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Neurological, neuropsychological, and psychosocial outcome following treatment of unruptured intracranial aneurysms: A review and commentary

Published online by Cambridge University Press:  06 February 2004

KARREN TOWGOOD
Affiliation:
Department of Psychology, University of Auckland, Auckland New Zealand
JENNI A. OGDEN
Affiliation:
Department of Psychology, University of Auckland, Auckland New Zealand
EDWARD MEE
Affiliation:
Department of Neurosurgery, Auckland Hospital, Auckland, New Zealand

Abstract

Thirty studies published between 1977 and 2001 that focus on outcome following unruptured intracranial aneurysm (UIA) treatment are reviewed. Although findings from these studies suggest outcome from UIA treatment is reasonably good (between 5% and 25% morbidity and between 0–7% mortality), many of the complex issues associated with the treatment of UIAs remain controversial. Most of the studies reviewed address outcome in terms of mortality and neurological morbidity. Very few studies exist which include measures of outcome such as cognitive status, psychosocial functioning and quality of life. Given that patients facing treatment tend to be healthy middle-aged adults with many years of active working and social life ahead of them, it is important to take into account the long-term consequences of either harboring an UIA, or having it treated. The small number of studies that include cognitive, psychosocial and quality of life outcomes are reviewed in some detail and suggestions made for improving future UIA outcome research. (JINS, 2004, 10, 114–134.)

Type
CRITICAL REVIEW
Copyright
© 2004 The International Neuropsychological Society

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References

REFERENCES

Alexander, M.J. & Spetzler, R.F. (1999). Treatment of unruptured cerebral aneurysms. Surgical Neurology, 51, 255362.Google Scholar
Asari, S. & Ohmoto, T. (1993). Natural history and risk factors of unruptured cerebral aneurysms. Clinical Neurology and Neurosurgery, 95, 205214.Google Scholar
Aseltine, R.H., Jr., Carlson, K.J., Fowler, F.J., Jr., & Barry, M.J. (1995). Comparing prospective and retrospective measures of treatment outcomes. Medical Care, 33, 6776.Google Scholar
Ausman, J.I. (2001). The death of cerebral aneurysm surgery. Surgical Neurology, 56, 348.Google Scholar
Bavinzski, G., Killer, M., Gruber, A., Reinprecht, A., Gross, C.E., & Richling, B. (1999). Treatment of basilar artery bifurcation aneurysms by using Guglielmi detachable coils: a 6-year experience. Journal of Neurosurgery, 90, 843853.Google Scholar
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. (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.Google Scholar
Bergner, M., Bobbitt, R.A., Carter, W.B., & Gilson, B.S. (1981). The sickness impact profile: development and final revision of a health status measure. Medical Care, XIX, 787805.Google Scholar
Berry, E., Jones, R.A.C., West, C.G.H., & Brown, J.D.K. (1997). Outcome of subarachnoid haemorrhage: An analysis of surgical variables, cognitive and emotional sequelae related to SPECT scanning. British Journal of Neurosurgery, 11, 378387.Google Scholar
Bornstein, R.A., Weir, B.K.A., Petruk, K.C., & Disney, L.B. (1987). Neuropsychological function in patients after subarachnoid hemorrhage. Neurosurgery, 21, 651654.Google Scholar
Brandt, J., Spencer, M., & Folstein, M. (1988). The Telephone Interview for Cognitive Status. Neuropsychiatry, Neuropsychology, and Behavioural Neurology, 1, 111117.Google Scholar
Brilstra, E.H., Rinkel, G.J.E., van der Graff, Y., van Rooij, W.J.J., & Algra, A. (1999). Treatment of intracranial aneurysms by embolization with coils: A systematic review. Stroke, 30, 470476.Google Scholar
Broderick, J.P. (2000). Coiling, clipping, or medical management of unruptured intracranial aneurysms: Time to randomize? Annals of Neurology, 48, 56.Google Scholar
