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Wu J, Sun H, Ma J. Causal association between depression and intracranial aneurysms: a bidirectional two-sample Mendelian randomization study. Front Neurol 2024; 15:1346703. [PMID: 38419712 PMCID: PMC10899323 DOI: 10.3389/fneur.2024.1346703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/02/2024] [Indexed: 03/02/2024] Open
Abstract
Background Although observational studies have suggested a bidirectional relation between depression and intracranial aneurysms (IAs), their causal relations remain unclear. Thus we aimed to assess the causal association between depression and IAs. Methods We conducted a bidirectional two-sample Mendelian randomization (MR) study using summary-level data from publicly available genome-wide association studies of depression (n = 500,199), IAs (n = 79,429), unruptured intracranial aneurysm (uIA) (n = 74,004), and subarachnoid hemorrhage (SAH) (n = 77,074). MR analyses included the inverse-variance weighted (IVW) method as the primary analytic, plus weighted-median, simple mode, weighted mode, MR-Egger, and MR PRESSO. Results Genetically predicted depression was strongly positively related to IAs (odds ratio [OR] = 1.69, 95% confidence interval [CI] 1.19-2.39, p = 0.003), uIA (OR = 1.96, 95% CI 1.06-3.64, p = 0.032), and SAH (OR = 1.73, 95% CI 1.14-2.61, p = 0.009). Reverse MR analyses showed that while genetically predicted uIA was positively related to depression (OR = 1.02, 95% CI 1.00-1.05, p = 0.044), no causal relations were observed for either IAs or SAH for depression. Conclusion Our findings provide evidence of a causal effect of depression on IAs, uIA, and SAH. For the reverse MR analyses, we found a causal impact of uIA on depression, but no causal influence of either IAs or SAH for depression.
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Affiliation(s)
- Jujiang Wu
- Neurointensive Care Unit, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Hao Sun
- Neurointensive Care Unit, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
| | - Junqiang Ma
- Neurointensive Care Unit, The First Affiliated Hospital of Shantou University Medical College, Shantou, China
- Department of Population Medicine, Shantou University Medical College, Shantou, China
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Yoshiura T, Takeuchi S, Toyooka T, Tomiyama A, Wada K, Nakao Y, Yamamoto T, Mori K. Effectiveness of Keyhole Clipping of Unruptured Intracranial Aneurysms Detected by "Brain Dock" in Healthy Japanese Adults. Neurol Med Chir (Tokyo) 2024; 64:28-35. [PMID: 37940568 PMCID: PMC10835578 DOI: 10.2176/jns-nmc.2023-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
In Japan, brain docking has enhanced the detection of unruptured intracranial aneurysms in healthy adults. At our institution, surgical clipping is the first-line treatment for unruptured intracranial aneurysms (UIA). In this study, the differences in neurological and radiological outcomes, as well as cognitive and psychological results, between standard clipping and keyhole clipping for these aneurysms detected via brain docking were evaluated. The study included 131 aneurysms detected via "brain dock." Of these, 65 were treated with keyhole clipping surgery (keyhole clipping group), and 66 were treated with standard clipping surgery (standard clipping group). Evaluations at 3 months included the National Institutes of Health Stroke Scale, modified Rankin Scale, Mini-Mental State Examination, Hasegawa's Dementia Scale-revised, Beck Depression Inventory, Hamilton Rating Scale for Depression, and radiological abnormalities. The mean operative time and postoperative hospitalization period were significantly shorter in the keyhole clipping group than in the standard clipping group (p < 0.001). Between the groups, no significant differences in postoperative neurological complications or radiological abnormalities were found. The keyhole clipping group demonstrated slightly but significantly better Beck Depression Inventory and Hamilton Rating Scale for Depression scores than the standard clipping group (Beck Depression Inventory, p = 0.046; Hamilton Rating Scale for Depression, p < 0.01). Both the Beck Depression Inventory and Hamilton Rating Scale for Depression scores at 3 months were significantly enhanced (p < 0.001) in the keyhole clipping group. These findings propose that keyhole clipping could be considered a new therapeutic option for small UIA detected via brain docking.
