Skip to main content

Advertisement

SpringerLink
Log in

Early neuropsychological sequelae of aneurysm surgery and subarachnoid haemorrhage

  • Clinical Articles
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

In order to disclose the immediate cognitive sequelae of early aneurysm surgery and subarachnoid haemorrhage (SAH), a series of 28 patients was examined neuropsychologically one to 13 days (median 5 days) after surgery. Cognitive deficits emerged in short- and long-term memory, language and in different functions of attention. There was no effect of ACoA aneurysm location on neuropsychological test performance. No substantial effect of premature aneurysm rupture or surgical approach could be revealed. Temporary clipping of vessels was associated with significantly worse selective attention and phasic alertness (p < 0.05, respectively). Partial resection of the gyrus rectus led to a worse short-term memory (p = 0.02). In regression analyses, the duration of temporary clipping was associated with worse short-term memory (adjusted r2 = 0.68; p = 0.007) and decreased phasic alertness (adjusted r2 = 0.47; p = 0.035). The clinical state on admission (Hunt and Hess) predicted an impaired phasic alertness (adjusted r2 = 0.43; p = 0.004). It is concluded from the results, that certain procedures and events in aneurysm surgery can have neuropsychological effects. The present study is restricted by the small sample size. Therefore, a prospective study with a larger patient sample is required for further confirmation of the present findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Amthauer R (1953) Der Intelligenz-Struktur-Test IST. Hogrefe, Göttingen

    Google Scholar 

  2. Arena R, Gainotti G (1978) Constructional apraxia and visuopractic disabilities in relation to laterality of cerebral lesions. Cortex 14: 463–473

    PubMed  Google Scholar 

  3. Barbarotto R, De Santis A, Basso A, Spagnoli D, Capitani E (1989) Neuropsychological follow-up of patients operated for aneurysms of the middle cerebral artery and posterior communicating lesions. Cortex 25: 275–288

    PubMed  Google Scholar 

  4. Batjer H, Samson D (1986) Intraoperative aneurysm rupture: incidence, outcome and suggestions for surgical management. Neurosurgery 18: 701–707

    PubMed  Google Scholar 

  5. Benton AL (1981) Der Benton Test. Huber, Bern

    Google Scholar 

  6. Bornstein RA, Weir BK, Petruk KC, Disney LB (1987) Neuropsychological function in patients after subarachnoid hemorrhage. Neurosurgery 21: 651–654

    PubMed  Google Scholar 

  7. Brickenkamp R (1978) Test d2. Aufmerksamkeits-Belastungs-Test. Hogrefe, Göttingen

    Google Scholar 

  8. Chansky N (1967) Validity of the Benton visual retention test. Percept Mot Skills 24: 1126

    Google Scholar 

  9. Charbel FT, Ausman JI, Dias FG, Malik GM, Dujovny M, Sanders J (1991) Temporary clipping in aneurysm surgery: technique and results. Surg Neurol 36: 83–90

    PubMed  Google Scholar 

  10. Damasio AR, Tranel D, Damasio H (1989) Amnesia caused by herpes simplex encephalitis, infarctions of the basal forebrain, Alzheimer's disease and anoxia/ischemia. In: Squire L, Gainotti G (eds) Handbook of neuropsychology, Vol 3. Elsevier, Amsterdam, pp 149–166

    Google Scholar 

  11. De Luca J (1992) Cognitive dysfunction after aneurysm of the anterior communicating artery. J Clin Exp Neuropsychol 14: 924–934

    PubMed  Google Scholar 

  12. Deruty R, Patet JD, Mottolese C, Portilla F (1988) Long-term outcome of the management of ruptured intracranial aneurysm: review of 328 consecutive patients treated over a period of 12 years. Neurol Res 10: 217–220

    PubMed  Google Scholar 

  13. Deruty R, Pelissou-Guyotat I, Mottolese C, Bognar L, Oubouklik A (1992) Surgical management of unruptured intracranial aneurysms. Acta Neurochir (Wien) 119: 35–41

    Google Scholar 

  14. De Santis A, Laiacona M, Barbarotto R, Basso A, Villani R, Spagnoli D, Capitani E (1989) Neuropsychological outcome of patients operated upon for an intracranial aneurysm. Analysis of general prognostic factors and of the effects of the location of the aneurysm. J Neurol Neurosurg Psychiatry 52: 1123–1140

    Google Scholar 

  15. Essen C, Jakobsen K-E, Löfgren J, Roos A, Starmark J-E, Stephensen H, Billing M, Svensson E (1991) Complexity of recovery following ruptured intracranial aneurysm and operation. Paper presented at the Proceedings of the Annual Congregation of the Swedish Medical Association, Stockholm

  16. Fisher CM, Kistler JP, Davis JM (1980) Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 6: 1–9

    PubMed  Google Scholar 

  17. Gade A (1992) Amnesia after operations on aneurysms of the anterior communicating artery. Surg Neurol 18: 46–49

    Google Scholar 

  18. Gilsbach JM, Harders AG (1989) Morbidity and mortality after early aneurysm surgery — a prospective study with nimodipine prevention. Acta Neurochir (Wien) 96: 1–7

    Google Scholar 

  19. Gilsbach JM, Harders AG, Eggert HR, Hornyak ME (1988) Early aneurysm surgery: a 7 year clinical practice report. Acta Neurochir (Wien) 90: 91–102

