Recovery to Preinterventional Functioning, Return-to-Work, and Life Satisfaction After Treatment of Unruptured Aneurysms.
OBJECTIVE
The eventual goal of preventive treatment of unruptured intracranial aneurysms is to increase the number of life years with high life satisfaction. Insight in the time with reduced functioning, working capacity, and life satisfaction after aneurysm treatment is pivotal to balance the pros and cons of preventive aneurysm occlusion.


METHODS
We sent a questionnaire on time-to-recovery to preintervention functioning and return-to-work and life satisfaction to patients treated for an unruptured aneurysm between 2000 and 2013. Changes in life satisfaction before treatment, during recovery, and at follow-up were assessed with Wilcoxon signed-rank tests.


RESULTS
The questionnaire was sent to 159 patients of whom 110 (69%) responded. The mean follow-up time after aneurysm treatment was 6 years (SD 4). Fifty-four patients had endovascular and 56 had microsurgical occlusion. Complete recovery to preintervention functioning was reported by 81% (95% confidence interval [CI], 74-88) of patients, with a median time-to-recovery of 3 months (range 0-48). Complete work recovery was reported by 78% (95% CI, 66-87) of patients. The proportion of patients with high life satisfaction reduced from 76% (95% CI, 67-84) before treatment to 52% (95% CI, 43-61) during the period of recovery (P<0.01) and restored largely at long-term follow-up (67% [95% CI, 59-76], P=0.08).


CONCLUSIONS
Life satisfaction is significantly reduced during the period of recovery after treatment of unruptured aneurysms. In the long-term, ≈1 out of 5 patients reports incomplete recovery. These treatment effects should be kept in mind when considering preventive aneurysm treatment. Prospective studies are needed to better compare these losses in patients treated for unruptured aneurysms with those who had subarachnoid hemorrhage.
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., J.A.N.B., B.H.V., A.A., M.D.I.V.), Department of Radiology (I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands; and Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands (J.M.A.V.-M., M.W.P.). D.Backes-2@umcutrecht.nl.
Daan
D
Backes
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., J.A.N.B., B.H.V., A.A., M.D.I.V.), Department of Radiology (I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands; and Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands (J.M.A.V.-M., M.W.P.).
Gabriel J E
GJ
Rinkel
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., J.A.N.B., B.H.V., A.A., M.D.I.V.), Department of Radiology (I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands; and Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands (J.M.A.V.-M., M.W.P.).
Irene C
IC
van der Schaaf
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., J.A.N.B., B.H.V., A.A., M.D.I.V.), Department of Radiology (I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands; and Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands (J.M.A.V.-M., M.W.P.).
Jenny A
JA
Nij Bijvank
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., J.A.N.B., B.H.V., A.A., M.D.I.V.), Department of Radiology (I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands; and Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands (J.M.A.V.-M., M.W.P.).
Bon H
BH
Verweij
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., J.A.N.B., B.H.V., A.A., M.D.I.V.), Department of Radiology (I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands; and Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands (J.M.A.V.-M., M.W.P.).
Johanna M A
JM
Visser-Meily
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., J.A.N.B., B.H.V., A.A., M.D.I.V.), Department of Radiology (I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands; and Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands (J.M.A.V.-M., M.W.P.).
Marcel W
MW
Post
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., J.A.N.B., B.H.V., A.A., M.D.I.V.), Department of Radiology (I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands; and Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands (J.M.A.V.-M., M.W.P.).
Ale
A
Algra
From the Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus (D.B., G.J.E.R., J.A.N.B., B.H.V., A.A., M.D.I.V.), Department of Radiology (I.C.v.d.S.), and Julius Center for Health Sciences and Primary Care (A.A.), University Medical Center Utrecht, Utrecht, the Netherlands; and Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands (J.M.A.V.-M., M.W.P.).
Mervyn D I
MD
Vergouwen
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D062707:Return to Work; D011795:Surveys and Questionnaires
intracranial aneurysm; quality of life; recovery; subarachnoid hemorrhage; treatment