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Neurological, neuropsychological, and functional outcome following treatment for unruptured intracranial aneurysms


The objective of this study was to carry out a detailed investigation of the neurological, neuropsychological, and return-to-work status of treatment for unruptured intracranial aneurysms (UIAs). A prospective design was used to evaluate the outcome of UIA treatment in a group of 26 UIA patients. Over a 24-month period UIA patients were assessed prior to treatment, during hospitalization, at three months and at six months following treatment. Their performance was compared to a group of 20 matched controls. Neurological morbidity as a result of the UIA treatment was 5%, as assessed by the Glasgow Outcome Scale (GOS) or Rankin at 3 months. The Telephone Interview for Cognitive Status (TICS) proved to be unreliable as a measure of cognitive change. Reliability of change analysis was more sensitive than group analysis, and revealed a pattern of cognitive deficits in 10% of patients as a result of the UIA treatment. In addition, 25% of patients reported a change in work role as a result of the UIA treatment. While 10% of patients sustained mild to moderate neurological and cognitive impairments 3 to 6 months following UIA treatment, their deficits were not as wide-ranging nor as severe as those sustained by patients who survive a subarachnoid hemorrhage (SAH). (JINS, 2005, 11, 522–534.)

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Address correspondence and reprint requests to: Karren Towgood, Ph.D., Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland, New Zealand. E-mail:
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Adams, K.M., Brown, G.G., & Grant, I. (1985). Analysis of covariance as a remedy for demographic mismatch of research subject groups: Some sobering simulations. Journal of Clinical and Experimental Neuropsychology, 7, 445462.
Alexander, M.J. & Spetzler, R.F. (1999). Treatment of unruptured cerebral aneurysms. Surgical Neurology, 51, 255362.
Ausman, J.I. (1999). The New England Journal of Medicine report on unruptured intracranial aneurysms: A critique. Surgical Neurology, 51, 227229.
Baddeley, A., Emslie, H., & Smith, I.N. (1992). The Speed and Capacity of Language-Processing Test. Bury St Edmunds: Thames Valley Test Company.
Barber, M. & Stott, S.J. (2004). Validity of the Telephone Interview for Cognitive Status (TICS) in post-stroke subjects. International Journal of Geriatric Psychiatry, 19, 7579.
Bederson, J.B., Awad, I.A., Wiebers, D.O., Piepgras, D., Haley, E.C. Jr., Brott, T., Hademenos, G., Chyatte, D., Rosenwasser, R., Caroselli, C., & Members. (2000). Recommendations for the management of patients with unruptured intracranial aneurysms: A statement for healthcare professionals from the Stroke Council of the American Heart Association. Stroke, 31, 27422750.
Brandt, J., Spencer, M., & Folstein, M. (1988). The Telephone Interview for Cognitive Status. Neuropsychiatry, Neuropsychology, and Behavioural Neurology, 1, 111117.
Cesarini, K.G., Hårdmark, H.-G., & Persson, L. (1999). Improved survival after aneurysmal subarachnoid hemorrhage: A review of case management during a 12-year period. Journal of Neurosurgery, 90, 664672.
Chelune, G.J. (2002). Making neuropsychological outcome research consumer friendly: A commentary on Keith et al. (2002). Neuropsychology, 16, 422425.
Chelune, G.J., Naugle, R.I., Lüders, H.O., Sedlack, J., & Awad, I.A. (1993). Individual change after epilepsy surgery: Practice effects and base-rate information. Neuropsychology, 7, 4152.
Desmond, D.W., Tatemici, T.K., & Hanzawa, L. (1994). The Telephone Interview for Cognitive Status (TICS): Reliability and validity in a stroke sample. International Journal of Geriatric Psychiatry, 9, 803807.
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). Mini-Mental State—A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Frison, L. & Pocock, S.J. (1992). Repeated measures in clinical trials: Analysis using mean summary statistics and its implications for design. Statistics in Medicine, 11, 16851704.
Fukunaga, A., Uchida, K., Hashimoto, J., & Kawase, T. (1999). Neuropsychological evaluation and cerebral blood flow study of 30 patients with unruptured cerebral aneurysms before and after surgery. Surgical Neurology, 51, 132139.
Heaton, R.K., Temkin, N., Dikmen, S., Avitable, N., Taylor, M.J., Marcotte, T.D., & Grant, I. (2001). Detecting change: A comparison of three neuropsychological methods using normal and clinical samples. Archives of Clinical Neuropsychology, 16, 7591.
Hillis, A.E., Anderson, N., Sampath, P., & Rigamonti, D. (2000). Cognitive impairments after surgical repair of ruptured and unruptured aneurysms. Journal of Neurology, Neurosurgery and Psychiatry, 69, 608615.
Hop, J.W., Rinkel, G.J.E., Algra, A., & van Gijn, J. (1997). Case-fatality rates and functional outcome after subarachnoid haemorrhage. Stroke, 28, 660664.
ISUIA. (1998). Unruptured intracranial aneurysms—risk of rupture and risks of surgical intervention. The New England Journal of Medicine, 339, 17251733.
ISUIA. (2003). Unruptured intracranial aneurysms: Natural history, clinical outcome, and risks of surgical and endovascular treatment. Lancet, 362, 103110.
Iverson, G.L. (2001). Interpreting change on the WAIS-III/WMS-III in clinical samples. Archives of Clinical Neuropsychology, 16, 183191.