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Affiliation(s)
- Toru Yoshiura
- Department of Neurosurgery, National Defense Medical College
| | - Satoru Takeuchi
- Department of Neurosurgery, National Defense Medical College
| | | | - Arata Tomiyama
- Department of Neurosurgery, National Defense Medical College
| | - Kojiro Wada
- Department of Neurosurgery, National Defense Medical College
| | - Yasuaki Nakao
- Department of Neurosurgery, Juntendo University, Shizuoka Hospital
| | - Takuji Yamamoto
- Department of Neurosurgery, Juntendo University, Shizuoka Hospital
| | - Kentaro Mori
- Department of Neurosurgery, Tokyo General Hospital
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Li J, Tan Z, Yi X, Fu Y, Zhu L, Zeng F, Han Z, Ren Z, Zhang Y, Chen BT. Association of brain morphology and phenotypic profile in patients with unruptured intracranial aneurysm. Front Aging Neurosci 2023; 15:1202699. [PMID: 37434739 PMCID: PMC10330710 DOI: 10.3389/fnagi.2023.1202699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023] Open
Abstract
Introduction Studies have found a varying degree of cognitive, psychosocial, and functional impairments in patients with unruptured intracranial aneurysms (UIAs), whereas the neural correlates underlying these impairments remain unknown. Methods To examine the brain morphological alterations and white matter lesions in patients with UIA, we performed a range of structural analyses to examine the brain morphological alterations in patients with UIA compared with healthy controls (HCs). Twenty-one patients with UIA and 23 HCs were prospectively enrolled into this study. Study assessment consisted of a brain magnetic resonance imaging (MRI) scan with high-resolution T1-weighted and T2-weighted imaging data, a Montreal Cognitive Assessment (MoCA), and laboratory tests including blood inflammatory markers and serum lipids. Brain MRI data were processed for cortical thickness, local gyrification index (LGI), volume and shape of subcortical nuclei, and white matter lesions. Results Compared to the HCs, patients with UIA showed no significant differences in cortical thickness but decreased LGI values in the right posterior cingulate cortex, retrosplenial cortex, cuneus, and lingual gyrus. In addition, decreased LGI values correlated with decreased MoCA score (r = 0.498, p = 0.021) and increased white matter lesion scores (r = -0.497, p = 0.022). The LGI values were correlated with laboratory values such as inflammatory markers and serum lipids. Patients with UIA also showed significant regional atrophy in bilateral thalami as compared to the HCs. Moreover, the LGI values were significantly correlated with thalamic volume in the HCs (r = 0.4728, p = 0.0227) but not in the patients with UIA (r = 0.11, p = 0.6350). Discussion The decreased cortical gyrification, increased white matter lesions, and regional thalamic atrophy in patients with UIA might be potential neural correlates of cognitive changes in UIA.
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Affiliation(s)
- Jianyu Li
- Yangtze Delta Region Institute, University of Electronic Science and Technology of China, Huzhou, China
- School of Life Sciences and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Zeming Tan
- Department of Neurosurgery, Xiangya Hospital Central South University, Changsha, China
| | - Xiaoping Yi
- Department of Radiology, Xiangya Hospital Central South University, Changsha, China
- Hunan Key Laboratory of Skin Cancer and Psoriasis, Xiangya Hospital Central South University, Changsha, China
- Hunan Engineering Research Center of Skin Health and Disease, Xiangya Hospital Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, China
| | - Yan Fu
- Department of Radiology, Xiangya Hospital Central South University, Changsha, China
| | - Liping Zhu
- Department of Radiology, Xiangya Hospital Central South University, Changsha, China
| | - Feiyue Zeng
- Department of Radiology, Xiangya Hospital Central South University, Changsha, China
| | - Zaide Han
- Department of Radiology, Xiangya Hospital Central South University, Changsha, China
| | - Zhanbing Ren
- Department of Physical Education, Shenzhen University, Shenzhen, China
| | - Yuanchao Zhang
- Yangtze Delta Region Institute, University of Electronic Science and Technology of China, Huzhou, China
- School of Life Sciences and Technology, University of Electronic Science and Technology of China, Chengdu, China
| | - Bihong T. Chen
- Department of Diagnostic Radiology, City of Hope National Medical Center, Duarte, CA, United States
