Few studies have examined patients’ ability to drive and quality of life (QOL) after microsurgical repair for unruptured intracranial aneurysms (uIAs). However, without a strong evidentiary basis, jurisdictional road transport authorities have recommended driving restrictions following brain surgery. In the present study, authors examined the outcomes of the microsurgical repair of uIAs by measuring patients’ perceived QOL and cognitive abilities related to driving.
Between January 2011 and January 2016, patients with a new diagnosis of uIA were prospectively enrolled in this study. Assessments were performed at referral, before surgery, and at 6 weeks and 12 months after surgery in those undergoing microsurgical repair and at referral and at 12 months in conservatively managed patients. Assessments included the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36, the off-road driver-screening instrument DriveSafe (DS), the modified Barthel Index (mBI), and the modified Rankin Scale (mRS).
One hundred sixty-nine patients were enrolled in and completed the study, and 112 (66%) of them had microsurgical repair of their aneurysm. In the microsurgical group, there was a trend for improved DS scores: from a mean (± standard deviation) score of 108 ± 10.7 before surgery to 111 ± 9.7 at 6 weeks after surgery to 112 ± 10.2 at 12 months after surgery (p = 0.05). Two percent of the microsurgical repair group and 4% of the conservatively managed group whose initial scores indicated competency to drive according to the DS test subsequently had 12-month scores deemed as not competent to drive; the difference between these 2 groups was not statistically significant (p > 0.99). Factors associated with a decline in the DS score among those who had a license at the time of initial assessment were an increasing age (p < 0.01) and mRS score > 0 at one of the assessments (initial, 6 weeks, or 12 months; p < 0.01).
Mean PCS scores in the microsurgical repair group were 52 ± 8.1, 46 ± 6.8, and 52 ± 7.1 at the initial, 6-week, and 12-month assessments, respectively (p < 0.01). These values represented a significant decline in the mean PCS score at 6 weeks that recovered by 12 months (p < 0.01). There were no significant changes in the MCS, mBI, or mRS scores in the surgical group.
Overall, QOL at 12 months for the microsurgical repair group had not decreased and was comparable to that in the conservatively managed group. Furthermore, as assessed by the DS test, the majority of patients were not affected in their ability to drive.
Correspondence Michael Kerin Morgan: Macquarie University, Sydney, NSW, Australia. email@example.com.INCLUDE WHEN CITING Published online March 2, 2018; DOI: 10.3171/2017.8.JNS171576.Disclosures Ms. O’Donnell has received a Macquarie University Postgraduate Research Scholarship and Australian Government Research Training Program Scholarship.
BackesDRinkelGJvan der SchaafICNij BijvankJAVerweijBHVisser-MeilyJM: Recovery to preinterventional functioning, return-to-work, and life satisfaction after treatment of unruptured aneurysms. Stroke46:1607–16122015
BackesD, RinkelGJ, van der SchaafIC, Nij BijvankJA, VerweijBH, Visser-MeilyJM, : Recovery to preinterventional functioning, return-to-work, and life satisfaction after treatment of unruptured aneurysms. 46:1607–1612, 20152592251410.1161/STROKEAHA.115.008795)| false
BrilstraEHRinkelGJvan der GraafYSluzewskiMGroenRJLoRT: Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils. A prospective, observational study. Cerebrovasc Dis17:44–522004
BrilstraEH, RinkelGJ, van der GraafY, SluzewskiM, GroenRJ, LoRT, : Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils. A prospective, observational study. 17:44–52, 200410.1159/00007389714530637)| false
BuijsJE, GreebeP, RinkelGJE: Quality of life, anxiety, and depression in patients with an unruptured intracranial aneurysm with or without aneurysm occlusion. 70:868–872, 201210.1227/NEU.0b013e318236729521937934)| false
O’DonnellJMorganMKSavageGBundyA: Measuring functional outcomes following surgery for unruptured, intracranial aneurysms and brain AVMs: validity and reliability of past and present instruments. Aust Occup Ther J60 (Suppl 1):242013 (Abstract)
O’DonnellJ, MorganMK, SavageG, BundyA: Measuring functional outcomes following surgery for unruptured, intracranial aneurysms and brain AVMs: validity and reliability of past and present instruments. 60 (Suppl 1):24, 2013 (Abstract))| false
OʼDonnellJM, MorganMK, BerviniD, HellerGZ, AssaadN: The risk of seizure after surgery for unruptured intracranial aneurysms: A prospective cohort study. 79:222–230, 20162667163310.1227/NEU.0000000000001176)| false
OtawaraY, OgasawaraK, KuboY, TomitsukaN, WatanabeM, OgawaA, : Anxiety before and after surgical repair in patients with asymptomatic unruptured intracranial aneurysm. 62:28–31, 200410.1016/j.surneu.2003.07.01215226063)| false
OtawaraY, OgasawaraK, OgawaA, YamadateK: Cognitive function before and after surgery in patients with unruptured intracranial aneurysm. 36:142–143, 200510.1161/01.STR.0000149925.36914.4e15569864)| false
ProustFMartinaudOGérardinEDerreySLevèqueSBiouxS: Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment. J Neurosurg110:19–292009
RaymondJ, DarsautTE, MolyneuxAJ: A trial on unruptured intracranial aneurysms (the TEAM trial): results, lessons from a failure and the necessity for clinical care trials. 12:64, 201110.1186/1745-6215-12-64)| false
WilsonJTL, HareendranA, HendryA, PotterJ, BoneI, MuirKW: Reliability of the modified Rankin Scale across multiple raters: benefits of a structured interview. 36:777–781, 20051571851010.1161/01.STR.0000157596.13234.95)| false