gms | German Medical Science

Objective: Cognitive deficits are widely described in patients with aneurysmal subarachnoid haemorrhage. However, only few series report on neuropsychological outcome after elective treatment of unruptured aneurysms. In this context, several authors have suggested that surgical clipping may lead to a neuropsychological deterioration and may impair the quality of life. The aim of this study was to assess the impact of elective aneurysm surgery on mental health and neuropsychological state.

Method: Thirteen patients which underwent surgical clipping of purely incidental aneurysms were prospectively assessed by a test battery including Wechsler Memory Scale (WMS), D2 test of attention and concentration (D2), Multiple-Choice Vocabulary Intelligence Test (MWT-B), Hospital Anxiety and Depression Scale (HADS), and Brief Symptom Index (BSI) before surgery, at discharge, and 6 weeks after treatment. Pair-Sample Wilcoxon signed-rank test was used to compare preoperative, postoperative and follow-up test results.

Results: There were 8 female and 5 male patients with a mean age of 57 years (range 42 - 72 years). 9 left-sided and 4 right-sided craniotomies were performed. During the follow-up period or already at discharge significant improvement was observed by applied neuropsychological tests. WMS demonstrated significant amelioration in all tested domains: auditive (p=0.003), visual (p=0.003), visual working (p=0.01), immediate (p=0.001), and delayed memory (p=0.003), respectively. Additionally, significant upgrade of D2 results was found after the surgery in both overall and error-corrected rates (p=0.023, and p=0.019, respectively). Furthermore, the levels of anxiety (p=0.012) and depression (p=0.016) decreased significantly during the postoperative follow-up period as measured by HADS. Finally, the levels of psychological distress were significantly reduced according to all BSI subtests: global severity index p=0.025, positive symptom total reduction p=0.015, and positive symptom distress index p=0.037, respectively. No changes in MWT-B results were found after the surgery.

Conclusions: In the short-term, clipping of unruptured aneurysms seems to have no negative impact on cognitive and psychological status. In contrast, patients with incidental aneurysms may benefit from elective aneurysm surgery in terms of mental health and cognitive abilities.