Abstract
Subjective assessment and patient-based parameters, including quality of life (QOL), anxiety and depression, have gained attention in the evaluation of functional outcome after treatment of unruptured intracranial aneurysms (UIAs). Patients may become seriously anxious and depressive after notification of the presence of UIAs because of fear for the rupture of their UIAs and the risk of intracranial surgery, thus leading to a consequent decline of cognitive function and QOL. In this prospective investigation, we assessed alterations in peri-operative depression and its influence on cognitive function in patients with asymptomatic UIAs.
Consecutive 100 patients with asymptomatic UIAs (mean age: 58.9 years) underwent clipping through supratentorial approaches between August 2003 and July 2008 at our institute. Among these patients, 117 UIAs located in the anterior circulation except for 2 basilar top aneurysms and 2 posterior cerebral artery aneurysms were approached mostly via the pterional or interhemispheric route. The cognitive test battery consisted of the Wechsler Adult Intelligence Scale-Revised (WAIS-R) and Kana-hiroi test which is one of examinations of frontal lobe function. Alterations in depression were assessed by Zung’s Self-rating Depression Scale (SDS). Cognitive tests and SDS were performed 2 weeks before, 2 months and 1 year after surgery.
Favorable outcome (modified Rankin Scale 0) was observed in 97 patients 2 months after surgery. The average post-operative total IQ of WAIS-R were significantly increased 2 months and 1 year after surgery, from 93.3 to 96.6 among all patients (p<0.0001) and to 101.1 among 48 patients (p<0.0001), respectively. Also, the average post-operative scores of Kana-hiroi test were significantly increased 2 months and 1 year after surgery, from 23.8 to 26.2 (p<0.01) and to 28.0 (p<0.001), respectively. On the other hand, post-operative changes in depressive mood were various in individual cases. The average SDS was 35.3, 35.4 and 34.5, before, 2 months and 1 year after surgery, respectively. However, inverse correlation of post-operative SDS and alterations in total IQ in individual cases 2 months after surgery was significant (r=-0.384, p<0.0001).
Surgical treatment of UIAs is well-established and does not impair cognitive function. However, peri-operative increased depression in some cases may lead to deterioration in cognitive function and a consequent QOL decline.
