Effect of temporary clipping on frontal lobe functions in patients with ruptured aneurysm of the anterior communicating artery.
BACKGROUND
After surgery for ruptured anterior communicating artery (ACoA) aneurysm, several patients who have achieved a favorable neurological outcome yet have been observed to suffer from a poor cognitive outcome. The aim of this study was to explore the possible effects of temporary clip applications on frontal lobe functions in the patients with ruptured ACoA aneurysm.


METHODS
Forty patients were chosen among a series of cases who underwent an early surgery (within 96 h) after ACoA aneurysm bleeding. All of them were in Hunt-Hess grade 1 or grade 2. Of the 40 patients, temporary clipping was used in 22 patients (group A), whereas it was not used in 18 patients (group B). These two groups were compared with 20 volunteers (group C) without neurologic or psychiatric disorders.


RESULTS
The mean duration of temporary vessel occlusion for both A1 was 8.2 +/- 2.9 min (4-15) in group A. Neither clinical nor radiographic strokes were detected. An improvement in frontal lobe function occurred at long term in group B patients. Whereas, cognitive deficits were persisting at long-term follow-up in group A, especially in patients who had temporary clipping duration longer than 9 min.


CONCLUSIONS
The results emphasize that the negative effects of temporary vessel occlusion on cognitive changes occur before ischemic damage. Thus, such negative effects of temporary clipping on cognitive functions should not be neglected by surgeons during surgery.
Akyuz
M
M
Department of Neurosurgery, Akdeniz University Medical School, Antalya, Turkey.
Erylmaz
M
M
Ozdemir
C
C
Goksu
E
E
Ucar
T
T
Tuncer
R
R
D000293:Adolescent; D000328:Adult; D017542:Aneurysm, Ruptured / Q000503:physiopathology / Q000601:surgery*; D003072:Cognition Disorders / Q000175:diagnosis / Q000503:physiopathology*; D003399:Craniotomy; D005260:Female; D005625:Frontal Lobe / Q000098:blood supply* / Q000503:physiopathology; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery; D008875:Middle Aged; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D010043:Outcome and Process Assessment, Health Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology*; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000503:physiopathology / Q000601:surgery*; D013525:Surgical Instruments