Brilstra Eva H, Rinkel Gabriel J E, van der Graaf Yolanda, Sluzewski Menno, Groen Rob J, Lo Rob T H, Tulleken Cornelis A F
Department of Neurology, University of Utrecht, The Netherlands.
Cerebrovasc Dis. 2004;17(1):44-52. doi: 10.1159/000073897. Epub 2003 Oct 3.
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.
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).
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.
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.
未破裂颅内动脉瘤手术后并发症发生率相对较高。已发表的血管内治疗数据显示并发症发生率较低。我们测量了通过夹闭或栓塞治疗未破裂动脉瘤对功能健康、生活质量以及焦虑和抑郁水平的影响。
在三个中心，我们前瞻性收集了接受夹闭或栓塞治疗的未破裂动脉瘤患者的数据。治疗方案由治疗医生自行决定。在治疗前、治疗后3个月和12个月，我们使用标准化问卷评估功能健康（Rankin量表评分）、生活质量（SF-36、欧洲生活质量量表）以及焦虑和抑郁水平（医院焦虑抑郁量表）。
19例患者接受了栓塞治疗，32例接受了夹闭治疗。手术组中，4例患者（12%）出现永久性并发症；37个动脉瘤中的36个（97%）成功夹闭。术后3个月，生活质量比术前差；术后12个月，有所改善但未完全恢复到基线水平。抑郁评分高于普通人群。血管内治疗组未出现永久性神经功能缺损并发症；19个动脉瘤中的16个（84%）栓塞率超过90%。1例患者因先前栓塞的动脉瘤破裂死亡。其他患者术后3个月和1年的生活质量与治疗前相似。
短期内，未破裂动脉瘤患者的手术对功能健康和生活质量有相当大的影响。1年后会出现恢复，但不完全。栓塞治疗不影响功能健康和生活质量。
