Successful aneurysm treatment may not improve quality of life

Wolters Kluwer HealthApr 2 2012

Patients with unruptured brain aneurysms have significant reductions in several areas of quality of life—especially physical functioning, reports a study in the April issue of Neurosurgery, official journal of the Congress of Neurological Surgeons. The journal is published by Lippincott Williams & Wilkins, a part of Wolters Kluwer Health.

Most aspects of quality of life are reduced even after successful aneurysm treatment, according to the new research by Julie E. Buijs and colleagues of University Medical Center, Utrecht, the Netherlands. The findings may have important implications for neurosurgeons and patients making decisions about treatment for unruptured aneurysms.

Aneurysms Affect Patients' Lives—Even Without Rupture…
Using standard questionnaires, the researchers assessed mental health and quality of life in 173 patients diagnosed with brain aneurysms. An aneurysm is a weakened spot in a blood vessel wall. If the aneurysm enlarges or ruptures (breaks), it can cause bleeding in the brain, called subarachnoid hemorrhage (SAH)—a life-threatening type of stroke.

All patients in the study had unruptured aneurysms, with no history of SAH. About half underwent surgery or nonsurgical (endovascular) treatment to block off the aneurysm. Dr. Buijs and colleagues sought to determine how living with an unruptured aneurysm affected patients' lives, including their mental health, physical health, and everyday functioning.

Patients with aneurysms did not have increased levels of anxiety or depression, compared to healthy people. However, they did have lower-than-normal scores in several aspects of quality of life, including both physical and mental health. The greatest impact was seen in the area of "physical role functioning"—the patients said they spent less time on work and other activities and got less done because of physical health problems.

…and Even After Aneurysm Treatment
The impact on quality of life was similar for patients who did and did not undergo treatment for their brain aneurysm. The only area that was better in treated patients was "emotional role functioning"—they did not report difficulty getting things done because of emotional problems.

Because of improved quality and availability of brain imaging techniques, more patients are being diagnosed with unruptured brain aneurysms. Surgical or nonsurgical treatment may be recommended for patients who have larger aneurysms or are considered at higher risk of rupture for other reasons. In other cases, the risk of rupture is deemed too small to warrant the risks of treatment.

Few previous studies have looked at other ways in which living with an unruptured aneurysm might affect patients' lives. For example, even after being reassured that they're at low risk, patients might have persistent anxiety about the possibility of rupture and SAH (or if treated, fears of developing new aneurysms).

The new study does not show any significant increase in anxiety or depression among patients with unruptured aneurysms. However, the researchers conclude, "Patients with an unruptured aneurysm have a reduced quality of life compared with the [healthy] population, mainly in physical domains."

In most aspects, the impact on quality of life appears similar with or without treatment. Dr. Buijs and colleagues call for further studies to evaluate the factors contributing to decreased quality of life in patients diagnosed with an aneurysm, along with possible changes in quality of life after treatment.