Haug Tonje, Sorteberg Angelika, Sorteberg Wilhelm, Lindegaard Karl-Fredrik, Lundar Tryggve, Finset Arnstein
Department of Neuropsychiatry and Psychosomatic Medicine, Rikshospitalet University Hospital, Oslo, Norway.
Neurosurgery. 2009 Mar;64(3):412-20; discussion 421-2. doi: 10.1227/01.NEU.0000338952.13880.4E.
To assess the impact of surgical treatment of unruptured and ruptured middle cerebral artery (MCA) aneurysms on cognitive functioning and health-related quality of life (HRQOL).
This was a prospective study enrolling 15 patients with unruptured MCA aneurysms and 22 patients with ruptured MCA aneurysms in good clinical condition postictally. Patients with unruptured aneurysms underwent preoperative neuropsychological testing and answered 2 HRQOL questionnaires. All patients were investigated 3 and 12 months postoperatively with a comprehensive neuropsychological test battery, clinical investigation, and interview. The modified Rankin Scale score, Glasgow Outcome Scale score, employment status, and 2 HRQOL questionnaires were also used for assessment.
Preoperative cognitive deficits were aggravated 3 months after surgery for the unruptured MCA aneurysm group, but after 12 months these patients performed at their preoperative level. Subjects who underwent clipping for ruptured MCA aneurysms had reduced verbal memory; otherwise, they had close to normal cognitive function 12 months postoperatively. There was no difference between the 2 groups in Rankin Scale score or Glasgow Outcome Scale score. High preoperative levels of anxiety and depression markedly decreased after repair of an unruptured aneurysm; however, in both groups, HRQOL was reduced on the same measures even 12 months after surgery. Patients treated for unruptured MCA aneurysms regained their preoperative employment status, whereas only 60% of those who had bled from their aneurysm had returned to full-time work after 12 months.
Surgical treatment of unruptured MCA aneurysms does not cause new cognitive deficits, but it reduces some aspects of HRQOL in a similar manner as in patients who undergo clipping for ruptured MCA aneurysms.
评估手术治疗未破裂和破裂大脑中动脉（MCA）动脉瘤对认知功能及健康相关生活质量（HRQOL）的影响。
这是一项前瞻性研究，纳入15例未破裂MCA动脉瘤患者和22例破裂MCA动脉瘤且发作后临床状况良好的患者。未破裂动脉瘤患者术前接受神经心理学测试并回答2份HRQOL问卷。所有患者在术后3个月和12个月接受全面神经心理学测试组、临床检查及访谈。改良Rankin量表评分、格拉斯哥预后量表评分、就业状况及2份HRQOL问卷也用于评估。
未破裂MCA动脉瘤组术后3个月术前认知缺陷加重，但12个月后这些患者的表现恢复到术前水平。接受破裂MCA动脉瘤夹闭术的患者言语记忆减退；否则，术后12个月他们的认知功能接近正常。两组在Rankin量表评分或格拉斯哥预后量表评分上无差异。未破裂动脉瘤修复后，术前高水平的焦虑和抑郁明显减轻；然而，两组在相同测量指标上，即使术后12个月HRQOL仍降低。未破裂MCA动脉瘤治疗患者恢复了术前就业状况，而动脉瘤出血患者中只有60%在12个月后恢复全职工作。
手术治疗未破裂MCA动脉瘤不会导致新的认知缺陷，但与接受破裂MCA动脉瘤夹闭术的患者类似，它会在某些方面降低HRQOL。
