Shetova I M, Shtadler V D, Aronov M S, Piradov M A, Krylov V V
Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russia.
Zh Nevrol Psikhiatr Im S S Korsakova. 2023;123(3. Vyp. 2):41-49. doi: 10.17116/jnevro202312303241.
To study the long-term results of surgical treatment of patients operated on for cerebral aneurysms and their impact on functional recovery, independence and cognitive functions in the long-term period.
A multivariate regression analysis of long-term results of surgical treatment of 324 patients for cerebral aneurysms was performed (on average after 3.5 years). Upon admission of the patient to the hospital for surgical intervention, a clinical diagnostic examination was performed to confirm the diagnosis and determine the volume, timing and type of intervention. In the late period, a clinical neurological study was performed, which included an assessment of the degree of disability with the Barthel index and a modified Rankin scale, cognitive functions with MMSE, and the mental sphere with HADS.
The severity of the condition at admission, corresponding to grade III-IV according to the Hunt-Hess classification, was the risk factor for an unfavorable prognosis for the recovery of patients in the long-term period of cerebral aneurysm surgery. The severe condition of patients at the onset of the disease increases the risk of disability by 1.9 times (<0.05) and the risk of dementia by 6 times (<0.05). An independent risk factor for the development of cognitive impairment is the patient's age: with an increase in age by 1 year, the MMSE score decreases by 0.27 (<0.05). The prevalence of hemorrhage according to the Fisher classification, corresponding to grade III, is a predictor of the development of angiospasm in 91% of cases. In patients with established angiospasm, the risk of developing dementia and pre-dementia cognitive impairment was 57.3% (<0.05). The best predictions for recovery of cognitive functions in the long-term period were observed in patients who underwent simultaneous aneurysm clipping with extra-intracranial anastomosis (mean MMSE score 25) compared with patients who underwent only aneurysm clipping (mean score 20), endovascular intervention (average score 21) or microsurgical intervention followed by intrathecal fibrinolytic injection (mean MMSE score of 20) (<0.05).
The predictors of unfavorable recovery of cognitive functions and the development of disability in the long-term period of surgical treatment of cerebral aneurysms were the severity of the condition at admission, corresponding to III-IV st. according to the Hunt-Hess classification, the age of the patient at the time of the intervention, the prevalence of hemorrhage according to Fisher, and the choice of surgical technique.
研究脑动脉瘤手术患者的长期手术效果及其对长期功能恢复、独立性和认知功能的影响。
对324例脑动脉瘤手术患者的长期手术效果进行多因素回归分析（平均术后3.5年）。患者入院接受手术干预时，进行临床诊断检查以确诊并确定干预的范围、时机和类型。在后期，进行临床神经学研究，包括用巴氏指数和改良Rankin量表评估残疾程度、用简易精神状态检查表评估认知功能以及用医院焦虑抑郁量表评估心理状态。
根据Hunt-Hess分级，入院时病情严重程度为III-IV级，是脑动脉瘤手术患者长期恢复预后不良的危险因素。疾病发作时患者的严重病情使残疾风险增加1.9倍（<0.05），痴呆风险增加6倍（<0.05）。认知障碍发生的独立危险因素是患者年龄：年龄每增加1岁，简易精神状态检查表评分降低0.27（<0.05）。根据Fisher分级，III级出血的发生率是91%病例中血管痉挛发生的预测指标。在已发生血管痉挛的患者中，发生痴呆和痴呆前认知障碍的风险为57.3%（<0.05）。与仅接受动脉瘤夹闭术（平均评分20）、血管内介入治疗（平均评分21）或显微手术加鞘内纤维蛋白溶解注射术（平均简易精神状态检查表评分为20）的患者相比，同时进行动脉瘤夹闭术和颅内外吻合术的患者在长期认知功能恢复方面的预测效果最佳（平均简易精神状态检查表评分25）（<0.05）。
脑动脉瘤手术治疗长期认知功能恢复不良和残疾发生的预测因素是入院时病情严重程度（根据Hunt-Hess分级为III-IV级）、干预时患者年龄、Fisher分级的出血发生率以及手术技术的选择。
