Importance of neuropsychological evaluation after surgery in patients with unruptured cerebral aneurysms

Surg Neurol. 2003 Apr;59(4):269-75; discussion 275-6. doi: 10.1016/s0090-3019(03)00043-0.

Abstract

Background: We evaluated neuropsychological function before and after surgery in patients with unruptured cerebral aneurysms.

Methods: Neuropsychological functions in 43 patients with unruptured cerebral aneurysms were evaluated before and 1 month after surgery. The neuropsychological examination included the Mini-Mental State examination, "Kana-hiroi" test, Kohs Block Design test, and Miyake's Memory test. Then, if scores of even a single test were decreased 1 month after surgery, the tests were performed again 5 months later. In 24 of the 43 subjects, cerebral blood flow (CBF) was measured before and 1 month after surgery by single-photon emission tomography.

Results: The outcome in all patients was evaluated as good according to the Glasgow Outcome Score (GOS). In 17 (40%) of the 43 patients, neuropsychological function had deteriorated 1 month after surgery. The most sensitive test applied was the Miyake's Memory test. Of 14 patients with neuropsychological deterioration 1 month after surgery, 6 showed complete recovery, 5 showed partial recovery, and 3 still showed cognitive deterioration 6 months after surgery. Patients over 65 years old, those with anterior communicating artery aneurysms, those operated by interhemispheric approach, or those with systemic diseases showed a greater tendency toward a decline in postoperative neuropsychological function than the other patients. The postoperative CBF and vascular response in the frontal lobe of affected-side was decreased in cases showing cognitive deterioration.

Conclusions: These results suggested that the neuropsychological outcomes after surgery for unruptured cerebral aneurysms were not satisfactory.

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Brain / blood supply
  • Cognition Disorders / diagnosis
  • Cognition Disorders / etiology*
  • Female
  • Humans
  • Intracranial Aneurysm / complications
  • Intracranial Aneurysm / psychology*
  • Intracranial Aneurysm / surgery*
  • Male
  • Mental Status Schedule*
  • Middle Aged
  • Neuropsychological Tests
  • Prospective Studies
  • Regional Blood Flow
  • Tomography, Emission-Computed
  • Treatment Outcome