Mohanty Manju, Dhandapani Sivashanmugam, Gupta Sunil Kumar, Shahid Adnan Hussain, Patra Devi Prasad, Sharma Anchal, Mathuriya Suresh N
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
World Neurosurg. 2018 Sep;117:e430-e437. doi: 10.1016/j.wneu.2018.06.048. Epub 2018 Jun 18.
The cognitive impairments after treatment of ruptured aneurysms have often been underestimated. This study sought to assess their prevalence and analyze various associated factors.
Patients who were operated on for ruptured anterior circulation aneurysms and discharged with a Glasgow Outcome Scale score of 4-5 were studied at 3 months for various cognitive impairments. Continuous scales of memory (recent, remote, verbal, visual, and overall memory), verbal fluency (phonemic and category fluency), and others were studied in relation to various factors. Univariate and multivariate analyses were performed using SPSS version 21.
A total of 87 patients were included in our study. Phonemic fluency was the most affected, noted in 66% of patients. Although 56% had some memory-related impairments, 13 (15%) and 6 (7%) had moderate and severe deficits in recent memory and 19 (22%) and 12 (14%) had moderate and severe deficits in remote memory, respectively. Patients operated on for anterior cerebral artery (ACA) aneurysms had significantly greater impairments in recent (34% vs. 8%) and remote memory (43% vs. 28%) compared with the rest, both in univariate (P = 0.01 and 0.002, respectively) and multivariate analyses (P = 0.01 and 0.03, respectively). ACA-related aneurysms also had significantly greater independent impairments in phonemic fluency (P = 0.04), compared with others. The clinical grade had a significant independent impact only on remote memory (P = 0.01).
Cognitive impairments are frequent after treatment of ruptured anterior circulation aneurysms. Impairments in recent memory, remote memory, and phonemic fluency are significantly greater after treatment of ACA-related aneurysms, compared with others, independent of other factors.
破裂动脉瘤治疗后的认知障碍常常被低估。本研究旨在评估其发生率并分析各种相关因素。
对接受破裂前循环动脉瘤手术且出院时格拉斯哥预后评分4 - 5分的患者，在术后3个月研究各种认知障碍情况。研究了记忆（近期、远期、言语、视觉和总体记忆）、言语流畅性（音素流畅性和类别流畅性）等连续性量表与各种因素的关系。使用SPSS 21版进行单因素和多因素分析。
本研究共纳入87例患者。音素流畅性受影响最大，66%的患者存在该问题。虽然56%的患者有一些与记忆相关的障碍，但分别有13例（15%）和6例（7%）存在近期记忆中度和重度缺陷，19例（22%）和12例（14%）存在远期记忆中度和重度缺陷。在单因素分析（分别为P = 0.01和0.002）和多因素分析（分别为P = 0.01和0.03）中，与其他患者相比，接受大脑前动脉（ACA）动脉瘤手术的患者近期记忆（34%对8%）和远期记忆（43%对28%）的障碍明显更严重。与其他动脉瘤相比，ACA相关动脉瘤在音素流畅性方面也有明显更大的独立障碍（P = 0.04）。临床分级仅对远期记忆有显著的独立影响（P = 0.01）。
破裂前循环动脉瘤治疗后认知障碍很常见。与其他动脉瘤相比，ACA相关动脉瘤治疗后近期记忆、远期记忆和音素流畅性的障碍明显更严重，且不受其他因素影响。
