Abstract：
OBJECTIVE :Few studies have examined patients\' ability to drive and quality of life (QOL) after microsurgical repair for unruptured intracranial aneurysms (uIAs). However, without a strong evidentiary basis, jurisdictional road transport authorities have recommended driving restrictions following brain surgery. In the present study, authors examined the outcomes of the microsurgical repair of uIAs by measuring patients\' perceived QOL and cognitive abilities related to driving. METHODS: Between January 2011 and January 2016, patients with a new diagnosis of uIA were prospectively enrolled in this study. Assessments were performed at referral, before surgery, and at 6 weeks and 12 months after surgery in those undergoing microsurgical repair and at referral and at 12 months in conservatively managed patients. Assessments included the Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36, the off-road driver-screening instrument DriveSafe (DS), the modified Barthel Index (mBI), and the modified Rankin Scale (mRS). RESULTS: One hundred sixty-nine patients were enrolled in and completed the study, and 112 (66%) of them had microsurgical repair of their aneurysm. In the microsurgical group, there was a trend for improved DS scores: from a mean (± standard deviation) score of 108 ± 10.7 before surgery to 111 ± 9.7 at 6 weeks after surgery to 112 ± 10.2 at 12 months after surgery (p = 0.05). Two percent of the microsurgical repair group and 4% of the conservatively managed group whose initial scores indicated competency to drive according to the DS test subsequently had 12-month scores deemed as not competent to drive; the difference between these 2 groups was not statistically significant (p > 0.99). Factors associated with a decline in the DS score among those who had a license at the time of initial assessment were an increasing age (p < 0.01) and mRS score > 0 at one of the assessments (initial, 6 weeks, or 12 months; p < 0.01). Mean PCS scores in the microsurgical repair group were 52 ± 8.1, 46 ± 6.8, and 52 ± 7.1 at the initial, 6-week, and 12-month assessments, respectively (p < 0.01). These values represented a significant decline in the mean PCS score at 6 weeks that recovered by 12 months (p < 0.01). There were no significant changes in the MCS, mBI, or mRS scores in the surgical group. CONCLUSIONS: Overall, QOL at 12 months for the microsurgical repair group had not decreased and was comparable to that in the conservatively managed group. Furthermore, as assessed by the DS test, the majority of patients were not affected in their ability to drive.
摘要：
目的：很少有研究对未破裂颅内动脉瘤（uIAs）显微手术修复后患者的驱动能力和生活质量（QOL）进行检查。然而,没有强有力的证据基础，管辖道路运输当局建议在脑部手术后限制驾驶。在本研究中,作者通过测量患者的感知生活质量和与驾驶相关的认知能力来检查uIAs的显微外科修复结果。方法：2011年1月至2016年1月，前瞻性纳入新诊断为uIA的患者。评估在转诊时进行，手术前,在接受显微外科手术修复的患者中，在手术后6周和12个月时，在转诊时以及在保守管理的患者中，在12个月时。评估包括SF-36的物理组件摘要（PCS）和精神组件摘要（MCS），越野驾驶员筛查仪器DriveSafe（DS），修改后的Barthel指数(MBI)，和改良的兰金量表(mRS)。结果：一百六十九名患者被纳入并完成了研究，和112（66％）的他们的动脉瘤的显微外科修复。在显微外科手术组中，DS评分有改善趋势:从术前的平均(±标准差)评分108±10.7,到术后6周的111±9.7,再到术后12个月的112±10.2(p=0.05).2％的显微外科修复组和4％的保守管理组，其初始得分表明根据DS测试具有驾驶能力，随后有12个月的得分被认为没有驾驶能力；这两组之间的差异没有统计学意义（p>0.99）。在初次评估时具有执照的人中，与DS评分下降相关的因素是年龄增加（p<0.01），并且其中一项评估中的mRS评分>0（初始，6周,或12个月；p<0.01)。显微外科修复组的平均PCS评分在初始时分别为52±8.1、46±6.8和52±7.1，6周,和12个月的评估，分别(p<0.01)。这些值表示平均PCS评分在6周时显著下降,在12个月时恢复(p<0.01)。MCS没有明显变化,MBI,或手术组的mRS评分。结论：总体而言，显微外科修复组在12个月时的QOL没有下降，并且与保守管理组相当。此外，根据DS测试的评估，大多数患者的驾驶能力没有受到影响.
