gms | German Medical Science

Objective: In an increasing number of patients innocent intracranial aneurysms (IA) are detected incidentally. Beyond microsurgical clipping the option of endovascular coiling of IA raised rapidly in the last two decades. Effectivity of both methods in terms of occlusion completeness and neurological morbidity is a point of debate. Furthermore, the psychological impact of both treatment options remains as of yet unclear. Therefore, we analyzed the psychological burden of either surgical or endovascular occlusion of IA.

Methods: A consecutive series of 125 patients was available for a standardized telephone interview who have been treated by endovascular coiling or surgery for an IA at the University Hospital of Essen. 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 interview versions of the Impact of Event Scale (IES), the Hospital Anxiety and Depression Inventory (HADS) and several ad hoc questions.

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, delay treatment follow-up, aneurysm location and further clinical variables (p> .05, respectively). Levels of anxiety (HADS), intrusion (IES) and avoidance (IES) were equally distributed between both groups (p> .05, respectively). Those patients who have been treated by coiling exhibited more depression (HADS) and were more stressed by arousal (IES) and had a higher level of treatment-related psychological burden (IES Total score; p< .05, respectively). No significant effect of an earlier psychological illness or of an adverse event during the treatment could be detected (p> .05, respectively).

Conclusion: Patients after endovascular treatment exhibit an increased psychological burden, a higher level of arousal and more depressive symptoms as compared to those whose aneurysms have been clipped surgically. Differences in the acute clinical course did not influence the late psychological impact. Beyond other psychological factors it can be speculated that patients after coiling query whether their aneurysm has been completely neutralized. This should be addressed by future studies.