Coiling versus clipping for the treatment of aneurysmal subarachnoid hemorrhage: A longitudinal investigation into cognitive outcome
Coiling versus clipping for the treatment of aneurysmal subarachnoid hemorrhage: A longitudinal investigation into cognitive outcome
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DOI：
10.1227/01.neu.0000255335.72662.25
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发表时间：
2007-03-01
期刊：
影响因子：
4.8
通讯作者：
Cipolotti, Lisa
中科院分区：
文献类型：
--
作者：
Frazer, Duncan;Ahuja, Abha;Cipolotti, Lisa
目的：血管内弹簧圈栓塞已越来越多地用作神经外科夹闭术的替代方法，用于治疗动脉瘤破裂继发的蛛网膜下腔出血。本研究的目的是对动脉瘤性蛛网膜下腔出血患者的认知功能进行前瞻性、纵向研究。方法：前瞻性招募了 23 名在英国伦敦国家神经内科和神经外科医院接受动脉瘤性蛛网膜下腔出血治疗的患者。将 12 名接受手术夹闭的患者与 11 名接受血管内弹簧圈栓塞的患者进行比较。所有患者在急性期（治疗后 2 周内）均使用相同的一系列测试进行了全面、标准化的神经心理学评估。所有接受弹簧圈的患者以及 12 名接受夹闭术的患者中的 11 名在急性后长期随访（6 个月）阶段进行了重新评估。 结果：急性评估时的组比较显示，仅在一项言语回忆测量中，有利于弹簧圈患者的显着差异。然而，现阶段各组之间没有其他显着差异。在急性后评估中，夹住组在智力功能测量方面比盘绕组表现更好（P < 0.05），尽管在一系列认知测试中没有发现其他差异。急性和急性期之间的组内比较。急性后评估发现，两组患者的智力功能、记忆力、执行功能和信息处理速度方面的测量结果模棱两可，但均显着改善。结论：我们认为，血管内弹簧圈栓塞和手术夹闭之间的长期认知结果差异很小。在治疗后的急性期，我们认为，未接受神经外科干预的盘绕患者的认知结果可能比夹闭患者稍好。然而，这些差异逐渐趋于平稳，两组患者最终在急性后恢复阶段的认知功能都得到了广泛改善。
OBJECTIVE: Endovascular coiling has been used increasingly as an alternative to neurosurgical clipping for treating subarachnoid hemorrhage secondary to aneurysm rupture. The aim of the present study was to provide a prospective, longitudinal investigation into cognitive function in patients with aneurysmal subarachnoid hemorrhageMETHODS: Twenty-three patients who were treated for aneurysmal subarachnoid hemorrhage at the National Hospital for Neurology and Neurosurgery in London, England, were recruited prospectively. Twelve patients who underwent surgical clipping were compared with a group of 11 patients who underwent endovascular coiling. All patients underwent a comprehensive, standardized neuropsychological assessment using the same battery of tests at the acute stage (within 2 wk after treatment). All patients who underwent coiling and 11 of the 12 patients who underwent clipping were reassessed at the post-acute long-term follow-up (6 mo) stage.RESULTS: Group comparisons at the acute assessment revealed a significant difference favoring coiling patients on only one measure of verbal recall. However, there were no other significant differences, between the groups at this stage. At the post-acute assessment, the clipped group performed better than the coiled group on measures of intellectual functioning (P < 0.05), although no other differences were found on a range of cognitive tests. Intragroup comparisons between the acute and. post-acute assessments found equivocal, significant improvements in measures of intellectual functioning, memory, executive functions, and speed of information processing in both groups of patients.CONCLUSION: We argue that there are minimal differences in the long-term cognitive outcome between endovascular coiling and surgical clipping. In the acute phase after treatment, we suggest that coiled patients, having been spared neurosurgical intervention, may have a slightly better cognitive outcome than clipped patients. However, these differences level off and both groups of patients ultimately experience widespread improvement in cognitive functioning by the post-acute stage of recovery.