Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment

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François ProustDepartments of Neurosurgery,

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 M.D., Ph.D.
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Olivier MartinaudNeurology, Rouen University Hospital, Rouen; and

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 M.D.
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Emmanuel GérardinNeuroradiology, and

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 M.D.
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Stéphane DerreyDepartments of Neurosurgery,

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Sophie LevèqueDepartments of Neurosurgery,

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Sandrine BiouxNeurology, Rouen University Hospital, Rouen; and

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Eléonore TollardNeuroradiology, and

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 M.D.
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Erick ClavierNeuroradiology, and

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Olivier LangloisDepartments of Neurosurgery,

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Olivier GodefroyDepartment of Neurology, Amiens University Hospital, Amiens, France

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 M.D.
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Didier HannequinNeurology, Rouen University Hospital, Rouen; and

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 M.D., Ph.D.
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Pierre FrégerDepartments of Neurosurgery,

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Object

For anterior communicating artery (ACoA) aneurysms, endovascular coil embolization constitutes a safe alternative therapeutic procedure to microsurgical clip occlusion. The authors' aim in this study was to evaluate the quality of life (QOL), cognitive function, and brain structure damage after the treatment of ruptured ACoA aneurysms in a group of patients who underwent microsurgical clipping (36 patients) compared with a reference group who underwent endovascular coiling (14 patients).

Methods

At 14 months posttreatment all patients underwent evaluations by independent observers. These observers evaluated global efficacy, executive functions using a frontal assessment battery of tests (Trail making test, Stroop tasks, dual task of Baddeley, verbal fluency, and Wisconsin Card Sorting test), behavior dysexecutive syndrome (the Inventaire du Syndrome Dysexécutif Comportemental questionnaire [ISDC]), and QOL by using the Reintegration To Normal Living Index. Brain damage was analyzed using MR imaging.

Results

In the microsurgical clipping and endovascular coiling groups, the distribution on the modified Rankin Scale (p = 0.19) and mean QOL score (85.4 vs 83.4, respectively) were similar. Moreover, the proportion of executive dysfunctions (19.4 vs 28.6%, respectively) and the mean score on the ISDC questionnaire (8.9 vs 8.5, respectively) were not significant, but verbal memory was more altered in the microsurgical clipping group (p = 0.055). Magnetic resonance imaging revealed that the incidence of local encephalomalacia and the median number of lesions per patient increased significantly in the microsurgical clipping group (p = 0.003).

Conclusions

In the 2 groups, no significant difference was observed regarding QOL, executive functions, and behavior. Despite the significant decrease in verbal memory after microsurgical clipping, the interdisciplinary approach remains a safe and useful strategy.

Abbreviations used in this paper:

ACoA = anterior communicating artery; GBVLT = Grober and Buschke verbal learning test; GOS = Glasgow Outcome Score; GREFEX = Groupe de Réflexion sur les Fonctions Exécutives; ISDC = Inventaire du Syndrome Dysexécutif Comportemental; MADRS = Montgomery–Asberg Depression Rating Scale; mRS = modified Rankin Scale; QOL = quality of life; RNL = Reintegration to Normal Living; SAH = subarachnoid hemorrhage; SD = standard deviation; SF-36 = 36-Item Short Form Health Survey; WCST = Wisconsin Card Sorting Test.
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