gms | German Medical Science

Objective: In an increasing number of patients intracranial aneurysms (IA) are detected incidentally. In this regard, endovascular coiling as a treatment option of IA increased rapidly in the last two decades as compared to microsurgical clipping. Effectivity of both methods in terms of occlusion completeness and morbidity is still a matter of debate. However, besides the direct impact of functional sequelaes, the treatment impact on health realted quality of life (QOL) in both treatment options remains unclear. Therefore, we analyzed a representative and comparable consecutive cohort of patients undergoing either surgical or endovascular occlusion of IA regarding QOL.

Methods: A consecutive series of 125 patients was available for a standardized telephone interview being treated by endovascular coiling or surgery for an IA at the University Hospital of Essen (mean time post-treatment 57.75±13.56 months). Of these, 96 (77%) agreed to take part in the study. Both groups were statistically comparable in a wide range of sociodemographical and clinical parameters (p> .05, respectively). The interviews were performed in a strictly standardized manner by a specially trained interviewer who was neither neurosurgeon nor neuroradiologist. The phone calls covered the standardized SF-36 interview.

Results: Of the 96 participants 59 (61%) were treated by coiling and 37 (39%) were operated upon an IA. Both groups were comparable in terms of age, gender, delay treatment follow-up, functional outcome, radiological outcome aneurysm location and further clinical variables (p> .05, respectively). Compared to healthy population controls, patients after clipping or coiling procedure showed significantly decreased health related QOL in most summary scores and sub scores (except general health perceptions, vitality, mental health (p>.05, respectively)). In addition, summary scores and sub scores showed overall a tendency to be inferior in the coiling cohort compared to the clipping cohort, however showing no statistical significance (e.g. physical component summary score: 47.72 ± 11.23 vs. 45.23±12.33 and mental component summary score: 50.40±15.11 vs. 44.97±17.08). The tendency was much stronger in the mental summary scores and sub scores.

Conclusion: Treatment of an IA seems to have a strong impact on a person´s health related QOL. Although regarded as a less invasive and presumably less mentally stressful procedure, surprisingly, mental component scores of health related QOL in a cohort of patients that underwent coiling for IA were inferior when compared to a clipping cohort.