Quality of life after treatment for incidental, unruptured intracranial aneurysms

Background. Discovering an intracranial aneurysm may profoundly affect the patient's quality of life. Patients living with unruptured and untreated aneurysms often report symptoms of anxiety and depression. There are few trials studying the quality of life after treatment of unruptured intracranial aneurysms. We aimed to compare the quality of life and symptoms of anxiety or depression after endovascular coiling or open surgery clipping of unruptured intracranial aneurysms, in patients with no prior subarachnoid haemorrhage. Method. 73 living patients were included. 44 had undergone open surgery clipping and 31 had undergone endovascular coiling within the last 5.5 years. We registered a number of parameters from medical records and the patients' current quality of life was assessed by a questionnaire. 63 of 73 (86.3%) returned our questionnaire, which included the Norwegian version of SF-36 and the Hospital Anxiety and Depression Scale (HAD). Findings. Many patients treated for unruptured intracranial aneurysms have a relatively low quality of life. The low scores indicate that the patients experience limitations in their ability to work or accomplish desired activities due to perceived physical or mental handicaps. There were no significant differences between the open surgery group and the endovascular group when comparing quality of life parameters after treatment. A subgroup analysis of patients with a favourable functional outcome also showed reduced quality of life without any differences in the two treatment groups. There were no signs of improvement in quality of life over time. Conclusion. Quality of life after treatment does not seem to be a strong argument for choosing one modality of treatment over the other in patients with unruptured intracranial aneurysms. There are no significant differences in the quality of life of patients successfully treated using endovascular technique and patients who underwent craniotomy and clipping. We speculate that the low quality of life scores are due to factors unrelated to the aneurysms. The scores possibly reflect characteristics of a patient group where incidental aneurysms are more frequently diagnosed while undergoing extensive imaging procedures due to unrelated symptoms.