Turkish Neurosurgery 2018 , Vol 28 , Num 3
Treatment of Spontaneous Subarachnoid Hemorrhage and Self-Reported Neuropsychological Performance at 6 Months - Results of a Prospective Clinical Pilot Study on Good-Grade Patients
Elisabeth BR▄NDL1,Petra SCHÍDEL1,Sylvia BELE1,Martin PROESCHOLDT1,Judith SCHEITZACH1,Florian ZEMAN2,Alexander BRAWANSKI1,Karl-Michael SCHEBESCH1
1University Medical Center Regensburg, Department of Neurosurgery, Regensburg, Germany
2University Medical Center Regensburg, Center for Clinical Studies, Regensburg, Germany
DOI : 10.5137/1019-5149.JTN.21825-17.0 AIM: Limited focus has been placed on neuropsychological patient profiles after spontaneous subarachnoid hemorrhage (sSAH). We conducted a prospective controlled study in good-grade sSAH patients to evaluate the time course of treatment-specific differences in cognitive processing after sSAH.

MATERIAL and METHODS: Twenty-six consecutive sSAH patients were enrolled (drop out n=5). Nine patients received endovascular aneurysm occlusion (EV), 6 patients were treated microsurgically (MS), and 6 patients with perimesencephalic SAH (pSAH) underwent standardized intensive medical care. No patient experienced serious vasospasm-related ischemic or hemorrhagic complications. All patients were subjected to neuropsychological self-report assessment (36-Item Short Form Health Survey and ICD-10-Symptom-Rating questionnaire) subacutely (day 11 ? 35) after the onset of bleeding (t1) and at the 6-month follow-up (FU; t2).

RESULTS: From t1 to t2, MS and EV patients significantly improved in physical functioning (Pfi; p=.001 each) and the physical component summary (p=.010 vs. p=.015). Bodily pain (Pain; MS p=.034) and general health perceptions (EV p=.014) significantly improved, and nutrition disorder (EV p=.008) worsened. At FU, MS patients reported significantly better Pfi (vs. EV p=.046), less Pain (vs. EV p=.040), and more depression (vs. pSAH p=.035). Group-rate analyses of test differences showed a significant alleviation in nutrition disorder in MS (vs. EV p=.009).

CONCLUSION: All sSAH groups reported a significant deterioration in health. Though both MS and EV patients, improved in several physical items over time, our data suggest a better short-term Pfi, less Pain and improved nutrition disorder in surgically treated patients. pSAH patients performed significantly better in various aspects of physical and psychological functioning than patients with aneurysmal SAH. Keywords : Clip, Cognitive impairment, Coil, Neuropsychological outcome, Subarachnoid hemorrhage

Corresponding author : Elisabeth BR▄NDL, elisabeth.bruendl@ukr.de