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Algra AM, Greving JP, Wermer MJH, van Walderveen MAA, van der Schaaf IC, van der Zwan A, Visser-Meily JMA, Rinkel GJE, Vergouwen MDI. Quality of Life Outcomes Over Time in Patients With Unruptured Intracranial Aneurysms With and Without Preventive Occlusion: A Prospective Cohort Study. Neurology 2022; 99:e1715-e1724. [PMID: 35790419 DOI: 10.1212/wnl.0000000000200831] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 04/22/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES In counseling patients with an unruptured intracranial aneurysm (UIA), quality of life (QoL) outcomes are important for informed decision making. We evaluated QoL outcomes in patients with and without preventive aneurysm occlusion at multiple time points during the first year after UIA diagnosis and studied predictors of QoL outcomes. METHODS We performed a prospective cohort study in patients aged ≥18 years with a newly diagnosed UIA in 2 tertiary referral centers in the Netherlands between 2017 and 2019. Patients were sent QoL questionnaires at 7 (aneurysm occlusion) or 5 (no occlusion) moments during the first year after diagnosis. We collected baseline data on patient and aneurysm characteristics, passive coping style (Utrecht Coping List), occlusion modality, and neurologic complications. We assessed health-related QoL (HRQoL) with the EuroQol 5 dimensions (EQ-5D), emotional functioning with the Hospital Anxiety and Depression Scale (HADS), and restrictions in daily activities with the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-P). We used a linear mixed-effects model to assess the course of QoL over time and to explore predictors of QoL outcomes. RESULTS Of 153 eligible patients, 99 (65%) participated, of whom 30/99 (30%) underwent preventive occlusion. Patients undergoing occlusion reported higher baseline levels of passive coping, anxiety and depression, and restrictions than patients without occlusion. During recovery after occlusion, patients reported more restrictions compared with baseline (adjusted USER-P decrease 1 month post occlusion: -12.8 [95% CI -23.8 to -1.9]). HRQoL and emotional functioning gradually improved after occlusion (EQ-5D increase at 1 year: 8.6 [95% CI 0.1-17.0] and HADS decrease at 1 year: -5.4 [95% CI -9.4 to -1.5]). In patients without occlusion, the largest HRQoL improvement occurred directly after visiting the outpatient aneurysm clinic (EQ-5D increase: 9.2 [95% CI 5.5-12.8]). At 1 year, QoL outcomes were comparable in patients with and without occlusion. Factors associated with worse QoL outcomes were a passive coping style in all patients, complications in patients with occlusion, and higher rupture risks in patients without occlusion. DISCUSSION After UIA diagnosis, QoL improves gradually after preventive occlusion and directly after counseling at the outpatient clinic in patients without occlusion, resulting in comparable 1-year QoL outcomes. A passive coping style is an important predictor of poor QoL outcomes in all patients with UIA.
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Affiliation(s)
- Annemijn M Algra
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Jacoba P Greving
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Marieke J H Wermer
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Marianne A A van Walderveen
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Irene C van der Schaaf
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Albert van der Zwan
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Johanna M A Visser-Meily
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Gabriël J E Rinkel
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Mervyn D I Vergouwen
- From the Department of Neurology and Neurosurgery (A.M.A., A.Z., G.J.E.R., M.D.I.V.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; Julius Center for Health Sciences and Primary Care (J.P.G.), University Medical Center Utrecht, Utrecht University; Department of Neurology (M.J.H.W.), Leiden University Medical Center, Leiden University; Department of Radiology (M.A.A.W.), Leiden University Medical Center, Leiden University; Department of Radiology (I.C.S.), UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University; and Department of Rehabilitation (J.V.-M.), Physical Therapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, the Netherlands
