Proust François, Martinaud Olivier, Gérardin Emmanuel, Derrey Stéphane, Levèque Sophie, Bioux Sandrine, Tollard Eléonore, Clavier Erick, Langlois Olivier, Godefroy Olivier, Hannequin Didier, Fréger Pierre
Departments of Neurosurgery, Rouen University Hospital, Rouen, France.
J Neurosurg. 2009 Jan;110(1):19-29. doi: 10.3171/2008.3.17432.
For anterior communicating artery (ACoA) aneurysms, endovascular coil embolization constitutes a safe alternative therapeutic procedure to microsurgical clip occlusion. The authors' aim in this study was to evaluate the quality of life (QOL), cognitive function, and brain structure damage after the treatment of ruptured ACoA aneurysms in a group of patients who underwent microsurgical clipping (36 patients) compared with a reference group who underwent endovascular coiling (14 patients).
At 14 months posttreatment all patients underwent evaluations by independent observers. These observers evaluated global efficacy, executive functions using a frontal assessment battery of tests (Trail making test, Stroop tasks, dual task of Baddeley, verbal fluency, and Wisconsin Card Sorting test), behavior dysexecutive syndrome (the Inventaire du Syndrome Dysexécutif Comportemental questionnaire [ISDC]), and QOL by using the Reintegration To Normal Living Index. Brain damage was analyzed using MR imaging.
In the microsurgical clipping and endovascular coiling groups, the distribution on the modified Rankin Scale (p = 0.19) and mean QOL score (85.4 vs 83.4, respectively) were similar. Moreover, the proportion of executive dysfunctions (19.4 vs 28.6%, respectively) and the mean score on the ISDC questionnaire (8.9 vs 8.5, respectively) were not significant, but verbal memory was more altered in the microsurgical clipping group (p = 0.055). Magnetic resonance imaging revealed that the incidence of local encephalomalacia and the median number of lesions per patient increased significantly in the microsurgical clipping group (p = 0.003).
In the 2 groups, no significant difference was observed regarding QOL, executive functions, and behavior. Despite the significant decrease in verbal memory after microsurgical clipping, the interdisciplinary approach remains a safe and useful strategy.
对于前交通动脉（ACoA）动脉瘤，血管内弹簧圈栓塞术是一种安全的替代显微手术夹闭的治疗方法。本研究作者的目的是评估一组接受显微手术夹闭的破裂ACoA动脉瘤患者（36例）与接受血管内栓塞术的参照组患者（14例）治疗后的生活质量（QOL）、认知功能和脑结构损伤情况。
治疗后14个月，所有患者均由独立观察者进行评估。这些观察者通过以下方式评估总体疗效、执行功能：使用额叶评估成套测验（连线测验、Stroop任务、Baddeley双重任务、语言流畅性和威斯康星卡片分类测验）、行为执行障碍综合征（行为执行障碍综合征问卷[ISDC]），并使用重新融入正常生活指数评估生活质量。使用磁共振成像分析脑损伤情况。
在显微手术夹闭组和血管内栓塞组中，改良Rankin量表的分布（p = 0.19）和平均生活质量得分（分别为85.4和83.4）相似。此外，执行功能障碍的比例（分别为19.4%和28.6%）和ISDC问卷的平均得分（分别为8.9和8.5）无显著差异，但显微手术夹闭组的言语记忆改变更为明显（p = 0.055）。磁共振成像显示，显微手术夹闭组局部脑软化的发生率和每位患者的病灶中位数显著增加（p = 0.003）。
两组在生活质量、执行功能和行为方面未观察到显著差异。尽管显微手术夹闭后言语记忆显著下降，但多学科方法仍然是一种安全有效的策略。
