Introduction: Influence of postoperative brain damage and subdural fluid collection (SDFC) for neuropsychological function, and risk factors of its occurrence were studied in patients with unruptured cerebral aneurysms (UCAs).
Methods: In 108 clipping surgeries for 105 patients with UCAs, all patients completed the Wechsler Adult Intelligence Scale-Revised (WAIS-R) before and 1 month postoperatively. Deep white matter hyper-intensities (DWMH) and brain atrophy were evaluated on preoperative magnetic resonance imaging (MRI). Brain damage (large; 1 cm or more, small; smaller than 1 cm) and SDFC (thick; midline shift observed, thin; mass effect only) were evaluated on postoperative MRI. A decrease of 4 points or more in the WAIS-R score postoperatively was interpreted as deterioration.
Results: Twenty-five of 108 surgeries showed deterioration of WAIS-R postoperatively. Brain damage on MRI was observed in 15 surgeries (large; 7, small; 8), and 6 of those (40%) showed deterioration of WAIS-R. WAIS-R deteriorated more frequently in patients with large brain damage (4 of 7, 57%) than in those without it (19 of 93, 20%) (p<0.05). Brain damage occurred more frequently in patients with DWMH (5 of 23, 22%) than in those without DWMH (2 of 43, 5%) (p<0.05), and in patients with AcomA aneurysm (5 of 26, 19%) than in those with MCA aneurysm (1 of 33, 3%) (p<0.05). SDFC was observed in 14 surgeries (thick; 5, thin; 9), and 4 of those (29%) showed deterioration of WAIS-R. WAIS-R deteriorated more frequently in patients with thick SDFC (2 of 5, 40%) compared with those without SDFC (21 of 94, 22%). SDFC occurred more frequently in patients with brain atrophy (11 of 36, 31%) than in those without it (3 of 72, 4%) (p<0.01).
Conclusions: Neuropsychological dysfunction due to brain damage or SDFC was observed after clipping UCAs. The aneurysm location, presence of DWMH or brain atrophy was related to its occurrence.
Patient Care: I will evaluate the surgical results and amend the selection of patients and treatment method in order to improve patient outcome.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of patient selection for surgery, 2) Discuss the surgical approach for unruptured cerebral aneurysm, and 3) Identify an ideal treatment for unruptured cerebral aneurysm.