Byrne, J.V., John, M., & Molyneux, A.J. (1999). Five-year experience in using coil embolization for ruptured intracranial aneurysms: Outcomes and incidence of late rebleeding. Journal of Neurosurgery, 90, 656663.Google Scholar
Caplan, L.R. (1998). Should intracranial aneurysms be treated before they rupture? New England Journal of Medicine, 339, 17741775.Google Scholar
Casasco, A.E., Aymard, A., Gobin, Y.P., Houdart, E., Rogopoulos, A., George, B., Hodes, J.E., Cophignon, J., & Merland, J.J. (1993). Selective endovascular treatment of 71 intracranial aneurysms with platinum coils. Journal of Neurosurgery, 79, 310.Google Scholar
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.Google Scholar
Chelune, G.J. (2002). Making neuropsychological outcome research consumer friendly: A commentary on Keith et al. (2002). Neuropsychology, 16, 422425.Google Scholar
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.Google Scholar
Chung, R.Y., Carter, B.S., Norbash, A., Budzik, R., Putnam, C., & Ogilvy, C.S. (2000). Management outcomes for ruptured and unruptured aneurysms in the elderly. Neurosurgery, 47, 827833.Google Scholar
Chyatte, D. & Porterfield, R. (2001). Functional outcome after repair of unruptured intracranial aneurysms. Journal of Neurosurgery, 94, 417421.Google Scholar
Cognard, C., Weill, A., Spelle, L., Piotin, M., Castaings, L., Rey, A., & Moret, J. (1999). Long-term angiographic follow-up of 169 intracranial berry aneurysms occluded with detachable coils. Radiology, 212, 348356.Google Scholar
Cook, D.J., Guyatt, G.H., Laupacis, A., & Sackett, D.L. (1992). Rules of evidence and clinical recommendations on the use of antithrombotic agents. Chest, 102, 305S311S.Google Scholar
Debrun, G. (1999). Treatment of unruptured cerebral aneurysms. Surgical Neurology, 51, 255362.Google Scholar
Deruty, R., Pelissou-Guyotat, I., Mottolese, C., Bognar, L., & Oubouklik, A. (1992). Surgical management of unruptured intracranial aneurysms: Personal experience with 37 cases and discussion of the indications. Acta Neurochirurgica, 119, 3541.Google Scholar
Deruty, R., Pelissou-Guyotat, I., Mottolese, C., & Amat, D. (1996). Management of unruptured cerebal aneurysms. Neurological Research, 18, 3944.Google Scholar
Dorman, P., Dennis, M., & Sandercock, P. (2000). Are the modified “simple questions” a valid and reliable measure of health related quality of life after stroke? Journal of Neurology, Neurosurgery and Psychiatry, 64, 487493.Google Scholar
Dorsch, N.W.C. (2000). Unruptured aneurysms should generally be clipped. Journal of Neuroscience, 7, 346348.Google Scholar
Dumont, A.S., Giuseppe, L., & Kassell, N.F. (2002). Editorial: Unruptured aneurysms. Journal of Neurosurgery, 96, 5256.Google Scholar
Eskesen, V., Rosenørn, J., & Schmidt, K. (1988). The influence of unruptured intracranial aneurysms on life expectancy in relation to their size at the time of detection and to age. British Journal of Neurosurgery, 2, 379384.Google Scholar
Fleming, T.R. (1982). Historical controls, data banks, and randomized trials in clinical research: A review. Cancer Treatment Reports, 66, 11011105.Google Scholar
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.Google Scholar
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.Google Scholar
Hacein-Bey, L., Connolly, E.S., Jr., Duong, H., Vang, M.C., Lazar, R.M., Marshall, R.S., Young, W.L., Solomon, R.A., & Pile-Spellman, J. (1997). Treatment of inoperable carotid aneurysms with endovascular carotid occlusion after extracranial-intracranial bypass surgery. Neurosurgery, 41, 12251234.Google Scholar
Hackett, M.L. & Anderson, C.S. (2000). Health outcomes 1 year after subarachnoid hemorrhage: An international population-based study. Neurology, 55, 658662.Google Scholar
