脳血管障害の外科的治療と患者のQuality of Life(QOL) : くも膜下出血と未破裂脳動脈瘤を中心に  [in Japanese] Quality of Life (QOL) in Patients Underwent Surgery for Cerebrovascular Diseases : Review of the QOL Research in Subarachnoid Hemorrhage and Unruptured Aneurysms  [in Japanese]

Early outcome research in the neurosurgical literature on morbidity and mortality is now focusing on subjective or patient-based outcomes for assessing neurosurgical diseases and their treatment. The assessment of health-related QOL and its components based on the patient's health status is increasingly common in neurosurgical and other specialties. The popular Short Form-36 (SF-36) is a 36-item, patient-completed questionnaire that measures patient health-related QOL in each of 8 areas: physical functioning (PF), social functioning (SF), role-physical (RP), role-emotional (RE), mental health (MH), vitality (VT), bodily pain (BP), and general health perception (GH). Several out-come researches for patients who experienced subarachnoid hemorrhage concluded that SF-36 could detect mild disorders of cognitive or psychological function. QOL is also an important outcome measure for patients with unruptured intracranial aneurysms because these patients are usually in good health after treatment. We assessed QOL in 61 patients who underwent microsurgical clipping of unruptured aneurysms. Preoperatively, patients with unruptured aneurysms reported significantly decreased QOL. It further declined transiently after elective surgery, but within 3 years it returned to the mean level recorded for the reference population. In obtaining patient's informed consent, data on QOL like the above help patients who are debating whether to undergo treatment for unruptured aneurysms. Subjective QOL issues should be considered in the management of patients with other neurosurgical diseases. Comprehensive outcome research using several graded scales will be necessary for evaluation of patient's perception of health as well as neurological impairments and disability.