Fontanella M, Perozzo P, Ursone R, Garbossa D, Bergui M
Department of Neuroscience, Division of Neurosurgery, University of Torino, Italy.
Acta Neurochir (Wien). 2003 Oct;145(10):867-72; discussion 872. doi: 10.1007/s00701-003-0111-5.
After open surgery for ruptured ACoA aneurysms, several patients who have achieved a favourable neurological outcome still exhibit significant cognitive deficits. The aim of this study was to investigate the cognitive performances in patients with ACoA aneurysms submitted to different therapeutic options such as endovascular treatment and surgical clipping.
We evaluated 37 consecutive patients in WFNS grade I or II, who underwent an early treatment (within 48 hours) of a bleeding ACoA aneurysm: 20 out of 37 were surgically clipped (group A) and 17 were treated with endovascular coiling (group B). These two groups were compared with 16 patients (group C) with subarachnoid haemorrhage and negative cerebral panangiography and with 18 volunteers (group D) without neurological or psychiatric disorders. All patients were neurologically intact at discharge and were in Glasgow Outcome Scale 1 at 6 months follow-up after SAH. All subjects were tested to assess selective attention, verbal, spatial and logical memory, frontal lobe executive functions, language and intelligence. Depressive symptoms and anxiety were also examined.
Selective attention, verbal and spatial memory, and intelligence tests didn't show any significant difference between the patients and the controls. Surgically treated patients showed a significant worse performance on the logical memory and on the frontal lobe executive functions compared to controls, while the endovascular group and the group C (not treated) showed a significant decrease only in the literal fluency score.Moreover, the surgical group showed a significant impairment in using grammatical and syntactical rules to produce sentences. No significant difference was found between the group B, C and controls. Treated patients were not significantly more depressive or anxious than controls.
Investigation of neuropsychological deficits can show an impairment, even in patients classified as good outcome by Glasgow Outcome Scale (GOS). The frontal lobe functions and language are impaired especially in surgically treated in comparison with controls, but no significant difference was found respect to the endovascular and no treated patients (group C).
在进行前交通动脉（ACoA）动脉瘤破裂的开颅手术后，一些神经功能预后良好的患者仍表现出明显的认知缺陷。本研究的目的是调查接受不同治疗方案（如血管内治疗和手术夹闭）的ACoA动脉瘤患者的认知表现。
我们评估了37例世界神经外科联盟（WFNS）分级为I级或II级的连续患者，这些患者接受了出血性ACoA动脉瘤的早期治疗（48小时内）：37例中有20例接受了手术夹闭（A组），17例接受了血管内栓塞治疗（B组）。将这两组与16例蛛网膜下腔出血且全脑血管造影阴性的患者（C组）以及18例无神经或精神疾病的志愿者（D组）进行比较。所有患者出院时神经功能均完好，蛛网膜下腔出血（SAH）后6个月随访时格拉斯哥预后量表评分为1级。对所有受试者进行测试，以评估选择性注意力、言语、空间和逻辑记忆、额叶执行功能、语言和智力。还检查了抑郁症状和焦虑情况。
患者与对照组在选择性注意力、言语和空间记忆以及智力测试方面均未显示出任何显著差异。与对照组相比，接受手术治疗的患者在逻辑记忆和额叶执行功能方面表现明显更差，而血管内治疗组和C组（未治疗）仅在文字流畅性得分上有显著下降。此外，手术组在运用语法和句法规则造句方面有显著损害。B组、C组与对照组之间未发现显著差异。接受治疗的患者在抑郁或焦虑方面并不比对照组更明显。
神经心理学缺陷调查显示即使是格拉斯哥预后量表（GOS）分类为预后良好的患者也存在损害。与对照组相比，额叶功能和语言在接受手术治疗的患者中尤其受损，但在血管内治疗组和未治疗患者（C组）方面未发现显著差异。
