Article
Neurosurgical clipping as a predictive factor of cognitive dysfunctions?
Neurochirurgische Clippung als prädiktiver Faktor kognitiver Funktionsstörungen?
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Published: | May 4, 2005 |
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Outline
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Objective
Whether clipping or coiling is the best treatment option in cerebral aneurysms, one may assume in this ongoing debate that neurosurgical manipulation has an potential influence on cognitive dysfunctions due to the manipulation of the brain. A comparative study of perimesencephalic and aneurysmal SAH-patients as well as patients undergoing elective aneurysm surgery was carried out to differentiate the potential impact of SAH and surgical manipulation on long-term neuropsychological outcome.
Methods
Good neurological recovery at discharge was the inclusion criteria for standardized psychological testing concerning attention, memory, executive functions, intelligence and mood. Mean time from hospital discharge to reinvestigation was 23.43;20.50;30.43 months. There were 14 patients with a mean age of 53.9 years with a perimesencephalic SAH (Group C), Hunt&Hess (H&H) grade I-III, 13 SAH-patients (Group A), H&H grade I-III with a mean age of 52.6 years and 15 patients (mean age 53.5 years) who were surgically clipped on incidental anterior circulation aneurysms (Group B).
Results
In the psychological tests no significant differences could have been found between perimesencephalic, aneurysmal SAH and patients with an incidental diagnosed and treated aneurysm (p>0.075). Compared with age correlated normal controls all three groups showed no significant impairment in their cognitive functions (p>0.075).
Conclusions
SAH-patients, independent of its origin, without focal-neurological deficits on discharge are expected to show unsuspicious neuropsychological test results on long-term follow-up. In spite these results do not differ from patients undergoing elective aneurysm surgery, we conclude that neurosurgical manipulation does not worsen the psychological long-term outcome overall in patients with cerebral aneurysms.