Hadjivassiliou, M., Tooth, C.L., Romanowski, C.A.J., Byrne, J., Battersby, R.D.E., Oxbury, S., Creswell, C.S., Burkitt, E., Stokes, N.A., Paul, C., Mayes, A.R., & Sagar, H.J. (2001). Aneurysmal SAH: Cognitive outcome and structural damage after clipping and coiling. Neurology, 56, 16721677.Google Scholar
Hashi, K. (1999). Treatment of unruptured cerebral aneurysms. Surgical Neurology, 51, 255362.Google Scholar
Heiskanen, O. (1986). Risks of surgery for unruptured intracranial aneurysms. Journal of Neurosurgery, 65, 451453.Google Scholar
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.Google Scholar
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.Google Scholar
Hop, J.W., Rinkel, G.J.E., Algra, A., & van Gijn, J. (1998). Quality of life in patients and partners after aneurysmal subarachnoid hemorrhage. Stroke, 29, 798804.Google Scholar
Hütter, B.-O., Gilsbach, G.M., & Kreitschmann, I. (1995). Quality of life and cognitive deficits after subarachnoid haemorrhage. British Journal of Neurosurgery, 9, 465475.Google Scholar
Inagawa, T., Hada, H., & Katoh, Y. (1992). Unruptured intracranial aneurysms in elderly patients. Surgical Neurology, 38, 364370.Google Scholar
International Subarachnoid Aneurysm Trial (ISAT) Collaborative Group. (2002). International subarachnoid aneurysm trial (ISAT) of neurosurgical versus endovascular coiling in 2,143 patients with ruptured intracranial aneurysms: A randomised trial. Lancet, 360, 12671274.Google Scholar
International Study of Unruptured Intracranial Aneurysm Investigators (ISUIA). (1998). Unruptured intracranial aneurysms—Risk of rupture and risks of surgical intervention. New England Journal of Medicine, 339, 17251733.Google Scholar
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.Google Scholar
Jennett, B. & Bond, M. (1975). Assessment of outcome after severe brain damage. Lancet, 1, 480484.Google Scholar
Johnston, S.C., Dudley, R.A., Gress, D.R., & Ono, L. (1999a). Surgical and endovascular treatment of unruptured cerebral aneurysms at university hospitals. Neurology, 52, 17991805.Google Scholar
Johnston, S.C., Gress, D.R., & Khan, J.G. (1999b). Which unruptured cerebral aneurysms should be treated? A cost-utility analysis. Neurology, 52, 18061815.Google Scholar
Johnston, S.C., Wilson, C.B., Halbach, V.V., Higashida, R.T., Dowd, C.F., McDermott, M.W., Applebury, C.B., Farley, T.L., & Gress, D.R. (2000). Endovascular and surgical treatment of unruptured cerebral aneurysms: Comparison of risks. Annals of Neurology, 48, 1119.Google Scholar
Johnston, S.C., Zhao, S., Dudley, R.A., Berman, M.F., & Gress, D.R. (2001). Treatment of unruptured cerebral aneurysms in California. Stroke, 32, 597605.Google Scholar
Jomin, M., Lesoin, F., Lozes, G., Fawaz, A., & Villette, L. (1987). Surgical prognosis of unruptured intracranial arterial aneurysms. Report of 50 cases. Acta Neurochirurgica, 85, 8588.Google Scholar
Juvela, S. (2002). Editorial: Unruptured aneurysms. Journal of Neurosurgery, 96, 5860.Google Scholar
Juvela, S., Porras, M., & Heiskanen, O. (1993). Natural history of unruptured intracranial aneurysms: A long-term follow-up study. Journal of Neurosurgery, 79, 174182.Google Scholar
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.Google Scholar
Kahara, V.J., Seppanen, S.K., Kuurne, T., & Laasonen, E.M. (1999). Patient outcome after endovascular treatment of intracranial aneurysms with reference to microsurgical clipping. Acta Neurologica Scandinavica, 99, 284290.Google Scholar
Kashiwagi, S., Yamashita, K., Kato, S., Takasago, T., & Ito, H. (2000). Elective neck clipping for unruptured aneurysms in elderly patients. Surgical Neurology, 53, 1420.Google Scholar
Kassell, N.F. (2001). Editorial comment: Treatment of unruptured cerebral aneurysms in California. Stroke, 32, 606610.Google Scholar
Keith, J.R. & Puente, A.E. (2002). Deficiencies in the detection of cognitive change. Neuropsychology, 16, 434439.Google Scholar
