SURGICAL REPAIR OF UNRUPTURED AND RUPTURED MIDDLE CEREBRAL ARTERY ANEURYSMS: IMPACT ON COGNITIVE FUNCTIONING AND HEALTH-RELATED QUALITY OF LIFE

OBJECTIVE: To assess the impact of surgical treatment of unruptured and ruptured middle cerebral artery (MCA) aneurysms on cognitive functioning and health-related quality of life (HRQOL). METHODS: This was a prospective study enrolling 15 patients with unruptured MCA aneurysms and 22 patients with ruptured MCA aneurysms in good clinical condition postictally. Patients with unruptured aneurysms underwent preoperative neuropsychological testing and answered 2 HRQOL questionnaires. All patients were investigated 3 and 12 months postoperatively with a comprehensive neuropsychological test battery, clinical investigation, and interview. The modified Rankin Scale score, Glasgow Outcome Scale score, employment status, and 2 HRQOL questionnaires were also used for assessment. RESULTS: Preoperative cognitive deficits were aggravated 3 months after surgery for the unruptured MCA aneurysm group, but after 12 months these patients performed at their preoperative level. Subjects who underwent clipping for ruptured MCA aneurysms had reduced verbal memory; otherwise, they had close to normal cognitive function 12 months postoperatively. There was no difference between the 2 groups in Rankin Scale score or Glasgow Outcome Scale score. High preoperative levels of anxiety and depression markedly decreased after repair of an unruptured aneurysm; however, in both groups, HRQOL was reduced on the same measures even 12 months after surgery. Patients treated for unruptured MCA aneurysms regained their preoperative employment status, whereas only 60% of those who had bled from their aneurysm had returned to full-time work after 12 months. CONCLUSION: Surgical treatment of unruptured MCA aneurysms does not cause new cognitive deficits, but it reduces some aspects of HRQOL in a similar manner as in patients who undergo clipping for ruptured MCA aneurysms.