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Park HY, Suh CH, Shim WH, Heo H, Kim WS, Lim JS, Lee JH, Kim HS, Kim SJ. Diagnostic yield of TOF-MRA for detecting incidental vascular lesions in patients with cognitive impairment: An observational cohort study. Front Neurol 2022; 13:958037. [PMID: 36090850 PMCID: PMC9453548 DOI: 10.3389/fneur.2022.958037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives The role of three-dimensional (3D) TOF-MRA in patients with cognitive impairment is not well established. We evaluated the diagnostic yield of 3D TOF-MRA for detecting incidental extra- or intracranial artery stenosis and intracranial aneurysm in this patient group. Methods This retrospective study included patients with cognitive impairment undergoing our brain MRI protocol from January 2013 to February 2020. The diagnostic yield of TOF-MRA for detecting incidental vascular lesions was calculated. Patients with positive TOF-MRA results were reviewed to find whether additional treatment was performed. Logistic regression analysis was conducted to identify the clinical risk factors for positive TOF-MRA findings. Results In total, 1,753 patients (mean age, 70.2 ± 10.6 years; 1,044 women) were included; 199 intracranial aneurysms were detected among 162 patients (9.2%, 162/1,753). A 3D TOF-MRA revealed significant artery stenoses (>50% stenosis) in 162 patients (9.2%, 162/1,753). The overall diagnostic yield of TOF-MRA was 16.8% (294/1,753). Among them, 92 patients (31.3%, 92/294) underwent either medical therapy, endovascular intervention, or surgery. In total, eighty-one patients with stenosis were prescribed with either antiplatelet medications or lipid-lowering agent. In total, fifteen patients (aneurysm: 11 patients, stenosis: 4 patients) were further treated with endovascular intervention or surgery. Thus, the “number needed to scan” was 19 for identifying one patient requiring treatment. Multivariate logistic regression analysis showed that being female (odds ratio [OR] 2.05) and old age (OR 1.04) were the independent risk factors for intracranial aneurysm; being male (OR 1.52), old age (OR 1.06), hypertension (OR 1.78), and ischemic heart disease history (OR 2.65) were the independent risk factors for significant artery stenosis. Conclusions Our study demonstrated the potential benefit of 3D TOF-MRA, given that it showed high diagnostic yield for detecting vascular lesions in patients with cognitive impairment and the considerable number of these lesions required further treatment. A 3D TOF-MRA may be included in the routine MR protocol for the work-up of this patient population, especially in older patients and patients with vascular risk factors.
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Affiliation(s)
- Ho Young Park
- Department of Radiology and Research, Asan Medical Center, Institute of Radiology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Chong Hyun Suh
- Department of Radiology and Research, Asan Medical Center, Institute of Radiology, University of Ulsan College of Medicine, Seoul, South Korea
- *Correspondence: Chong Hyun Suh
| | - Woo Hyun Shim
- Department of Radiology and Research, Asan Medical Center, Institute of Radiology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hwon Heo
- Department of Radiology and Research, Asan Medical Center, Institute of Radiology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Woo Seok Kim
- Department of Radiology and Research, Asan Medical Center, Institute of Radiology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae-Sung Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Jae-Hong Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Sung Kim
- Department of Radiology and Research, Asan Medical Center, Institute of Radiology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang Joon Kim
- Department of Radiology and Research, Asan Medical Center, Institute of Radiology, University of Ulsan College of Medicine, Seoul, South Korea
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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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7
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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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Wagner K, Srivatsan A, Mohanty A, Srinivasan VM, Saleem Y, Cherian J, James RF, Chen S, Burkhardt JK, Johnson J, Kan P. Cognitive outcomes after unruptured intracranial aneurysm treatment with flow diversion. J Neurosurg 2021; 134:33-38. [PMID: 31783369 DOI: 10.3171/2019.9.jns191910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 09/16/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Flow diversion is increasingly used to treat a variety of intracranial aneurysms with good safety and efficacy; however, there is some evidence that this treatment is associated with a larger postoperative ischemic burden on imaging than that with other traditional endovascular modalities. These findings typically