Minimally Invasive Coiling of Brain Aneurysms Results in Improved Psychological Outcomes

A study indicates that patients successfully treated for subarachnoid brain aneurysm with coiling need less psychological support than was previously reported after traditional surgical clipping.

Researchers at San Giovanni Bosco Hospital (Naples, Italy) evaluated quality of life in 30 subjects (12 males and 18 females, 24 to 73 years of age) who were selected from a database of 248 patients who underwent a coiling procedure in 2006 and 2007. The test group was asked to complete the Italian version of the 36-Item Short Form Questionnaire (SF-36) that is utilized by psychologists to assess the quality of life (QOL) of patients. The test allows for detailed analysis of eight different domains including physical functioning, role limitations because of physical problems, bodily pain, general health, vitality, social functioning, role limitations because of emotional problems, and mental health. These scores were then compared to data that was previously reported in medical literature for surgically clipped patients. An analysis of results showed that while with traditional neurosurgical clipping, which requires opening the skull, for aneurysmal subarachnoid hemorrhage a substantial proportion of subjects who demonstrated a sound recovery presented ongoing psychosocial disturbances, the QOL of the study subjects who underwent endovascular coiling were affected to a lesser degree.


In a second comparison, the test group scores were analyzed against a reference population consisting of fully healthy individuals. In this comparison, study results showed that overall scores between patients who had been successfully coiled and the reference population were not significantly different. However, further examination suggests that, on a scale of 0 to 100, the coiled population lost points in three specific areas related to mental well-being: 11 points in the area of social functioning; 17 points in the area of role limitations because of emotional problems; and 14 points in the category of mental health. These results indicate that some patients can be fragile, and thereby candidates for psychosocial support, even if initially rated as good-outcome subjects. The results of the study were presented at the Society of NeuroInterventional Surgery (SNIS) sixth annual meeting, held during July 2009 in Boca Raton (FL, USA).

"Now that coiling has, in essence, reached early adulthood, and we are comfortable with the significant number of successfully treated patients,” said study presenter neuroradiologist Antonio DeSimone, M.D. "we are being called upon to now focus on subjects rather than simply the accumulation of cases. At present, the coiling technique is so advanced that research--that will help inform the areas of psychosocial functioning that could benefit from support--is the next step we must take in our ongoing journey.”

The groundbreaking 2002 International Subarachnoid Aneurysm Trial (ISAT) was halted due to overwhelming evidence that minimally invasive endovascular coiling was, on average, superior to traditional surgical clipping in the treatment of brain aneurysms. The procedure is accomplished through a catheter or narrow tube that is inserted into the groin and threaded up through the arteries directly to the problem site in the brain. The coils, or mesh wires, usually made of Platinum, are then inserted into the aneurysm in order to prevent the space from filling with blood and rupturing.

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San Giovanni Bosco Hospital