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You W, Wu Y, Zheng H, Huang Y, Chen H, Wang W, Wang J. Analysis of Influencing Factors of Anxiety and Depression in Patients with Intracranial Dural Arteriovenous Fistulas before Endovascular Treatment: A Retrospective Study. Ann Indian Acad Neurol 2023; 26:927-935. [PMID: 38229640 PMCID: PMC10789434 DOI: 10.4103/aian.aian_744_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 01/18/2024] Open
Abstract
Background Typical treatment of dural arteriovenous fistula (DAVF) emphasizes clinical procedures such as surgery, radiotherapy, and endovascular treatment. However, external factors of adverse psychological emotions in patients with DAVF before treatment have not yet been evaluated in a multicenter study. Objectives This study aimed to fill the research gap regarding the effects of factors by evaluating the anxiety and depression status among patients with DAVF before and after endovascular treatment and identify factors influencing the development of anxiety and depression before their endovascular treatment. Methods This retrospective study included 168 DAVF patients treated at two independent neurosurgical medical centers from December 2012 to December 2022. The Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) were assessed before and after endovascular treatment. Demographic and clinical data were also collected. Statistical tests were performed to calculate the proportion of DAVF patients with anxiety and depression. A multivariate analysis was conducted to identify independent risk factors for anxiety and depression in patients with DAVF before endovascular treatment. Results A significant decrease in the percentage of patients with anxiety and depression was observed in patients after endovascular treatment compared with before treatment. Patients with DAVF who were at a higher risk for anxiety and depression were females had multiple visits, comorbid conditions, and a lower economic status and were presented with symptoms. Conclusion After endovascular treatment, the anxiety or depression symptoms of DAVF patients significantly improved. Our findings provide additional evidence to support the role of intravascular treatment in improved DAVF patients' psychological outcomes.
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Affiliation(s)
- Wei You
- Department of Neurosurgery, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Yiting Wu
- Department of Neurosurgery, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Hanlin Zheng
- Department of Neurosurgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Yan Huang
- Department of Neurosurgery, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Haiping Chen
- Department of Neurosurgery, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Weiwei Wang
- Department of Neurosurgery, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
| | - Jingfu Wang
- Department of Neurosurgery, Zhangzhou Municipal Hospital of Fujian Province and Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, China
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Wipplinger C, Wipplinger TM, Griessenauer CJ. Commentary: The Importance of the Temporary Clip Removal Phase on Exposure to Hypoxia: On-Line Measurement of Temporal Lobe Oxygen Levels During Surgery for Middle Cerebral Artery Aneurysms. Neurosurgery 2022; 90:e118-e120. [PMID: 35199653 DOI: 10.1227/neu.0000000000001888] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Tamara M Wipplinger
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, New York, USA
| | - Christoph J Griessenauer
- Department of Neurosurgery, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria.,Research Institute of Neurointervention, Paracelsus Medical University, Salzburg, Austria
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A meta-analysis on the prevalence of anxiety and depression in patients with unruptured intracranial aneurysms: exposing critical treatment gaps. Neurosurg Rev 2022; 45:2077-2085. [PMID: 35290550 DOI: 10.1007/s10143-022-01768-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/02/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
Unruptured intracranial aneurysms (UIAs) are a significant cause of anxiety and depression. Though the annual rupture rate is relatively low, ensuing mortality and morbidity may be high. Most published studies have focused on functional outcomes; however, limited studies have explored and reported on psychiatric outcomes, which are equally important. We aimed to review existing data on anxiety and depression in patients with UIAs. We systematically searched the databases of Pubmed, Cochrane, Scopus, EBSCOHOST, and ClinicalTrials.gov for studies that reported on anxiety and depression in patients with UIAs. Where available, we also reported data on aneurysm characteristics, treatment modalities, and functional outcomes of these populations. We performed a meta-analysis of proportions by random-effects modeling to compute the prevalence of anxiety and depression in patients with UIAs. Eighteen studies reporting a total of 1413 patients with UIAs were included in the systematic review. The mean age was 57.8 (range 27-79); 64% of whom were female. Random-effect modeling analysis showed an overall estimated prevalence of 28% [95% CI: 0.17-0.42] for anxiety and 21% [95% CI: 0.13-0.33] for depression among patients with UIAs. No significant difference was found in the prevalence of these conditions between treated vs untreated aneurysms. Our review highlights the heterogeneity of data from existing studies and the lack of standardized methodologies in determining psychiatric outcomes in patients with UIAs. It was also limited by the small sample sizes and patient counseling bias in the included studies. Larger, well-designed epidemiologic studies on patients with UIA should include more representative samples, assess for predictors of psychological outcomes, and explore the most optimal psychiatric assessment tools.
