gms | German Medical Science

Objective: In spite of an essentially improved treatment for ruptured intracranial aneurysms, many patients exhibit persistent impairments of their health-related quality of life (HRQOL) even after a good neurological result. However, the etiology of these impairments remains unclear. The present study was performed in order to analyze possible predictors of the late HRQOL after aneurysmal SAH.

Method: A consecutive series of 243 patients after surgery upon a ruptured intracranial aneurysm with a neurological result from good to fair (GOS=I-III) was investigated on average 28.2 (SD 4.6) months after SAH by means of the Aachen Life Quality Inventory (ALQI). The patient age was between 16-75 years. The severity of SAH was classified according to the CCT grading system of Fisher, while the clinical state on admission was rated according to the grading system of Hunt&Hess. We applied univariate and multivariate statistics in order to analyze the data.

Results: Beyond bleeding severity (Fisher grade) and duration of temporary clipping, predominantly age, the presence and severity of additional illnesses und the initial clinical grade (Hunt&Hess) were the most important clinical predictors of the late HRQOL after SAH. However, their effect was relatively marginal in terms of variance explained as compared to the large effects of depressive mood and, in particular, of the degree of psychological traumatization. Age and duration of temporary clipping (minutes) proved as significant predictors of life quality explaining up to 16% of the total variance in the case of the ALQI Total Score (p<0.001). The most important univariate predictors were included into a stepwise discriminant model, differentiating those patients with a good HRQOL from those with substantial impairments. By means of this model 71.4% of the less impaired patients and 82.6% of the substantially impaired patients could be classified correctly (Wilk’s Lambda .773; Eigenvalue .401; p<0.001).

Conclusions: Future research should analyze the prognostic significance of these parameters for the HRQOL in patients after endovascular treatment of ruptured intracranial aneurysms in order to compare them to microneurosurgically treated patients. From a practical point of view we suggest the inclusion of a simple routine check for symptoms of psychological traumatization into follow-up exams of patients after aneurysm rupture in order to refer them timely to specialized psychotherapists.