Keith, J.R., Puente, A.E., Malcolmson, K.L., Tartt, S., Coleman, A.E., & Marks, H.F., Jr. (2002). Assessing postoperative cognitive change after cardio pulmonary bypass surgery. Neuropsychology, 16, 411421.Google Scholar
Khanna, R.K., Malik, G.M., & Qureshi, N. (1996). Predicting outcome following surgical treatment of unruptured intracranial aneurysms: A proposed grading system. Journal of Neurosurgery, 84, 4954.Google Scholar
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.Google Scholar
Kobayashi, S. & Orz, Y. (1999). Treatment of unruptured cerebral aneurysms. Surgical Neurology, 51, 255362.Google Scholar
Kolb, B. & Whishaw, I. (1996). Fundamentals of human neuropsychology (4th ed.). New York: W.H. Freeman and Company.
Lawton, M.T. & Spetzler, R.F. (1995). Surgical management of giant intracranial aneurysms: Experience with 171 patients. Clinical Neurosurgery, 42, 245266.Google Scholar
Leber, K.A., Klein, G.E., Trummer, M., & Eder, H.G. (1998). Intracranial aneurysms: a review of endovascular and surgical treatment in 248 patients. Minimally Invasive Neurosurgery, 41, 8185.Google Scholar
Lempert, T.E., Malek, A.M., Halbach, V.V., Phatouros, C.C., Meyers, P.M., Dowd, C.F., & Higashida, R.T. (2000). Endovascular treatment of ruptured posterior circulation cerebral aneurysms: Clinical and angiographic outcomes. Stroke, 31, 100110.Google Scholar
Le Roux, P.D., Elliott, J.P., Downey, L., Newell, D.W., Grady, M.S., Mayberg, M.R., Eskridge, J.M., & Winn, H.R. (1995). Improved outcome after rupture of anterior circulation aneurysms: A retrospective 10-year review of 224 good-grade patients. Journal of Neurosurgery, 83, 394402.Google Scholar
Lezak, M.D. (1995). Neuropsychological assessment (3rd ed.). New York: Oxford University Press.
Lindley, R.I., Waddekk, F., Livingstone, M., Sandercock, P., Dennis, M.S., Slattery, J., Smith, B., & Warlow, C. (1994). Can simple questions assess outcome after stroke? Cerebrovascular Disease, 4, 314324.Google Scholar
Ljunggren, B., Sonesson, B., & Säveland, H. (1985). Cognitive impairment and adjustment in patients without neurological deficits after aneurysmal SAH and early operation. Journal of Neurosurgery, 62, 673679.Google Scholar
Lot, G., Houdart, E., Cophignon, J., Casasco, A., & George, B. (1999). Combined management of intracranial aneurysms by surgical and endovascular treatment. Modalities and results from a series of 395 cases. Acta Neurochirurgica, 141, 557562.Google Scholar
Mahoney, F.I. & Barthel, D.W. (1965, February). Functional evaluation: The Barthel Index Rehabilitation, Maryland State Medical Journal 6165.Google Scholar
Martin, N.A. (1997). Decision-making for intracranial aneurysm treatment: When to select surgery, and when to select endovascular therapy. Journal of Stroke and Cerebrovascular Diseases, 6, 253257.Google Scholar
Martin, N.A. (1998). The combination of endovascular and surgical techniques for the treatment of intracranial aneurysms. Neurosurgery Clinics of North America, 9, 897.Google Scholar
Maurice-Williams, R.S., Willison, J.R., & Hatfield, R. (1991). The cognitive and psychological sequelae of uncomplicated aneurysm surgery. Journal of Neurology, Neurosurgery and Psychiatry, 54, 335340.Google Scholar
Mavaddat, N., Sahakian, B.J., Hutchinson, P.J.A., & Kirkpatrick, P.J. (1999). Cognition following subarachnoid hemorrhage from anterior communicating artery aneurysm: Relation to timing of surgery. Journal of Neurosurgery, 91, 402407.Google Scholar
McKenna, P., Willison, B.A., Phil, B., Lowe, D., & Neil-Dwyer, G. (1989). Cognitive outcome and quality of life one year after subarachnoid hemorrhage. Neurosurgery, 24, 361367.Google Scholar
Millis, S.R. (2002). Measuring change: A commentary on Keith et al. (2002). Neuropsychology, 16, 426428.Google Scholar
Mitrushina, M.N., Boone, K.B., & D'Elia, L.F. (1999). Handbook of normative data for neuropsychological assessment. New York: Oxford University Press.