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Clarke RE, Jelen MB, Jones B, Toma AK, Pandit AS. Letter: "How to Defuse a Ticking Time Bomb?" Considering Psychosocial Factors in Patients With Small Unruptured Intracranial Aneurysms. Neurosurgery 2022; 90:e45-e46. [PMID: 34995243 DOI: 10.1227/neu.0000000000001764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Maria B Jelen
- Department of Psychology and Language Sciences, University College London, London, UK
| | - Bethany Jones
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Ahmed K Toma
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
| | - Anand S Pandit
- Victor Horsley Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK
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Dandurand C, Zhou L, Fitzmaurice G, Prakash S, Redekop G, Haw C, Gooderham P. Quality of life scores in patients with unruptured cerebral aneurysm: Prospective cohort study. J Clin Neurosci 2021; 91:350-353. [PMID: 34373051 DOI: 10.1016/j.jocn.2021.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/15/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Living with the diagnosis of an unruptured cerebral aneurysm can understandably cause distress to a patient. The goal of preventive treatment is to increase the number of years with good quality of life (QoL). OBJECTIVE This study aimed to measure the effect of unruptured intracranial aneurysm treatment on change in QoL scores measured by the SF36 and EQ-5D-5L. METHODS We prospectively collected SF36 and EQ-5D-5L survey data for patients with unruptured intracranial aneurysms at two time-points over 1 year between 2 treatment groups: observation and intervention (microsurgical and endovascular). Multivariable linear regression was used to examine treatment group differences in the mean change in scores from baseline to 1 year when adjusted for covariates. RESULTS 92 patients were included in the observation group and 68 patients were included in the intervention group, for a total of 160 patients. The intervention group had lower SF36 total scores at baseline (p = 0.001). With multivariate linear regression models, the effect of treatment on mean change in SF36 total score from baseline to 1 year was not statistically significant (p = 0.4); similarly, there was no difference in mean change in EQ-5D-5L. CONCLUSION In this large prospective study, preventive aneurysm treatment was not associated with a significant change in QoL score at 1 year compared to observation as measured by the SF36 and EQ-5D-5L. Further studies are needed to explore the lower QoL scores in patients seeking treatment and its impact on management decision making.
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Affiliation(s)
- Charlotte Dandurand
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada; T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Lily Zhou
- T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; UBC, Faculty of Medicine, Division of Neurology, Vancouver, Canada
| | - Garrett Fitzmaurice
- T.H. Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Swetha Prakash
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada.
| | - Gary Redekop
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada
| | - Charles Haw
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada
| | - Peter Gooderham
- UBC, Faculty of Medicine, Division of Neurosurgery, Vancouver, Canada
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Cognitive behavioral therapy reduces illness perceptions and anxiety symptoms in patients with unruptured intracranial aneurysm. J Clin Neurosci 2020; 80:56-62. [PMID: 33099367 DOI: 10.1016/j.jocn.2020.07.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 11/23/2022]
Abstract
The main purpose of this study was to assess the relation between cognitive behavioral therapy and possible changes in illness perceptions and anxiety in patients diagnosed with unruptured intracranial aneurysm. An observational study of an intervention with 67 patients with an unruptured intracranial aneurysm from two medical centers in a Colombian city (n = 35 on the intervention group) was carried out. To assess changes, measurements were taken at baseline and at one-year follow-up with the Beck Anxiety Inventory and the Illness Perception Questionnaire, brief version, taking into account the importance of perceptions in the process of adjusting to illness and acquiring healthy life habits. Hypotheses were tested by a structural model. The results obtained from this study showed that illness perceptions were related to anxiety levels at both time points; however, the relations were stronger before cognitive behavioral therapy (βt0 = 0.61, p < 0.01; βt1 = 0.37, p < 0.01). Cognitive behavioral therapy was found to be a moderator of changes in both illness perceptions and anxiety at the time of follow-up (β = -0.31, p < 0.01; β = -0.26, p < 0.01). The structural model suggests that cognitive behavioral therapy is associated with less anxiety (β = -0.17, p < 0.05) and better illness perceptions (β = -0.35, p < 0.01) in patients diagnosed with unruptured intracranial aneurysms.