do not manifest as neurological deficits, but any subtle effects on cognition remain unknown. In this study, the authors describe the neurocognitive performance of a cohort of patients with unruptured intracranial aneurysms (UIAs) before and after treatment with flow diversion. This is the first report of cognitive outcomes following aneurysm treatment with flow diversion. METHODS The authors prospectively collected data on cognitive function using the Montreal Cognitive Assessment (MoCA) tool in patients with UIAs who were undergoing endovascular aneurysm treatment with flow diversion between June 2017 and July 2019. Patients completed the MoCA prior to intervention, at the 1-month follow-up after treatment, and again at 6 months after the procedure. All patients with UIAs treated with flow diversion were included regardless of age, aneurysm location, or morphology, unless their functional status precluded completion of the MoCA instrument. A repeated-measures linear mixed-effects model was used to compare preintervention and postintervention cognitive status at the time intervals outlined. RESULTS Fifty-one patients with 61 aneurysms underwent endovascular aneurysm treatment with flow diversion (mean age 52.5 years, 90.2% females). There was no difference between baseline and postprocedure MoCA scores at any time interval (p > 0.05). The MoCA scores at baseline, 1 month postprocedure, and 6 months postprocedure were 26.1, 26.2, and 26.6, respectively. There was also no difference between pre- and postprocedure scores on any individual domain of the instrument (visuospatial, naming, attention, language, abstraction, delayed recall, and orientation) at any time interval (p > 0.05). Thirty-four patients had follow-up MRI or CT imaging, 5 of whom showed radiographic changes or ischemia. All patients with follow-up clinical evaluation had a 6-month modified Rankin Scale score ≤ 2. CONCLUSIONS Flow diversion is increasingly used in the treatment of intracranial aneurysms. This study suggests that this treatment may not alter neurocognitive function. Larger patient samples and longer follow-ups with other tests of cognitive functions are needed to confirm these findings.
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Affiliation(s)
| | | | | | | | | | - Jacob Cherian
- 4Department of Neurosurgery, Emory University, Atlanta, Georgia; and
| | - Robert F James
- 5Department of Neurosurgery, University of Louisville, Kentucky
| | - Stephen Chen
- 3Radiology, Baylor College of Medicine, Houston, Texas
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Kumon Y, Watanabe H, Tagawa M, Inoue A, Ohnishi T, Kunieda T. Relationship between Deep White Matter Hyperintensities on Magnetic Resonance Imaging and Postoperative Cognitive Function Following Clipping of Unruptured Intracranial Aneurysm. Neurol Med Chir (Tokyo) 2020; 61:152-161. [PMID: 33390419 PMCID: PMC7905299 DOI: 10.2176/nmc.oa.2020-0290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
To evaluate the effects on cognitive function of deep white matter hyperintensities (DWMHs) on magnetic resonance imaging (MRI) in patients treated surgically for unruptured intracranial aneurysms (UIAs). The subjects were 106 patients in whom a Wechsler adult intelligence scale-revised (WAIS-R) examination was performed 1 week before and 1 month after clipping surgery for asymptomatic UIAs. DWMH severity was evaluated on preoperative MR images by Fazekas scale, as follows: none (absence), mild (punctate foci), moderate (beginning confluence of foci), or severe (large confluent areas). A decrease of 7 or more points in intelligence quotient (IQ) postoperatively was considered deterioration. Fazekas score was none in 41 (none group), mild in 42 (mild group), moderate in 21, and severe in 2 patients (moderate/severe group). Patient characteristics, surgical factors, IQ change, and abnormal findings on postoperative MRI were compared among the groups. Although there was no statistically significant deterioration in IQ postoperatively in any group, the percentage of deteriorated patients was significantly higher in the moderate/severe group (34.8%) than in the other groups (4.9% in the none group, 7.1% in the mild group; p <0.01, p <0.05, respectively). Brain injury was observed more frequently on postoperative MR images in the moderate/severe group (17.4%) compared with the none group (2.4%; p = 0.052). The presence of moderate/severe DWMHs was an independent prognostic factor for postoperative cognitive dysfunction. In conclusion, the presence of moderate/severe DWMHs was a prognostic factor for postoperative cognitive dysfunction after surgery for UIAs.