Mizoi, K., Suzuki, J., & Yoshimoto, T. (1989). Surgical treatment of multiple aneurysms: Review of experience with 372 cases. Acta Neurochirurgica, 96, 814.Google Scholar
Mizoi, K., Yoshimoto, T., Nagamine, Y., Kayama, T., & Koshu, K. (1995). How to treat incidental cerebral aneurysms: A review of 139 consecutive cases. Surgical Neurology, 44, 114121.Google Scholar
Molyneux, A. (2000). Endovascular techniques in the management of intracranial aneurysms. In A.H. Kaye & P.M. Black (Eds.), Operative Neurosurgery (Vol. II, pp. 11541161). London: Churchill Livingstone.
Ogden, J.A., Levin, P.L., & Mee, E.W. (1990). Long-term neuropsychological and psychosocial effects of subarachnoid hemorrhage. Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 3, 260274.Google Scholar
Ogden, J.A., Mee, E.W., & Henning, M. (1993). A prospective study of impairment of cognition and memory and recovery after subarachnoid hemorrhage. Neurosurgery, 33, 572587.Google Scholar
Ogden, J.A., Mee, E.W., & Henning, M. (1994). A prospective study of psychosocial adaptation following subarachnoid haemorrhage. Neuropsychological Rehabilitation, 4, 730.Google Scholar
Ogden, J.A., Utley, T., & Mee, E.W. (1997). Neurological and psychosocial outcome 4 to 7 years after subarachnoid hemorrhage. Neurosurgery, 41, 2534.Google Scholar
Orz, Y.I., Hongo, K., Tanaka, Y., Nagashima, H., Osawa, M., Kyoshima, K., & Kobayashi, S. (2000). Risks of surgery for patients with unruptured intracranial aneurysms. Surgical Neurology, 53, 2129.Google Scholar
Qureshi, A.I., Suri, M.F., Khan, J., Kim, S.H., Fessler, R.D., Ringer, A.J., Guterman, L.R., & Hopkins, L.N. (2001). Endovascular treatment of intracranial aneurysms by using Guglielmi detachable coils in awake patients: Safety and feasibility. Journal of Neurosurgery, 94, 880885.Google Scholar
Raaymakers, T.W. (2000). Functional outcome and quality of life after angiography and operation for unruptured intracranial aneurysms. Journal of Neurology, Neurosurgery and Psychiatry, 68, 571576.Google Scholar
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.Google Scholar
Raftopoulos, C., Mathurin, P., Boscherini, D., Billa, R.F., Boven, M.V., & Hantson, P. (2000). Prospective analysis of aneurysm treatment in a series of 103 consecutive patients when endovascular embolization is considered the first option. Journal of Neurosurgery, 93, 178182.Google Scholar
Rankin, J. (1957). Cerebral vascular accidents in patients over the age of 60. II: Prognosis. Scottish Medical Journal, 2, 200215.Google Scholar
Redekop, G., Willinsky, R., Montanera, W., TerBrugge, K., Tymianski, M., & Wallace, C. (1999). Endovascular occlusion of basilar bifurcation aneurysms with electrolytically detachable coils. Canadian Journal of Neurological Science, 26, 172181.Google Scholar
Regli, L., Uske, A., & Tribolet, N.D. (1999). Endovascular coil placement compared with surgical clipping for the treatment of unruptured middle cerebral artery aneurysms: A consecutive series. Journal of Neurosurgery, 90, 10251030.Google Scholar
Rice, B.J., Peerless, S.J., & Drake, C.G. (1990). Surgical treatment of unruptured aneurysms of the posterior circulation. Journal of Neurosurgery, 73, 165173.Google Scholar
