Improvement of quality of life in patients surgically treated for asymptomatic unruptured intracranial aneurysms

Objective

To compare the preoperative and postoperative health‐related quality of life (QOL) and psychological state of patients with asymptomatic unruptured intracranial aneurysms (ICAs) who underwent elective surgery.

Methods

Out of 67 patients who underwent neck clipping of ICAs, we assessed the QOL of 61 patients using Short Form‐36 (SF‐36); their psychological state was rated on the Hospital Anxiety and Depression Scale (HADS) before, 3 months, and 1 and 3 years after treatment.

Results

The preoperative mean scores for each of the eight SF‐36 domains except bodily pain were significantly lower in the study population than in the reference population. 14 (20.9%) patients experienced surgical complications defined as neurological deterioration and/or abnormal CT findings within 30 days of the operation. Despite some complications, the QOL of all operated patients returned to the mean level of the reference population 3 years after treatment. At 3 months after surgery, the scores for psychosocial activities and general health perception were transiently below the preoperative levels. According to the HADS, the patients experienced mild anxiety before the operation; it disappeared by the third postoperative month.

Conclusions

Preoperatively, patients with unruptured ICAs reported a significantly decreased QOL. It further declined transiently after elective surgery, but it returned to the mean level recorded for the reference population within 3 years. Our findings suggest that these patients derived significant QOL benefits from their surgery. Hence subjective QOL issues should be considered in deciding whether treatment‐related risks and their natural history, such as their potential rupture, warrant surgery of asymptomatic unruptured ICAs.Some patients with unruptured intracranial aneurysms (ICAs) undergo elective microsurgical clipping to prevent subarachnoid haemorrhage (SAH) that may result in a poor prognosis. Bederson et al¹ suggested that a history of SAH and the presence of aneurysms with diameter >10 mm render patients with unruptured aneurysms, especially those with symptomatic lesions, eligible for surgical intervention. A systematic review of unruptured ICAs in Japan showed that the risk of rupture is significantly higher than that reported by international large‐scale studies.² Therefore, patients with asymptomatic and/or small (<10 mm) aneurysms tend to be treated surgically in Japan.The international guidelines for the management of unruptured ICAs are based on their natural history and surgical results,^3,4,5 and rates of surgical morbidity and mortality are considered objective epidemiological outcome measures. However, subjective assessments and patient‐based outcomes have gained attention in the evaluation of functional outcomes after treatment. Judgement parameters include anxiety, satisfaction with treatment and health‐related quality of life (QOL) issues. In neurosurgical outcome evaluations, the QOL after surgery for SAH,^6,7,8 vertebral artery dissection⁹ and acoustic neuroma¹⁰ has been assessed using universal health‐related QOL measures. Many patients with unruptured ICAs undergo elective surgery because they experience serious anxiety regarding their possible rupture and a consequent QOL decline. Although from a patient''s standpoint improved QOL is the goal of treatment, this issue has not been addressed adequately in the literature.Our previous retrospective study of long‐term health‐related QOL, anxiety and depression in patients who had undergone elective aneurysm clipping at our institute during the past 10 years¹¹ showed that most of the patients experienced a QOL similar to that of the general population. In the current prospective investigation, we assessed the preoperative and postoperative QOL of patients with unruptured ICAs who underwent elective surgery.