gms | German Medical Science

Objective: To compare QOL in patients who are seizure-free after selective amygdalahippocampectomy with patients who were diagnosed with an incidental aneurysm and treated with microsurgical clipping. Both groups were operated via pterional craniotomy and a transsylvian approach. The aim was to show the impact of the surgical procedure itself (both groups) and to distinguish the impact of the removal of temporomesial structures (epilepsy group).

Methods: 26 patients were matched in each group. There were no malignancies, no brain diseases or pre-operative deficits in the history. All patients had an uneventful post-operative course. All epilepsy patients were completely seizure-free postoperatively. The postoperative angiography of aneurysm patients showed the complete obliteration of the single aneurysm of the internal carotid artery or its branches, respectively. Patients were asked to complete two questionnaires concerning QOL and overall QOL and different domains were compared.

Results: Mean age was 48 years (range 31 - 63); mean follow-up was 87 months (range 12 - 162). The period between initial diagnosis and operation was 5.6 months (range 1 - 22, aneurysm group) and 29.7 years (range 4 - 55, epilepsy group), respectively. Patients after epilepsy surgery rate their QOL significantly better than patients after vascular surgery (p = 0.05, BONNUS; p = 0.13, SF36). Concerning different domains, patients after clipping feel significantly limited in their physical capabilities (p = 0.05, SF36; p = 0.21, HRQOL) and mood (p = 0.01, BONNUS; p = 0.19, SF36). Social situation and cognitive capabilities show no statistically significant difference between both groups. The assessment of the changes postoperatively in QOL (BONNUS) shows positive trends in the overall QOL and all domains in the group of epilepsy patients and – vice versa – negative trends in the overall QOL and all domains in the group with patients after clipping (p = 0.05 for overall QOL, p = 0.01 for emotional situation). In both groups the postoperative changes in cognitive capabilities was rated the worst.

Conclusions: Interestingly, patients after uneventful clipping of an incidental aneurysm (and thus a diagnosed finding, not a disease) feel much more affected in their QOL than expected – even in domains that obviously should be better than in the group of patients after resection of the temporomesial structures. This may be due to the potentially life-threatening condition that appeared acutely and to the loss of personal integrity after brain surgery.