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Affiliation(s)
- Yoshiaki Kumon
- Department of Neurosurgery, Washokai Sadamoto Hospital, Matsuyama, Ehime, Japan
| | - Hideaki Watanabe
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Masahiko Tagawa
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Akihiro Inoue
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
| | - Takanori Ohnishi
- Department of Neurosurgery, Washokai Sadamoto Hospital, Matsuyama, Ehime, Japan
| | - Takeharu Kunieda
- Department of Neurosurgery, Ehime University Graduate School of Medicine, Toon, Ehime, Japan
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10
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Menon G. Outcome Assessment Following Aneurysmal Subarachnoid Hemorrhage - Need for a Comprehensive Tool. Neurol India 2020; 68:108-110. [PMID: 32129257 DOI: 10.4103/0028-3886.279711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal, Karnataka, India
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11
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Real-time neuropsychological testing during endovascular occlusion of a fusiform aneurysm in the left middle cerebral artery. INTERDISCIPLINARY NEUROSURGERY 2019. [DOI: 10.1016/j.inat.2019.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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12
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Anxiety, depression and quality of life in patients with a treated or untreated unruptured intracranial aneurysm. J Clin Neurosci 2017; 45:223-226. [DOI: 10.1016/j.jocn.2017.07.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 04/03/2017] [Accepted: 07/11/2017] [Indexed: 11/21/2022]
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13
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Alotaibi NM, Guha D, Ahuja CS, Spears J, Muller PJ, Tucker WS, Hudson AR, Macdonald RL. History of neurosurgery at University of Toronto: the St. Michael's story. J Neurosurg 2017; 127:1417-1425. [PMID: 28128690 DOI: 10.3171/2016.9.jns161119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In this paper, the authors describe the history of neurosurgery at St. Michael's Hospital, University of Toronto. St. Michael's has long been regarded as one of the top teaching and research hospitals in Canada. A detailed literature review of published and unpublished works was performed to formulate a succinct but in-depth review of its development, successes, and challenges. This fascinating 125-year history serves as a reminder of the importance of their institution's origins, and the authors hope that it will be a useful guide for developing programs around the world.
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Affiliation(s)
- Naif M Alotaibi
- Division of Neurosurgery, Department of Surgery, and.,Institute of Medical Science, University of Toronto; and
| | - Daipayan Guha
- Division of Neurosurgery, Department of Surgery, and.,Institute of Medical Science, University of Toronto; and
| | - Christopher S Ahuja
- Division of Neurosurgery, Department of Surgery, and.,Institute of Medical Science, University of Toronto; and
| | - Julian Spears
- Division of Neurosurgery, Department of Surgery, and
| | - Paul J Muller
- Division of Neurosurgery, Department of Surgery, and
| | | | - Alan R Hudson
- Division of Neurosurgery, Department of Surgery, and
| | - R Loch Macdonald
- Division of Neurosurgery, Department of Surgery, and.,Institute of Medical Science, University of Toronto; and.,Division of Neurosurgery, St. Michael's Hospital, Labatt Family Centre of Excellence in Brain Injury and Trauma Research, Keenan Research Centre for Biomedical Science, and the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Surgery, University of Toronto, Ontario, Canada
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14
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Guan J, Karsy M, Couldwell WT, Schmidt RH, Taussky P, MacDonald JD, Park MS. Factors influencing management of unruptured intracranial aneurysms: an analysis of 424 consecutive patients. J Neurosurg 2016; 127:96-101. [PMID: 27715433 DOI: 10.3171/2016.7.jns16975] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The choice between treating and observing unruptured intracranial aneurysms is often difficult, with little guidance on which variables should influence decision making on a patient-by-patient basis. Here, the authors compared demographic variables, aneurysm-related variables, and comorbidities in patients who received microsurgical or endovascular treatment and those who were conservatively managed to determine which factors push the surgeon toward recommending treatment. METHODS A retrospective chart review was conducted of all patients diagnosed with an unruptured intracranial aneurysm at their institution between January 1, 2013, and January 1, 2016. These patients were dichotomized based on whether their aneurysm was treated. Demographic, geographic, socioeconomic, comorbidity, and aneurysm-related information was analyzed to assess which factors were associated with the decision to treat. RESULTS A total of 424 patients were identified, 163 who were treated surgically or endovascularly and 261 who were managed conservatively. In a multivariable model, an age < 65 years (OR 2.913, 95% CI 1.298-6.541, p = 0.010), a lower Charlson Comorbidity Index (OR 1.536, 95% CI 1.274-1.855, p < 0.001), a larger aneurysm size (OR 1.176, 95% CI 1.100-1.257, p < 0.001), multiple aneurysms (OR 2.093, 95% CI 1.121-3.907, p = 0.020), a white race (OR 2.288, 95% CI 1.245-4.204, p = 0.008), and living further from the medical center (OR 2.125, 95% CI 1.281-3.522, p = 0.003) were all associated with the decision to treat rather than observe. CONCLUSIONS Whereas several factors were expected to be considered in the decision to treat unruptured intracranial aneurysms, including age, Charlson Comorbidity Index, aneurysm size, and multiple aneurysms, other factors such as race and proximity to the medical center were unanticipated. Further studies are needed to identify such biases in patient treatment and improve treatment delineation based on patient-specific aneurysm rupture risk.
