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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2000 May;68(5):571–576. doi: 10.1136/jnnp.68.5.571

Functional outcome and quality of life after angiography and operation for unruptured intracranial aneurysms

T Raaymakers 1
PMCID: PMC1736938  PMID: 10766885

Abstract

OBJECTIVES—To assess outcome after elective treatment for unruptured intracranial aneurysms.
METHODS—Of 193 consecutive patients with subarachnoid haemorrhage 626 first degree relatives (parents, siblings, children) were screened with magnetic resonance angiography. Subsequently, 18 relatives underwent elective angiography and operation. Outcome was assessed in terms of impairments (neurological examination), disabilities (Barthel index), handicaps (Rankin scale), and quality of life (sickness impact profile (SIP) and short form-36 (SF-36)) 3 months and 1 year after operation; it was compared with baseline measurements.
RESULTS—Before angiography all patients had a normal neurological examination, optimal Barthel and Rankin scores, and a quality of life similar to that in a reference population. Three months postoperatively five patients (28%; 95% confidence interval (95% CI) 10-54%) had neurological impairments (one after angiography), two (11%; 95% CI 1-35%) had a decrease in Barthel index, and 15 (83%; 95% CI 59-96%) had suboptimal Rankin scores (none was dependent in daily living). Quality of life (SIP and SF-36) was reduced for most domains. After 1 year, five patients still had neurological impairments, all had an optimal Barthel index, and eight (47%; 95% CI 23-72%) had suboptimal Rankin scores. Quality of life returned to baseline levels for all SIP and most SF-36 domains.
CONCLUSIONS—Treatment of unruptured aneurysms has a considerable short term negative impact on functional health and quality of life in most patients, despite the low rate of impairments. Outcome improves markedly but not completely within 1 year after operation.



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Selected References

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  1. Bamford J. M., Sandercock P. A., Warlow C. P., Slattery J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1989 Jun;20(6):828–828. doi: 10.1161/01.str.20.6.828. [DOI] [PubMed] [Google Scholar]
  2. Bergner M., Bobbitt R. A., Carter W. B., Gilson B. S. The Sickness Impact Profile: development and final revision of a health status measure. Med Care. 1981 Aug;19(8):787–805. doi: 10.1097/00005650-198108000-00001. [DOI] [PubMed] [Google Scholar]
  3. Bromberg J. E., Rinkel G. J., Algra A., Greebe P., van Duyn C. M., Hasan D., Limburg M., ter Berg H. W., Wijdicks E. F., van Gijn J. Subarachnoid haemorrhage in first and second degree relatives of patients with subarachnoid haemorrhage. BMJ. 1995 Jul 29;311(7000):288–289. doi: 10.1136/bmj.311.7000.288. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Hop J. W., Rinkel G. J., Algra A., van Gijn J. Case-fatality rates and functional outcome after subarachnoid hemorrhage: a systematic review. Stroke. 1997 Mar;28(3):660–664. doi: 10.1161/01.str.28.3.660. [DOI] [PubMed] [Google Scholar]
  5. Hop J. W., Rinkel G. J., Algra A., van Gijn J. Quality of life in patients and partners after aneurysmal subarachnoid hemorrhage. Stroke. 1998 Apr;29(4):798–804. doi: 10.1161/01.str.29.4.798. [DOI] [PubMed] [Google Scholar]
  6. Jacobs H. M., Luttik A., Touw-Otten F. W., de Melker R. A. De 'sickness impact profile'; resultaten van een valideringsonderzoek van de Nederlandse versie. Ned Tijdschr Geneeskd. 1990 Oct 6;134(40):1950–1954. [PubMed] [Google Scholar]
  7. Jenkinson C., Lawrence K., McWhinnie D., Gordon J. Sensitivity to change of health status measures in a randomized controlled trial: comparison of the COOP charts and the SF-36. Qual Life Res. 1995 Feb;4(1):47–52. doi: 10.1007/BF00434383. [DOI] [PubMed] [Google Scholar]
  8. MAHONEY F. I., BARTHEL D. W. FUNCTIONAL EVALUATION: THE BARTHEL INDEX. Md State Med J. 1965 Feb;14:61–65. [PubMed] [Google Scholar]
  9. Mangione C. M., Goldman L., Orav E. J., Marcantonio E. R., Pedan A., Ludwig L. E., Donaldson M. C., Sugarbaker D. J., Poss R., Lee T. H. Health-related quality of life after elective surgery: measurement of longitudinal changes. J Gen Intern Med. 1997 Nov;12(11):686–697. doi: 10.1046/j.1525-1497.1997.07142.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. RANKIN J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 1957 May;2(5):200–215. doi: 10.1177/003693305700200504. [DOI] [PubMed] [Google Scholar]
  11. Raaymakers T. W., Rinkel G. J., Limburg M., Algra A. Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis. Stroke. 1998 Aug;29(8):1531–1538. doi: 10.1161/01.str.29.8.1531. [DOI] [PubMed] [Google Scholar]
  12. Ruggieri P. M., Poulos N., Masaryk T. J., Ross J. S., Obuchowski N. A., Awad I. A., Braun W. E., Nally J., Lewin J. S., Modic M. T. Occult intracranial aneurysms in polycystic kidney disease: screening with MR angiography. Radiology. 1994 Apr;191(1):33–39. doi: 10.1148/radiology.191.1.8134594. [DOI] [PubMed] [Google Scholar]
  13. Ware J. E., Jr, Sherbourne C. D. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed] [Google Scholar]
  14. Wolfe C. D., Taub N. A., Woodrow E. J., Burney P. G. Assessment of scales of disability and handicap for stroke patients. Stroke. 1991 Oct;22(10):1242–1244. doi: 10.1161/01.str.22.10.1242. [DOI] [PubMed] [Google Scholar]
  15. de Bruin A. F., Diederiks J. P., de Witte L. P., Stevens F. C., Philipsen H. Assessing the responsiveness of a functional status measure: the Sickness Impact Profile versus the SIP68. J Clin Epidemiol. 1997 May;50(5):529–540. doi: 10.1016/s0895-4356(97)00047-4. [DOI] [PubMed] [Google Scholar]
  16. de Haan R., Limburg M., Schuling J., Broeshart J., Jonkers L., van Zuylen P. Klinimetrische evaluatie van de Barthel-index, een maat voor beperkingen in het dagelijks functioneren. Ned Tijdschr Geneeskd. 1993 May 1;137(18):917–921. [PubMed] [Google Scholar]
  17. van Swieten J. C., Koudstaal P. J., Visser M. C., Schouten H. J., van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988 May;19(5):604–607. doi: 10.1161/01.str.19.5.604. [DOI] [PubMed] [Google Scholar]

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