Coils

Abstract

Background: Relatively high rates of complications occur after operation for unruptured intracranial aneurysms. Published data on endovascular treatment suggest lower rates of complications. We measured the impact of treatment of unruptured aneurysms by clipping or coiling on functional health, quality of life, and the level of anxiety and depression. Methods: In three centres, we prospectively collected data on patients with an unruptured aneurysm who were treated by clipping or coiling. Treatment assignment was left to the discretion of the treating physicians. Before, 3 and 12 months after treatment, we used standardised questionnaires to assess functional health (Rankin Scale score), quality of life (SF-36, EuroQol), and the level of anxiety and depression (Hospital Anxiety and Depression Scale). Results: Nineteen patients were treated by coiling and 32 by clipping. In the surgical group, 4 patients (12%) had a permanent complication; 36 of all 37 aneurysms (97%) were successfully clipped. Three months after operation, quality of life was worse than before operation; 12 months after operation, it had improved but had not completely returned to baseline levels. Scores for depression were higher than in the general population. In the endovascular group, no complications with permanent deficits occurred; 16 of 19 aneurysms (84%) were occluded by more than 90%. One patient died from rupture of the previously coiled aneurysm. In the others, quality of life after 3 months and after 1 year was similar to that before treatment. Conclusions: In the short term, operation of patients with an unruptured aneurysm has a considerable impact on functional health and quality of life. After 1 year, recovery occurs but it is incomplete. Coil embolisation does not affect functional health and quality of life.

Recovery to Preinterventional Functioning, Return-to-Work, and Life Satisfaction After Treatment of Unruptured Aneurysms

“…3,12 For microsurgical treatment, other studies found that clipping of unruptured intracranial aneurysms has a negative impact on health-related quality of life in the first 3 months after treatment, which improves markedly but not completely within 1 year after surgery. 10,13,14 For endovascular treatment, only one study including 19 patients assessed health-related quality of life after treatment of unruptured aneurysms and found no effect.…”

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

“…These have generally indicated that there may be a short-term negative impact on quality of life but largely with full recovery to baseline or to reference population values by 1 to 3 years after treatment. 215,216 In terms of specific complications after UIA surgery, the rate of seizure after craniotomy for UIA is poorly defined. Analyses of administrative data sets have reported a very low incidence of 0.1% for status epilepticus 199 and as high as 9.2% when reporting any seizures, 217 although these studies do not account for preexisting seizures or use of anticonvulsant drugs.…”

Intracranial Manifestations of Autosomal Dominant Polycystic Kidney Disease

“…Giant and posterior circulation aneurysms have a higher rate of postoperative complications compared with small anterior circulation aneurysms [60] . In one study, unruptured aneurysm coil embolization was associated with permanent complication rate of 6.7% and 1,4% mortality [58] .…”

“…Overall risk of death or permanent disability following treatment of ruptured aneurysm is approximately 5%, and for permanent cognitive functions impairment is about 10%. Some authors believe that risk is higher for neurosurgical clipping than endovascular coiling [57,58] . The risk associated with surgery is the higher the larger is the IA diameter, so aneurysms detected during screening procedure as generally smaller are associated with slightly lower risk [59] .…”