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Personality and anxiety are related to health-related quality of life in unruptured intracranial aneurysm patients selected for non-intervention: A cross sectional study. PLoS One 2020; 15:e0229795. [PMID: 32163437 PMCID: PMC7067413 DOI: 10.1371/journal.pone.0229795] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/14/2020] [Indexed: 01/19/2023] Open
Abstract
Background Personality traits and mental health problems have been previously reported in unruptured intracranial aneurysm (UIA) patients; however, few studies have clarified the relations between these variables and health-related quality of life (HRQoL). This study was designed to characterize the personality traits, HRQoL and mental health of patients with UIA and to evaluate whether personality has an influence on HRQoL and whether this is mediated by the patients' emotional symptoms. Methods Sixty-three patients with UIAs (mean age 62.6 years, 83.9% women) answered questionnaires for depression, anxiety, HRQoL and personality traits between June 2016 and May 2019. Results Eight percent of the sample had depression, and 27.4% had anxiety. Participants showed high levels of responsibility, kindness and neuroticism and low levels of extraversion and openness. HRQoL scores were normal compared with the Colombian population. Structural equation analysis showed that patients' HRQoL was negatively affected by anxiety levels and that the latter are associated with the patient's personality, where neuroticism is directly associated with symptomatology and inversely associated with extraversion. Conclusions The results of this study showed the importance of personality and emotional symptoms in the HRQoL of UIA patients. These results are important for developing strategies for psychological counseling in patients with UIAs.
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Rinaldo L, Johnson DM, Vine RL, Rabinstein AA, Lanzino G. Differences between patient- and professional-reported modified Rankin Scale score in patients with unruptured aneurysms. J Neurosurg 2019; 131:397-402. [PMID: 30095335 DOI: 10.3171/2018.3.jns18247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Clinical trials forming the basis of current guidelines for the management of intracranial aneurysms have relied on patient-reported modified Rankin Scale (mRS) scores to assess functional outcome. The effect of patient demographics on perception of disability and, by extension, patient-reported mRS score, is not well understood. METHODS A consecutive series of patients with a previously treated or untreated unruptured intracranial aneurysm (UIA) prospectively underwent a structured interview with a trained nurse. At the conclusion of this interview, the patients were assigned an mRS score in accordance with their degree of disability. During the same visit, patients were also required to grade themselves on a paper sheet containing the mRS and corresponding information. Data on patient and aneurysm characteristics were also collected during the same visit. Agreement between patient- and nurse-reported mRS scores was assessed using Cohen's kappa coefficient. The effect of patient demographics on the frequency of higher patient- than nurse-reported mRS scores was assessed using the Pearson's chi-square and Fisher's exact tests. RESULTS A total of 209 patients with a UIA were included in the study, 38 of whom (18.2%) had undergone previous treatment. The majority of patients were female (161/209, 77.0%), and the mean age of the cohort was 60.2 years (SD 13.7 years). Agreement between patient- and nurse-reported mRS scores occurred in 72.7% of cases (95% CI 66.3%-78.3%), with a kappa coefficient of 0.58 (95% CI 0.49-0.67). Patients younger than 75 years were more likely to report a higher mRS score than the nurse (19.4% vs 3.4%, p = 0.034). Among female patients, those without a college degree were more likely to report a higher mRS score than the nurse (22.5% vs 9.5%, p = 0.035). CONCLUSIONS The results suggest that patient demographics may influence perception of disability. These findings should be considered when using patient-reported mRS scores to determine functional outcome.