Richardson, J.T.E. (1989). Performance in free recall following rupture and repair of intracranial aneurysm. Brain and Cognition, 9, 210226.Google Scholar
Richardson, J.T.E. (1991). Cognitive performance following rupture and repair of intracranial aneurysm. Acta Neurologica Scandinavica, 83, 110122.Google Scholar
Ropper, A.H. & Zervas, N.T. (1984). Outcome 1 year after SAH from cerebral aneurysm. Journal of Neurosurgery, 60, 909915.Google Scholar
Roy, D., Milot, G., & Raymond, J. (2001). Endovascular treatment of unruptured aneurysms. Stroke, 32, 19982008.Google Scholar
Samson, D.S., Hodosh, R.M., & Clark, W.K. (1977). Surgical management of unruptured asymptomatic aneurysms. Journal of Neurosurgery, 46, 731734.Google Scholar
Samson, D.S. (1996). Surgery for unruptured intracranial aneurysms. In R.H. Wilkins & S.S. Rengachary (Eds.), Neurosurgery: Second edition (Vol. II). New York: McGraw Hill.
Sanders, C., Eger, M., Donovan, J., Tallon, D., & Frankel, S. (1998). Reporting on quality of life in randomised controlled trials: Bibliographic study. British Medical Journal, 317, 11911194.Google Scholar
Säveland, H., Hillman, J., Brandt, L., Edner, G., Jakobsson, K., & Algers, G. (1992). Overall outcome in aneurysmal subarachnoid hemorrhage: A prospective study from neurosurgical units in Sweden during a 1-year period. Journal of Neurosurgery, 76, 729734.Google Scholar
Säveland, H., Sonesson, B., Ljunggren, B., Brandt, L., Uski, T., Zygmunt, S., & Hindfelt, B. (1986). Outcome evaluation following subarachnoid hemorrhage. Journal of Neurosurgery, 64, 191196.Google Scholar
Sawrie, S.M. (2002). Analysis of cognitive change: A commentary on Keith et al. (2002). Neuropsychology, 16, 429431.Google Scholar
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.Google Scholar
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.Google Scholar
Smith, G.E. (2002). What is the outcome we seek? A commentary on Keith et al. (2002). Neuropsychology, 16, 432433.Google Scholar
Solomon, R.A. & Baker, C.J. (1992). Direct surgical approaches to giant intracranial aneurysms. Neurosurgery Quarterly, 2, 127.Google Scholar
Solomon, R.A., Mayer, S.A., & Tarmay, J.J. (1996). Relationship between the volume of craniotomies for cerebral aneurysm performed at New York State hospitals and in-hospital mortality. Stroke, 27, 1317.Google Scholar
Solomon, R.A., Fink, M.E., & Pile-Spellman, J. (1994). Surgical management of unruptured intracranial aneurysms. Journal of Neurosurgery, 80, 440446.Google Scholar
Steiger, H.J., Medele, R., Bruckmann, H., Schroth, G., & Reulen, H.J. (1999). Interdisciplinary management results in 100 patients with ruptured and unruptured posterior circulation aneurysms. Acta Neurochirurgica, 141, 359367.Google Scholar
Sturaitis, M.K., Rinne, J., Chaloupka, J.C., Kaynar, M., Lin, Z., & Awad, I.A. (2000). Impact of Guglielmi detachable coils on outcomes of patients with intracranial aneurysms treated by a multidisciplinary team at a single institution. Journal of Neurosurgery, 93, 569580.Google Scholar