Jacobsen, N.S. & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 1219.
Juvela, S., Porras, M., & Heiskanen, O. (1993). Natural history of unruptured intracranial aneurysms: A long-term follow-up study. Journal of Neurosurgery, 79, 174182.
Juvela, S., Porras, M., & Poussa, K. (2000). Natural history of unruptured intracranial aneurysms: Probability of and risk factors for aneurysm rupture. Journal of Neurosurgery, 93, 379387.
Kaplan, E., Goodglass, H., & Weintraub, S. (1983). The Boston Naming Test. Philadelphia: Lea & Febiger.
King, J.T. Jr., Berlin, J.A., & Flamm, E.S. (1994). Morbidity and mortality from elective surgery for asymptomatic, unruptured, intracranial aneurysms: A meta-analysis. Journal of Neurosurgery, 81, 837842.
Le Roux, P.D., Elliott, J.P., Eskridge, J.M., Cohen, W., & Winn, H.R. (1998). Risks and benefits of diagnostic angiography after aneurysm surgery: A retrospective analysis of 597 studies. Neurosurgery, 42, 12481255.
Miller, E.N. (2001). California Computerized Assessment Package Manual (2nd ed.). Los Angeles, CA: Eric N. Miller, Ph.D. & Norland Software.
Mueller, J., Kiernan, R., & Langston, J.W. (2001). Manual for COGNISTAT (The Neurobehavioural Cognitive Status Examination). Fairfax, CA: The Northern California Neurobehavioural Group, Inc.
Nabors, N.A., Millis, S.R., & Rosenthal, M. (1997). Use of the Neurobehavioural Cognitive Status Examination (Cognistat) in traumatic brain injury. Journal of Head Trauma Rehabilitation, 12, 7984.
Nanda, A. & Vannemreddy, P.S.S.V. (2002). Surgical management of unruptured aneurysms: Prognostic indicators. Surgical Neurology, 58, 1320.
Ogden, J.A. (1985). Anterior-posterior interhemispheric differences in the loci of lesions producing visual hemineglect. Brain and Cognition, 4, 5975.
Ogden, J.A., Mee, E.W., & Henning, M. (1994). A prospective study of psychosocial adaption following subarachnoid haemorrhage. Neuropsychological Rehabilitation, 4, 1.
Plassman, B.L., Newman, T.T., Welsh, K.A., Helms, M., & Breitner, J.C.S. (1994). Properties of the Telephone Interview for Cognitive Status. Neuropsychiatry, Neuropsychology, and Behavioural Neurology, 7, 234241.
Raaymakers, T.W. (2000). Functional outcome and quality of life after angiography and operation for unruptured intracranial aneurysms. Journal of Neurology, Neurosurgery & Psychiatry, 68, 571576.
Raaymakers, T.W., Rinkel, G.J., Limburg, M., & Algra, A. (1998). Mortality and morbidity of surgery for unruptured intracranial aneurysms: A meta-analysis. Stroke, 29, 15311538.
Rankin, J. (1957). Cerebral vascular accidents in patients over the age of 60. II: Prognosis. Scottish Medical Journal, 2, 200215.
Reitan, R.M. (1958). Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271276.
Rinkel, G.J.E., Djobuti, M., Algra, A., & van Gijn, J. (1998). Prevalence and risk of rupture of intracranial aneurysms: A systematic review. Stroke, 29, 251256.
Ruff, R.M., Light, R.H., Barker, S.B., & Levin, H.S. (1996). Benton Controlled Oral Word Association: Reliability and updated norms. Archives of Clinical Neuropsychology, 11, 329338.
Sawrie, S.M., Chelune, G.J., Naugle, R.I., & Lüders, H.O. (1996). Empirical methods for assessing meaningful neuropsychological change following epilepsy surgery. Journal of the International Neuropsychological Society, 2, 556564.
Slade, P., Sanchez, P., Townes, B., & Aldea, G. (2001). The use of neurocognitive tests in evaluating the outcome of cardiac surgery: Some methodological considerations. Journal of Cardiothoracic and Vascular Anesthesia, 15, 48.
Spreen, O. & Strauss, E. (1998). A compendium of neuropsychological tests: Administration, norms and commentary. (2nd ed.). New York: Oxford University Press.
Teasdale, G. & Jennett, B. (1974). Assessment of coma and impaired consciousness: A practical scale. Lancet, 2, 8184.
Towgood, K.J., Ogden, J.A., & Mee, E.W. (2004). Neurological, neuropsychological, psychosocial and functional outcome of unruptured intracranial aneurysm treatment: A review and commentary. Journal of the International Neuropsychological Society, 10, 114134.
Wechsler, D. (1997a). Wechsler Adult Intelligence Scale (3rd ed.). San Antonio, TX: The Psychological Corporation.
Wechsler, D. (1997b). Wechsler Memory Scale (3rd ed.). San Antonio, TX: The Psychological Corporation.
WHO. (1980). International Classification of Impairments, Disabilities and Handicaps. Geneva: World Health Organisation.
WHO. (2001). International Classification of Functioning, Disability and Health (Final draft, full version). Geneva: World Health Organisation.
Winn, H.R., Jane_Sr., J.A., Taylor, J., Kaiser, D., & Britz, G.W. (2002). Prevalence of asymptomatic incidental aneurysms: Review of 4568 arteriograms. Journal of Neurosurgery, 96, 4349.
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