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Hedderich DM, Reess TJ, Thaler M, Berndt MT, Moench S, Lehm M, Andrisan T, Maegerlein C, Meyer B, Ryang YM, Zimmer C, Wostrack M, Friedrich B. Hippocampus subfield volumetry after microsurgical or endovascular treatment of intracranial aneurysms-an explorative study. Eur Radiol Exp 2019; 3:13. [PMID: 30900111 PMCID: PMC6428873 DOI: 10.1186/s41747-019-0092-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 02/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To study hippocampus subfield volumes in patients after microsurgical clipping (MC) and/or endovascular coiling (EC) of intracranial aneurysms. METHODS Hippocampus subfield volumetry was performed using FreeSurfer v6.0 in 51 patients (35 females, mean age 54.9 ± 11.9 years, range 24-78 years). Visual inspection of image and segmentation quality was performed prior to statistical analyses. Multiple regression analysis, controlled for age, sex, and side of treatment, was used to assess the impact of prior MC and history of subarachnoid haemorrhage (SAH) on hippocampus subfield volumes (cornu ammonis (CA)-2/3, CA-4, subiculum). Partial correlation analyses were used to assess effect of multiple treatments on hippocampus subfield volumes. RESULTS Prior MC was significantly associated with lower hippocampal subfield volumes in MC patients for right and left CA-2/3 (β = -22.32 [-40.18, -4.45]; p = 0.016 and β = -20.03 [-39.38, -0.68]; p = 0.043) and right CA-4 (β = -17.00 [-33.86, 0.12]; p = 0.048). History of SAH was not significantly associated with hippocampal subfield volumes. We observed a higher disease burden in the MC cohort. The number of aneurysms correlated with right-sided hippocampal subfield volumes while the number of treatment interventions did not. CONCLUSION In this explorative study, we found that history of MC was significantly associated with lower volumes in distinct hippocampal subfields, which may be a consequence of a more extensive treatment. This could indicate specific atrophy of CA-2/3 after MC and should motivate hippocampal subfield assessment in larger cohorts.
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Affiliation(s)
- Dennis M Hedderich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.
| | - Tim J Reess
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, Technical University of Munich, Munich, Germany
| | - Matthias Thaler
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maria T Berndt
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Sebastian Moench
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Manuel Lehm
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Tiberiu Andrisan
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Maegerlein
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maria Wostrack
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Benjamin Friedrich
- Department of Diagnostic and Interventional Neuroradiology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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Huang J, Zeng C, Xiao J, Zhao D, Tang H, Wu H, Chen J. Association between depression and brain tumor: a systematic review and meta-analysis. Oncotarget 2017; 8:94932-94943. [PMID: 29212279 PMCID: PMC5706925 DOI: 10.18632/oncotarget.19843] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/04/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Patients with brain tumor are in risk of depression or depressive symptoms, but the estimated prevalence varies between studies. The aim of this study is to get a proper summarized estimate of depression prevalence in brain tumor patients. METHODS Literature search on Pubmed, PsycINFO, and Cochrane library from January 1981 through October 2016. The prevalence of depression or depressive symptoms in brain tumor patients was estimated by screening scales and analyzed using stratified meta-analysis and subgroup analysis. The prevalence of depression level or symptoms during the follow-up periods was detected by secondary analysis. RESULTS Among the 37 studies included in this meta-analysis, 25 used a cross-sectional design and 12 used longitudinal study. The pooled prevalence was 21.7% (971/4518 individuals, 95 % confidence interval (CI) 18.2%-25.2%) for overall sample. Lower prevalence was detected in studies with sample size ≥100 than <100, lower grade tumor than high grade tumor, studies using clinician-rated depression scales than self-rated or non-depression-specific ones, and in patients from UK, Germany and Italy than USA. After analyzing 6 longitudinal studies, prevalence of depression remained no change in the follow-up periods. No significant differences were observed between study designs and tumor types. CONCLUSIONS The estimated prevalence of depression or depressive symptoms among brain tumor patients was 21.7%, affected by depression assessment type, sample size, tumor grade and country. Diagnosis and treatment of co-morbid depression in brain tumor patients need to be addressed in future studies for better life quality and oncology management.
