gms | German Medical Science

64th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

26 - 29 May 2013, Düsseldorf

Subtle deficits and structural brain changes in patients with favorable outcomes after treatment of cerebral aneurysms: preliminary results of an ongoing clinical trial

Meeting Abstract

  • Maria Wostrack - Neurochirurgische Klinik des Klinikums Rechts der Isar, TU München
  • Benjamin Friedrich - Abteilung für Neuroradiologie des Klinikums Rechts der Isar, TU München
  • Katrin Hammer - Neurochirurgische Klinik des Klinikums Rechts der Isar, TU München
  • Kathrin Harmening - Neurochirurgische Klinik des Klinikums Rechts der Isar, TU München
  • Bernhard Meyer - Neurochirurgische Klinik des Klinikums Rechts der Isar, TU München
  • Yu-Mi Ryang - Neurochirurgische Klinik des Klinikums Rechts der Isar, TU München

Deutsche Gesellschaft für Neurochirurgie. 64. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Düsseldorf, 26.-29.05.2013. Düsseldorf: German Medical Science GMS Publishing House; 2013. DocDI.12.06

doi: 10.3205/13dgnc280, urn:nbn:de:0183-13dgnc2807

Published: May 21, 2013

© 2013 Wostrack et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Despite good neurological outcome after treatment of cerebral aneurysm with or without preceding subarachnoid hemorrhage (SAH) many patients are complaining about mood disorders and chronic headaches. We aimed to investigate whether the history of SAH or treatment modality are crucial for neuropsychological deficits and if any specific brain changes are associated with these disorders.

Method: 50 case-matched pairs of patients with or without previous SAH treated by surgical clipping or endovascular coiling are intended to be prospectively assessed by a test battery including Hospital Anxiety and Depression Scale (HADS), Beck depression inventory (BDI) and Headache Impact Test (HIT-6). Additionally, brain MRI including H1-MR spectroscopy to assess N-acetylaspartate (NAA), glutamate (Glu), and glutamate+glutamine (Glx) concentrations as well as volumetry of medial temporal atrophy are performed. So far, 37 consecutive patients were enrolled: n=27 with preceding SAH (coil n=9, clip n=18), n=10 with incidental aneurysms (coil n=5, clip n=5); MRI was performed in 29 cases.

Results: No substantial differences were found between patients with and without previous SAH in respect of depression, anxiety and headaches. However, we observed clearly higher mean scores in all tests in patients treated surgically vs. patients treated by coiling: HADS 13.9 vs 9.7; BDI 13.57 vs 11.26; HIT-6 52.57 vs 48.26, respectively. HADS scores were also increased in patients with multiple aneurysms resulting in multiple treatments: 13.18 vs 9.7 in those with single treatment. Spectroscopy revealed slight reductions of hippocampal Glx in patients with previous SAH: 0.013 vs 0.0109 in non-SAH subjects. All surgically treated patients showed lower mean concentrations of hippocampal NAA (0.00479 vs 0.00946), Glu (0.0065 vs 0.00835) and Glx (0.011 vs 0.013) compared to those treated by coiling. Hippocampal atrophy could be detected only in patients who suffered SAH or were treated surgically. A negative correlation between HADS scores and NAA and hippocampal volumes was observed.

Conclusions: Aneurysm surgery seems to be associated with higher morbidity in respect of mood disorders and headache compared to endovascular treatment independent of preceding SAH. Clipping and SAH may both cause structural and spectroscopic brain changes including loss of hippocampal volume, transmitter concentration and neuronal density. Mood disorders after aneurysm treatment correlate with hippocampal changes.