Craniotomy for Treatment of Unruptured Aneurysms Is Not Associated With Long-Term Cognitive Dysfunction

Abstract

Background and Purpose-Many studies have reported frequent cognitive deficits associated with subarachnoid hemorrhage (SAH) and aneurysm repair. One study found more severe cognitive deficits after clipping than coiling of aneurysms, raising the possibility that deficits are due to surgery instead of SAH itself. This possibility was directly addressed by evaluating the cognitive effects of surgery without SAH. The goal of this study was to identify changes in cognitive function associated with surgical clipping of unruptured intracerebral aneurysms. Methods-A consecutive series of 25 patients who underwent surgical clipping of Ն1 unruptured intracerebral aneurysm were tested within 1 week preoperatively and again postoperatively (before hospital discharge and at 3-month follow-up if they had deficits at discharge) on a neuropsychological battery. Different forms of each test were used preoperatively and postoperatively to reduce practice effects. Paired t tests were used to examine differences between preoperative and postoperative test scores across individuals. Results-On most tests, there was no significant change between preoperative and postoperative scores. A significant decline in accuracy before hospital discharge was found only in figure copying (PϽ0.04) and associative learning (PϽ0.01), and significant slowing was found on 1 test (PϽ0.01). Even on these tests, only 3 of 25 patients showed significant deterioration. All but 1 patient returned to baseline by the 3-month follow-up. Conclusions-We found no evidence of subtle cognitive deficits resulting from aneurysm clipping alone, suggesting that the common impairments after surgery for ruptured aneurysms are due to SAH itself, complications of SAH such as vasospasm or hydrocephalus, or perioperative stroke.

Cognitive Function Before and After Surgery in Patients With Unruptured Intracranial Aneurysm

“…3 Other previous cognitive study confirmed safe surgery for UIAs, although no CBF study was done. 9 Our results confirmed that neither cognitive function nor CBF decreased after surgery. Previous research showed that surgical repair of UIAs does not affect CBF if the surgery can be completed with fine surgical manipulation.…”

Guidelines for the Management of Patients With Unruptured Intracranial Aneurysms

“…210,211 There have been contradictory results in series that used more comprehensive neuropsychological batteries. 210,212,213 Nonetheless, it appears that standard outcomes instruments such as the mRS and the Glasgow Outcome Scale do not correlate with results of the Mini-Mental State Examination after aneurysm surgery, 214 and thus, the incorporation of cognitive assessment of patients can provide additional useful outcomes information. A number of small series have also examined quality of life using health outcome scales such as the Short Form-36 and the Hospital Anxiety and Depression Scale (HADS).…”

Management of incidentally discovered intracranial vascular abnormalities

“…Along similar lines, surgical treatment has produced low rates of morbidity and mortality in patients with unruptured aneurysms in expert hands. 5,108,109,123,141 Tuffiash et al 141 demonstrated no cognitive effects of craniotomy for unruptured aneurysms. Furthermore, the unparalleled team of Dr. Charles Drake and colleagues was able to clip unruptured basilar bifurcation aneurysms smaller than 12.5 mm in diameter with a 3.6% risk of poor outcome and no mortality.…”