Sundt, T.M. & Piepgras, D.G. (1979). Surgical approach to giant intracranial aneurysms: Operative experience with 80 cases. Journal of Neurosurgery, 51, 731742.Google Scholar
Tateshima, S., Murayama, Y., Gobin, Y.P., Duckwiler, G.R., Guglielmi, G., & Viñuela, F. (2000). Endovascular treatment of basilar tip aneurysms using Guglielmi detachable coils: Anatomic and clinical outcomes in 73 patients from a single institution. Neurosurgery, 47, 13321342.Google Scholar
Tidswell, P., Dias, P.S., Sagar, D.M., Mayes, A.R., & Battersby, R.D.E. (1995). Cognitive outcome after aneurysm rupture: Relationship to aneurysm site and perioperative complications. Neurology, 45, 875882.Google Scholar
Vanninen, R., Koivisto, T., Saari, T., Hernesniemi, J., & Vapalahti, M. (1999). Ruptured intracranial aneurysms: Acute endovascular treatment with electrolytically detachable coils—A prospective randomized study. Radiology, 211, 325336.Google Scholar
Vilkki, J., Holst, P., Öhmann, J., Servo, A., & Heiskanen, O. (1990). Social outcome related to cognitive performance and computed tomographic findings after surgery for a ruptured intracranial aneurysm. Neurosurgery, 26, 579585.Google Scholar
Viñuela, F., Duckwiler, G., & Mawad, M. (1997). Guglielmi detachable coil embolization of acute intracranial aneurysm: Perioperative anatomical and clinical outcome in 403 patients. Journal of Neurosurgery, 86, 475482.Google Scholar
Wade, D.T. (1996). Measurement in neurological rehabilitation. New York: Oxford University Press Inc.
Wardlaw, J.M. & White, P.M. (2000). The detection and management of unruptured intracranial aneurysms. Brain, 123, 205221.Google Scholar
Ware, J.E., Jr. & Sherbourne, C.D. (1992). The MOS 36-Item short-form health survey (SF-36). Medical Care, 30, 473483.Google Scholar
Weir, B. (2002). Unruptured intracranial aneurysms: A review. Journal of Neurosurgery, 96, 342.Google Scholar
Weir, B., Disney, L.B., & Karrison, T. (2002). Sizes of ruptured and unruptured aneurysms in relation to their sites and ages of patients. Journal of Neurosurgery, 96, 6470.Google Scholar
Wiebers, D.O., Piepgras, D., Brown, R.D., Jr., Meissner, I., Torner, J., Kassell, N.F., Whisnant, J.P., Huston, J., & Nichols, D.A. (2002). Editorial: Unruptured aneurysms. Journal of Neurosurgery, 96, 5051.Google Scholar
Wirth, F.P., Laws, E.R., Piepgras, D., & Scott, R.M. (1983). Surgical treatment of incidental intracranial aneurysms. Neurosurgery, 12, 507511.Google Scholar
World Health Organization. (1980). International classification of impairments, disabilities and handicaps. Geneva: Author.
World Health Organization. (2001). International classification of functioning, disability and health. Final draft. Full version. Geneva: Author.
Yoshimoto, T. & Mizoi, K. (1997). Importance of management of unruptured cerebral aneurysms. Surgical Neurology, 47, 522526.Google Scholar
Zubilaga, A.F., Guglielmi, G., Viñuela, F., & Duckwiler, G.D. (1994). Endovascular occlusion of intracranial aneurysms with electrically detachable coils: Correlation of aneurysm neck size and treatment results. American Journal of Neuroradiology, 15, 815820.Google Scholar