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Affiliation(s)
- Jian Guan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Richard H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Joel D MacDonald
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Min S Park
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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15
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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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16
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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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17
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Brinjikji W, Zhu YQ, Lanzino G, Cloft HJ, Murad MH, Wang Z, Kallmes DF. Risk Factors for Growth of Intracranial Aneurysms: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2015; 37:615-20. [PMID: 26611992 DOI: 10.3174/ajnr.a4575] [Citation(s) in RCA: 139] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 07/21/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Understanding risk factors for intracranial aneurysm growth is important for patient management. We performed a meta-analysis examining risk factors for intracranial aneurysm growth in longitudinal studies and examined the association between aneurysm growth and rupture. MATERIALS AND METHODS We searched the literature for longitudinal studies of patients with unruptured aneurysms. We examined the associations of demographics, multiple aneurysms, prior subarachnoid hemorrhage, family history of aneurysm or subarachnoid hemorrhage, smoking, and hypertension; and aneurysm shape, size, and location with aneurysm growth. We studied the association between aneurysm growth and rupture. A meta-analysis was performed by using a random-effects model by using summary statistics from included studies. RESULTS Twenty-one studies including 3954 patients with 4990 aneurysms with 13,294 aneurysm-years of follow-up were included. The overall proportion of growing aneurysms was 3.0% per aneurysm-year (95% CI, 2.0%-4.0%). Patient risk factors for growth included age older than 50 years (3.8% per year versus 0.9% per year, P < .01), female sex (3.2% per year versus 1.3% per year, P < .01), and smoking history (5.5% per year versus 3.5% per year, P < .01). Characteristics associated with higher growth rates included cavernous carotid artery location (14.4% per year), nonsaccular shape (14.7% per year versus 5.2% per year for saccular, P < .01), and aneurysm size (P < .01). Aneurysm growth was associated with a rupture rate of 3.1% per year compared with 0.1% per year for stable aneurysms (P < .01). CONCLUSIONS Observational evidence provided multiple clinical and anatomic risk factors for aneurysm growth, including age older than 50 years, female sex, smoking history, and nonsaccular shape. These findings should be considered when counseling patients regarding the natural history of unruptured intracranial aneurysms.
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Affiliation(s)
- W Brinjikji
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.)
| | - Y-Q Zhu
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.)
| | - G Lanzino
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.)
| | - H J Cloft
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.)
| | - M H Murad
- Center for Science of Healthcare Delivery (M.H.M., Z.W.), Mayo Clinic, Rochester, Minnesota
| | - Z Wang
- Center for Science of Healthcare Delivery (M.H.M., Z.W.), Mayo Clinic, Rochester, Minnesota
| | - D F Kallmes
- From the Departments of Radiology (W.B., Y.-Q.Z., G.L., H.J.C., D.F.K.) Neurosurgery (G.L., H.J.C., D.F.K.)
