Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment
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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DOI：
10.3171/2008.3.17432
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发表时间：
2009-01-01
影响因子：
4.1
通讯作者：
Freger, Pierre
中科院分区：
文献类型：
--
作者：
Proust, Francois;Martinaud, Olivier;Freger, Pierre
目的。对于前交通动脉 (ACoA) 动脉瘤，血管内弹簧圈栓塞是显微外科夹闭塞的安全替代治疗方法。作者在这项研究中的目的是评估一组接受显微手术夹闭的患者（36 名患者）与接受血管内弹簧圈栓塞的参考组（14 名患者）相比，治疗破裂的 ACoA 动脉瘤后的生活质量 (QOL)、认知功能和脑结构损伤。方法。治疗后 14 个月，所有患者均接受独立观察员的评估。这些观察者使用一系列正面评估测试（轨迹制定测试、Stroop 任务、Baddeley 双重任务、语言流畅性和威斯康星卡片分类测试）评估整体效能、执行功能、行为执行障碍综合征（Inventaire du Syndrome Dysexecutif Compportemental 问卷[ISDC]），并使用重新融入正常生活指数评估生活质量。使用 MR 成像分析脑损伤。结果。在显微手术夹闭组和血管内弹簧圈栓塞组中，改良Rankin量表（p = 0.19）和平均生活质量评分（分别为85.4 vs 83.4）的分布相似。此外，执行功能障碍的比例（分别为19.4％和28.6％）和ISDC问卷的平均得分（分别为8.9％和8.5％）并不显着，但显微手术夹闭组的言语记忆改变更大（p = 0.055）。磁共振成像显示，显微手术夹闭组的局部脑软化症发生率和每位患者的中位病变数量显着增加（p = 0.003）。结论。在两组中，在生活质量、执行功能和行为方面没有观察到显着差异。尽管显微手术夹闭后言语记忆显着下降，但跨学科方法仍然是一种安全且有用的策略。 （DOI：10.3171/2008.3.17432）
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 Dysexecutif 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. (DOI: 10.3171/2008.3.17432)