Postoperative cognitive dysfunction after endovascular treatments for unruptured intracranial aneurysms: A pilot study

Abstract

Objective Post operative cognitive dysfunction (POCD) has been widely observed after major surgery, particularly in elderly patients with general anesthesia (GA). However, a specific unanswered question is whether different approaches to anesthetic managements are associated with different cognitive outcomes after endovascular treatments for unruptured intracranial aneurysms (UIAs). The purpose of this study is to assess the correlation of POCD with GA versus monitored anesthesia care (MAC). Methods We performed a pragmatic, prospective study to assess the association between different anesthetic approaches and POCD. We compared the pre- and post-procedural Montreal Cognitive Assessment (MoCA) scores in patients with normal cognition who underwent treatments of UIAs with various endovascular methods, using either GA or MAC. Results A total of 23 patients with UIAs were enrolled in the study. Seven (30.4%) and sixteen (69.6%) UIAs were treated without perioperative complications under GA or MAC, respectively. There was a significant decline in the post-procedural MoCA score under GA (mean difference = 1.14; 95% confidence interval = [0.42–1.87], P < 0.01). By contrast, there was no significant difference of MoCA score between pre- and post-procedure under MAC (mean difference = 0.19; 95% confidence interval = [−0.29–0.67], P = 0.59). Conclusions Treating UIAs using MAC was associated with a decrease in POCD as compared to GA in patients undergoing endovascular treatments for UIAs with normal cognition. Larger randomized studies are needed to confirm these findings.

Considering Psychological and Cognitive Factors in Interventional Neuroradiology: A Systematic Literature Review

“…Among them, 11/15 studies included prospective analysis, and in 5/11, a pre-and posttreatment cognitive status assessment was performed. 50,51,53,54,58 Only 1/15 was an RCT. [5][6][7] The 4 retrospective studies 17,49,52,56 involved patients with RIAs (1/4) 49 and patients with UIAs (1/4), 52 patients with endovascular treatment (1/4), 56 and patients with AVMs (1/4).…”

“…54 In general terms, carefully monitored anesthesia contributes to improved postoperative cognitive outcomes. 52,53 The 4/15 articles investigating patients with acute stroke treated by mechanical thrombectomy, alone or in combination with thrombolysis, 3,56 demonstrated that mechanical thrombectomy improves cognitive performance. 55,57 The 2/15 articles in this group using advanced fMRI highlighted possible rearrangements of the neuronal network related to cognitive decline and potential recovery after treatment in patients with cerebrovascular malformations (AVMs and DAVFs).…”

Effect of exercise-nutrition-psychology oriented nursing in patients undergoing interventional embolization for intracranial aneurysm

“…The patient's family members were taught of abdominal massage techniques to give the patients massage every morning and evening, and the correct way of defecation was educated, avoiding excessive force that may trigger cardiac arrhythmia. All of these can further improve the health behavior of patients and promote rapid recovery [31,32].…”