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18
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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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19
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Bonares MJ, Egeto P, de Oliveira Manoel AL, Vesely KA, Macdonald RL, Schweizer TA. Unruptured intracranial aneurysm treatment effects on cognitive function: a meta-analysis. J Neurosurg 2015; 124:784-90. [PMID: 26381251 DOI: 10.3171/2014.12.jns141625] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The treatment of an unruptured intracranial aneurysm (UIA) is not free of morbidity and mortality, and the decision is made by weighing the risks of treatment complications against the risk of aneurysm rupture. This meta-analysis quantitatively analyzed the literature on the effects of UIA treatment on cognition. METHODS MEDLINE, Embase, and PsycInfo were systematically searched for studies that reported on the cognitive status of UIA patients before and after aneurysm treatment. The search was restricted to prospective cohort and case-control studies published between January 1, 1998, and January 1, 2013. The analyses focused on the effect of treatment on general cognitive functioning, with an emphasis on 4 specific cognitive domains: executive functions, verbal and visual memory, and visuospatial functions. RESULTS Eight studies, with a total of 281 patients, were included in the meta-analysis. Treatment did not affect general cognitive functioning (effect size [ES] -0.22 [95% CI -0.78 to 0.34]). Executive functions and verbal memory domains trended toward posttreatment impairment (ES -0.46 [95% CI -0.93 to 0.01] and ES -0.31 [95% CI -1.24 to 0.61]), and performance of visual memory tasks trended toward posttreatment improvement (ES 1.48 [95% CI -0.36 to 3.31]). Lastly, treatment did not significantly affect visuospatial functions (ES -0.08 [95% CI -0.30 to 0.45]). CONCLUSIONS The treatment of an UIA does not seem to affect long-term cognitive function. However, definitive conclusions were not possible due to the paucity of studies addressing this issue.
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Affiliation(s)
| | - Peter Egeto
- Keenan Research Centre for Biomedical Science and
| | | | - Kristin A Vesely
- Keenan Research Centre for Biomedical Science and.,Institutes of 3 Medical Science and
| | - R Loch Macdonald
- Keenan Research Centre for Biomedical Science and.,Division of Neurosurgery, St. Michael's Hospital, Toronto; and ,Department of Neurosurgery, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Tom A Schweizer
- Keenan Research Centre for Biomedical Science and.,Division of Neurosurgery, St. Michael's Hospital, Toronto; and ,Biomaterials and Biomedical Engineering and.,Department of Neurosurgery, Faculty of Medicine, University of Toronto, Ontario, Canada
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20
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Kalb S, Spetzler RF. Middle Cerebral Artery Bifurcation Aneurysms: When and How to Treat Asymptomatic Unruptured Aneurysms. World Neurosurg 2015; 84:620-2. [DOI: 10.1016/j.wneu.2015.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
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Wenz H, Wenz R, Ehrlich G, Groden C, Schmieder K, Fontana J. Patient characteristics support unfavorable psychiatric outcome after treatment of unruptured intracranial aneurysms. Acta Neurochir (Wien) 2015; 157:1135-45; discussion 1145. [PMID: 26007696 DOI: 10.1007/s00701-015-2451-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 05/07/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Previous studies demonstrated an unfavorable psychological outcome after treatment of unruptured intracranial aneurysms despite an objectively favorable clinical and radiological outcome. The current study was therefore designed to analyze the psychiatric vulnerability of this specific patient collective. MATERIALS AND METHODS Patients treated for a WHO grade I meningioma and incidental intracranial aneurysms in two German neurosurgical centers between 2007 and 2013 were screened for exclusion criteria including malignant/chronic diseases, recurrence of the tumor/aneurysm after more than 12 months and focal neurological deficits, among others. Seventy-five meningioma patients (M) and 56 incidental aneurysm patients (iA) met the inclusion criteria. The past medical psychiatric history, post-morbid personality characters and coping strategies were determined by questionnaires mailed to the patients in a printed version (Brief COPE, Big Five Personality Test). RESULTS Fifty-eight M and 45 iA patients returned the questionnaires. Patients with iA demonstrated significantly higher pre-interventional rates of depressive episodes (p = 0.002) and psychological supervision (p = 0.038). These findings were especially aggravated in iA patients who received their cranial imaging for unspecific symptoms such as dizziness, headaches or tinnitus (n = 33, history of depressions: 39.4%; previous psychological supervision: 33.3%). Furthermore, the analysis of the Big Five personality traits revealed remarkably elevated neuroticism scores in the iA collective. CONCLUSION The current study demonstrates an increased rate of positive pre-interventional psychiatric histories in the iA collective. Although those patients represent only a small subgroup, they still may play an important role concerning the overall outcome after iA treatment. Early detection and psychological support in this subgroup might help to improve the overall outcome. Further studies are needed to evaluate the influence of this new aspect on the multifactorial etiology of unfavorable psychiatric outcome after treatment of iA.
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