Treatment of Unruptured Intracranial Aneurysms and Cognitive Performance: Preliminary Results of a Prospective Clinical Trial

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• 作者：Elisabeth Brü ; ndl¹ ; ^{elisabeth.bruendl@ukr.de" class="auth_mail" title="E-mail the corresponding author} ; Christina Bö ; hm¹ ; Ralf Lü ; rding² ; Petra Schö ; del¹ ; Sylvia Bele¹ ; Andreas Hochreiter¹ ; Judith Scheitzach¹ ; Florian Zeman³ ; Alexander Brawanski¹ ; Karl-Michael Schebesch¹
• 关键词：Clip ; Cognition ; Coil ; Neuropsychological assessment ; Outcome ; Unruptured intracranial aneurysms
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：94
• 期：Complete
• 页码：145-156
• 全文大小：7285 K

文摘

Few studies have addressed the effect of treatment of unruptured intracranial aneurysm (UIA) on cognitive function.

Objective

ra0015">Neuropsychological assessment after UIA treatment is underreported, and prospective trials have repeatedly been demanded. In 2014, we conducted a prospective controlled study to evaluate the differences in cognitive processing caused by the treatment of anterior circulation UIAs.

Patients and Methods

ra0020">Thirty patients were enrolled until September 2015. Ten patients received endovascular aneurysm occlusion (EV), 10 patients were treated microsurgically (MS), and 10 patients with surgically treated degenerative lumbar spine disease (LD) served as control. All patients underwent extended standardized neuropsychological assessment before (t₁) and 6 weeks after treatment (t₂). Tests included verbal, visual, and visuospatial memory, psychomotor functioning, executive functioning, and its subdomains verbal fluency and cognitive flexibility. We statistically evaluated intragroup and intergroup changes.

Results

ra0025">Intragroup comparisons and group-rate analysis showed no significant impairment in overall neuropsychological performance, either postinterventionally or postoperatively. However, the postoperative performance in cognitive processing speed, cognitive flexibility, and executive functioning was significantly worse in the MS group than in the EV (P = 0.038) and LD group (P = 0.02). Compared with the EV group, patients with MS showed significant postoperative impairment in a subtest for auditory-verbal memory (Wechsler Memory Scale, Fourth Edition, Logical Memory II; MS vs. EV P = 0.011). The MS group trended toward posttreatment impairment in subtests for verbal fluency and semantic memory (Regensburg Word Fluency Test; MS vs. EV P = 0.083) and in auditory-verbal memory (Wechsler Memory Scale, Fourth Edition, Logical Memory II; MS vs. LD P = 0.06).

Conclusions

ra0030">Our preliminary data showed no effect of anterior circulation UIA treatment on overall neuropsychological function but impaired short-term executive processing in surgically treated patients.