Cognition following subarachnoid hemorrhage from anterior communicating artery aneurysm: relation to timing of surgery
Cognition following subarachnoid hemorrhage from anterior communicating artery aneurysm: relation to timing of surgery
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DOI：
10.3171/jns.1999.91.3.0402
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发表时间：
1999-09-01
影响因子：
4.1
通讯作者：
Kirkpatrick, PJ
中科院分区：
文献类型：
--
作者：
Mavaddat, N;Sahakian, BJ;Kirkpatrick, PJ
物体。本研究旨在明确前交通动脉(ACOA)动脉瘤破裂所致蛛网膜下腔出血(SAH)手术后的神经心理变化，并评价手术时机对夹闭SAH的影响。使用剑桥神经心理测试自动化电池对前交通动脉瘤患者的认知结果进行评估，该动脉瘤已导致蛛网膜下腔出血。对年龄在70岁以下、神经功能恢复良好(格拉斯哥预后评分为4或5)的成年患者在术后6至24个月进行研究。根据发病后手术时间将患者分为早期(0~3d)和晚期(3d后)两组。对手术时机视而不见的评价者进行了神经心理学分析。对47名平均年龄为51.5岁的患者进行了测试。他们与年龄和智商(IQ)匹配的对照组进行了比较，方法是使用全国成人阅读测试中估计的患病前智商。患者在语言流畅性、模式识别和空间工作记忆的多项任务中表现出缺陷；这种缺陷的轮廓与接受颞叶切除的患者相似。然而，早期手术组和晚期手术组之间的认知表现没有显著差异。在开放手术治疗破裂的前交通动脉瘤后，取得良好神经学结果的患者仍然表现出显著的认知缺陷，主要是在对颞叶功能障碍敏感的测试中。然而，早期手术并不会带来更高的神经心理残疾风险。
Object. This Study was conducted to define neuropsychological changes following operation for subarachnoid hemorrhage (SAH) caused by rupture of an anterior communicating artery (ACoA) aneurysm and to assess the influence of the timing of surgery to clip the aneurysm.Methods. Cognitive outcome was evaluated using the Cambridge Neuropsychological Test Automated Battery in patients with an ACoA aneurysm that had caused an SAH. Adult patients younger than 70 years of age who had achieved a favorable neurological outcome (Glasgow Outcome Scale scores of 4 or 5) were studied 6 to 24 months postsurgery. Patients were divided into early (Days 0-3) and late surgery groups (after Day 3) according to the timing of surgery after the ictus. Neuropsychological analysis was performed by reviewers who were blinded to the timing of surgery.Forty-seven patients whose mean age was 51.5 years were tested. They were compared with age- and intelligence quotient (IQ)-matched controls by using premorbid IQ as estimated on the National Adult Reading Test. Patients showed deficiencies in several tasks of verbal fluency, pattern recognition, and spatial working memory; this profile of deficits was similar to that seen in patients who underwent temporal lobe excisions. However, there was no significant difference in cognitive performance between the early and late surgery groups.Conclusions. After open surgery for ruptured ACoA aneurysms, patients who have achieved a favorable neurological outcome still exhibit significant cognitive deficits, primarily in tests sensitive to temporal lobe dysfunction. However, early surgery does not carry a higher risk of neuropsychological disability.