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Affiliation(s)
- Jing Huang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Chao Zeng
- Department of Thoracic Surgery, Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Juxiong Xiao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Danwei Zhao
- Xiangya Medical School, Central South University, Changsha, Hunan, China
| | - Hui Tang
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Haishan Wu
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
| | - Jindong Chen
- Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Mental Health Institute of The Second Xiangya Hospital, Central South University, Chinese National Clinical Research Center on Mental Disorders (Xiangya), Chinese National Technology Institute on Mental Disorders, Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan, China
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Bründl E, Böhm C, Lürding R, Schödel P, Bele S, Hochreiter A, Scheitzach J, Zeman F, Brawanski A, Schebesch KM. Treatment of Unruptured Intracranial Aneurysms and Cognitive Performance: Preliminary Results of a Prospective Clinical Trial. World Neurosurg 2016; 94:145-156. [PMID: 27392894 DOI: 10.1016/j.wneu.2016.06.112] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 06/26/2016] [Accepted: 06/27/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND Few studies have addressed the effect of treatment of unruptured intracranial aneurysm (UIA) on cognitive function. OBJECTIVE Neuropsychological assessment after UIA treatment is underreported, and prospective trials have repeatedly been demanded. In 2014, we conducted a prospective controlled study to evaluate the differences in cognitive processing caused by the treatment of anterior circulation UIAs. PATIENTS AND METHODS Thirty patients were enrolled until September 2015. Ten patients received endovascular aneurysm occlusion (EV), 10 patients were treated microsurgically (MS), and 10 patients with surgically treated degenerative lumbar spine disease (LD) served as control. All patients underwent extended standardized neuropsychological assessment before (t1) and 6 weeks after treatment (t2). Tests included verbal, visual, and visuospatial memory, psychomotor functioning, executive functioning, and its subdomains verbal fluency and cognitive flexibility. We statistically evaluated intragroup and intergroup changes. RESULTS Intragroup comparisons and group-rate analysis showed no significant impairment in overall neuropsychological performance, either postinterventionally or postoperatively. However, the postoperative performance in cognitive processing speed, cognitive flexibility, and executive functioning was significantly worse in the MS group than in the EV (P = 0.038) and LD group (P = 0.02). Compared with the EV group, patients with MS showed significant postoperative impairment in a subtest for auditory-verbal memory (Wechsler Memory Scale, Fourth Edition, Logical Memory II; MS vs. EV P = 0.011). The MS group trended toward posttreatment impairment in subtests for verbal fluency and semantic memory (Regensburg Word Fluency Test; MS vs. EV P = 0.083) and in auditory-verbal memory (Wechsler Memory Scale, Fourth Edition, Logical Memory II; MS vs. LD P = 0.06). CONCLUSIONS Our preliminary data showed no effect of anterior circulation UIA treatment on overall neuropsychological function but impaired short-term executive processing in surgically treated patients.
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Affiliation(s)
- Elisabeth Bründl
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany.
| | - Christina Böhm
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Ralf Lürding
- Department of Neurology, University Medical Center Regensburg, Regensburg, Germany
| | - Petra Schödel
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Sylvia Bele
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Andreas Hochreiter
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Judith Scheitzach
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center Regensburg, Regensburg, Germany
| | - Alexander Brawanski
- Department of Neurosurgery, University Medical Center Regensburg, Regensburg, Germany
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Wenz H, Wenz R, Maros ME, Groden C, Schmieder K, Fontana J. The neglected need for psychological intervention in patients suffering from incidentally discovered intracranial aneurysms. Clin Neurol Neurosurg 2016; 143:65-70. [DOI: 10.1016/j.clineuro.2016.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/08/2016] [Accepted: 02/10/2016] [Indexed: 10/22/2022]
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Fontana J, Wenz R, Groden C, Schmieder K, Wenz H. The Preinterventional Psychiatric History as a Major Predictor for a Reduced Quality of Life After Treatment of Unruptured Intracranial Aneurysms. World Neurosurg 2015; 84:1215-22. [DOI: 10.1016/j.wneu.2015.06.047] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 11/25/2022]
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