Importance of neuropsychological evaluation after surgery in patients with unruptured cerebral aneurysms.
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.
Department of Neurological Surgery, Ehime University School of Medicine, Ehime, Japan.
Shiro
S
Ohue
Yoshihisa
Y
Oka
Yoshiaki
Y
Kumon
Shinsuke
S
Ohta
Saburo
S
Sakaki
Takao
T
Hatakeyama
Toshitaka
T
Shiraishi
Sadanori
S
Takeda
Takanori
T
Ohnishi
D000328:Adult; D000367:Age Factors; D000368:Aged; D001921:Brain / Q000098:blood supply; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000523:psychology* / Q000601:surgery*; D008297:Male; D008609:Mental Status Schedule; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D012039:Regional Blood Flow; D014055:Tomography, Emission-Computed; D016896:Treatment Outcome