gms | German Medical Science

Objective: Previous studies demonstrated an unfavorable psychiatric outcome after treatment of unruptured intracranial aneurysms despite a favorable clinical and radiological outcome. The current study was therefore designed to analyze the psychological vulnerability of this specific patient collective.

Method: Patients treated due to a meningioma WHO °I and unruptured intracranial aneurysms in two neurosurgical centers between 2007 and 2013 were screened for exclusion criteria including malignant/chronic diseases, recurrence of the tumor/aneurysm after more than 12 months and focal neurological deficits among others. The pre-interventional psychiatric history, the post-morbid character traits and the preferred coping strategies were determined by questionnaires which were mailed to the patients(Big-Five Personality Test, Brief COPE). Depressions and post-traumatic stress was determined by the Beck Depression Inventory, the Impact of Event Scale and the civilian Post-traumatic Stress Disorder Check List.

Results: 58 M patients and 45 iA patients returned the questionnaires. Patients with iA demonstrated significantly higher rates of pre-interventional depressive episodes (p=0.002, Fisher-exact test) and psychological supervision (p=0.038, Fisher-exact test). Moreover, iA patients demonstrated above average neuroticism scores in their character traits in contrast to the M group. Significant differences could be detected regarding the preferred coping strategies with a significant higher level of active coping in the M group (p=0.045, Mann-Whitney U test) and a significant higher level of denial in the iA group (p=0.033, Mann-Whitney U test). Significantly higher rates of moderate/severe depressions (p=0.002, Fisher-exact test) and PTSD (p=0.026, Fisher-exact test) were detected in the iA Group. The Impact of Event Scale also showed significantly higher values in the iA group (p=0.004, Mann-Whitney U-Test). Those significant differences were not reproducible anymore after excluding the iA patients with pre-interventional psychiatric histories from statistical analysis. No significant differences could be detected between the endovascular and surgical groups.

Conclusions: The results of the current study seem to identify the unruptured intracranial aneurysm patient population as a distinctive psychologically vulnerable patient collective. These results might explain the previously demonstrated unfavorable psychiatric outcome after surgical and endovascular interventions in this patient collective.