Outcomes of surgery for unruptured aneurysm & subarachnoid hemorrhage

  • Research type

    Research Study

  • Full title

    Motor & cognitive outcomes of surgical treatment for unruptured aneurysm and subarachnoid hemorrhage

  • IRAS ID

    145257

  • Contact name

    Mark Mon-Williams

  • Contact email

    m.mon-williams@leeds.ac.uk

  • Sponsor organisation

    Leeds Teaching Hospital NHS Trust

  • Research summary

    Aneurysmal Subarachnoid Hemorrhage (aSAH) can cause a number of cognitive and motor difficulties, which in turn may significantly impact a patient’s quality of life (e.g. Al-Khindi, Macdonald, & Schweizer, 2012). Intracranial Aneurysm Treatment (IAT) options including coiling and clipping are available, but to date there is little high quality empirical research examining the effects of aSAH on fine motor and cognitive outcomes. This is also the case in patients who have been diagnosed with an Unruptured Aneurysm (UA) but in the absence of a hemorrhage (i.e. a problem typically identified on a scan without previous history of stroke), and subsequently undergo IAT as a preventative (non-emergency) measure.

    In cases of aSAH, anecdotal reports (from patients and clinical leads) indicate that despite patients scoring well on clinical outcome measures post-operatively (which would suggest a full recovery), many patients encounter memory problems, do not return to work, and experience significant fear and anxiety as a consequence of their experience (e.g. fear of a future stroke). To date, there is also very little research surrounding the potential for IAT to yield post-operative deficits in elective ‘asymptomatic’ patients. Given the crude quality of the standardized clinical measures currently used to determine readiness of discharge and screen for deficits after IAT, it is vital to develop more robust and highly sensitive measures of post-operative neuropsychological and motor outcomes. This will allow us to (i) measure movement and cognition in patient groups with UA and aSAH; (ii) explore differences in outcomes between treatment methods (i.e. coiling vs. clipping); (iii) identify neural underpinnings of post-operative deficits by comparing neuropsychological data with structural brain changes assessed with scans obtained as a standard process during admission and follow up; (iv) design effective screening methods to support post-operative care, and inform the design of appropriate rehabilitation programmes, in the future.

    In sum, our research team proposes a longitudinal study whereby a sensitive Kinematic Assessment Tool (KAT) will be used as an objective measure of cognitive and motor domains in UA and aSAH patients that undergo IAT. The KAT is a series of touch-screen computerized tasks that have already been evidenced as providing objective measures of cognitive and motoric performance in adults and children. We will recruit a sample of patients who are matched for surgical procedure (including elective UA coiling and clipping cases, and acute aSAH coiling and clipping patients), but are otherwise fit and healthy. These patients will be tested post-operatively prior to their discharge from the ward (i.e. between 1-30 days, but will depend on the condition and IAT method) and then again at 6 weeks, 6 months and 24 months post-IAT. Our protocol will gain a more detailed understanding of patients’ post-operative abilities above and beyond what can be measured with standardized clinical tests (a selection of which will also be included at all four testing sessions). We will distinguish between the effects of surgery and the effects of the neurological condition by comparing patients who have the same IAT procedure (i.e. coil or clip) but for a different condition (i.e. UA compared to aSAH). We will explore relative outcomes of the two IAT methods by comparing patients with the same condition (i.e. UA or aSAH) but who had a different type of IAT (i.e. coil compared to clip). To explore neurological underpinnings of deficits encountered after treatment for UA or aSAH, we compare kinematic data and standard neuropsychological test scores with structural brain changes assessed with scans (i.e. MR/CT/Catheter angiogram), which are obtained as a standard process during admission and follow-up. This will allow us to make some initial predictions about the underlying neurological causes of the clinical and psychological changes seen in this patient group. All data gathered by our selection performance measures in the patient groups will also be compared with a set of age-matched controls (i.e. no UA or aSAH), recruited as part of our future studies.

    Given the paucity of research surrounding the patients’ own perspective of post-operative recovery from UA and aSAH, an optional qualitative interview (i.e. focus group) will be included, where patients will be invited to discuss from their own personal experience, any symptoms, fears and/or concerns that they encountered as a consequence of their treatment. Including this qualitative element within our project will ensure that subtle outcomes are not missed, and inform our approach to examining the motor and cognitive outcomes of UA and aSAH in any future work.

  • REC name

    Yorkshire & The Humber - Leeds West Research Ethics Committee

  • REC reference

    14/YH/0009

  • Date of REC Opinion

    20 Feb 2014

  • REC opinion

    Further Information Favourable Opinion