    Google Scholar 

  20. Gilsbach JM, Reulen HJ, Ljunggren B, Brandt L, Avon Holst H, Mokry M, von Essen C, Conzen MA (1990) Early aneurysm surgery and preventive therapy with intravenously administered nimodipine: a multicenter, double-blind, dose-comparison study. Neurosurgery 26: 458–464

    PubMed  Google Scholar 

  21. Grady CL, Grimes AM, Petronas N (1989) Divided attention as measured by dichotic speed performance in dementia of the Alzheimer type. Arch Neurol 46: 317–330

    PubMed  Google Scholar 

  22. Greenberg IM (1984) Cerebral aneurysm rupture during neurosurgery. Neurosurgery 15: 243–245

    PubMed  Google Scholar 

  23. Hahlweg K, Kühnlein I (1981) Die Bewährung des Benton Test in der psychiatrischen Klinik I Aufgabenanalyse und Bestimmung der inneren Konsistenz II Konstruktvalidität und differentielle Gültigkeit. Diagnostica 27: 1–17

    Google Scholar 

  24. Hütter BO, Gilsbach JM (1992) Cognitive deficits after rupture and early repair of anterior communicating artery aneurysms. Acta Neurochir (Wien) 116: 6–13

    Google Scholar 

  25. Hütter BO, Gilsbach JM (1993) Which neuropsychological deficits are hidden behind a good Outcome (Glasgow = I) after aneurysmal subarachnoid hemorrhage? Neurosurgery 33: 999–1006

    PubMed  Google Scholar 

  26. Hütter BO, Gilsbach JM, Kreitschmann I (1994) Is there a difference in cognitive deficits after aneurysmal subarachnoid hemorrhage and subarachnoid hemorrhage of unknown origin? Acta Neurochir (Wien) 127: 129–135

    Google Scholar 

  27. Hunt WE, Hess RM (1968) Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 28: 14–20

    PubMed  Google Scholar 

  28. Inagawa T, Hada H, Katoh Y (1992) Unruptured intracranial aneurysms in elderly patients. Surg Neurol 38: 364–370

    PubMed  Google Scholar 

  29. Jabre A, Symon L (1987) Temporary vascular occlusion during aneurysm surgery. Surg Neurol 27: 47–63

    Google Scholar 

  30. Jennett B, Bond M (1975) Assessment of outcome after severe brain damage. A practical scale. Lancet 1(1): 480–484

    PubMed  Google Scholar 

  31. Kidooka M, Nakasu Y, Watanabe K, Matsuda M, Handa J (1987) Monitoring of somatosensory evoked potentials during aneurysm surgery. Surg Neurol 27: 69–76

    Google Scholar 

  32. Laiacona M, De Santis A, Barbarotto R, Basso A, Spanioli D, Capitani E (1989) Neuropsychological follow-up of patients operated for aneurysms of the anterior communicating artery. Cortex 25: 261–273

    PubMed  Google Scholar 

  33. Ljunggren B, Sonesson B, Säveland H, Brandt L (1985) Cognitive impairment and adjustment in patients without neurological deficits after aneurysmal SAH and early operation. J Neurosurg 62: 673–679

    PubMed  Google Scholar 

  34. Maurice-Williams RS, Willison RJ, Hatfield R (1991) The cognitive and psychological sequelae of uncomplicated aneurysm surgery. J Neurol Neurosurg Psychiatry 54: 335–340

    PubMed  Google Scholar 

  35. McKenna P, Willison JR, Lowe D, Neil-Dwyer G (1989) Cognitive outcome and quality of life one year after subarachnoid hemorrhage. Neurosurgery 24: 361–367

    PubMed  Google Scholar 

  36. Momma F, Wang AD, Symon L (1987) Effects of temporary arterial occlusions on somatosensory evoked response in aneurysm surgery. Surg Neurol 27: 343–352

    PubMed  Google Scholar 

  37. Moosbrugger W (1987) Multivariate statistische Verfahren. Kohlhammer, Stuttgart

    Google Scholar 

  38. Mooig JJ, Buchthal A, Belopavlovic M (1987) Somatosensory evoked potential monitoring of temporary middle cerebral artery occlusion during aneurysm operation. Neurosurgery 21: 492–496

    PubMed  Google Scholar 

  39. Morecraft RJ, Geula C, Mesulam MM (1992) Cytoarchitecture and neural afferents of orbitofrontal cortex in the brain of the monkey. J Comp Neurol 323: 341–358

    PubMed  Google Scholar 

  40. Nebes RD, Brady CB (1989) Focused and divided attention in Alzheimer's disease. Cortex 25: 305–315

    PubMed  Google Scholar 

  41. Nestor PG, Parasuraman R, Haxby JV (1991) Divided attention and metabolic brain dysfunction in mild dementia of the Alzheimer's type. Neuropsychologia 29: 379–387

    PubMed  Google Scholar 

  42. Ogden JA, Mee EW, Henning M (1993) A prospective study of impairment of cognition and memory and recovery after subarachnoid hemorrhage. Neurosurgery 33: 572–587

    PubMed  Google Scholar 

  43. Orgass B (1982) Deutsche Bearbeitung des Token Tests von E DeRenzi und LA Vignolo. Beltz, Weinheim

    Google Scholar 

  44. Perneczky A, Koos WT (1982) Special remarks on microsurgical techniques for cerebral aneurysms. Acta Neurochir (Wien) 63: 101–103

    Google Scholar 

  45. Posner MI (1982) Cumulative development of attentional theory. Am Psychol 37: 168–179

    Google Scholar 

  46. Posner MI, Petersen ST (1990) The attentional system of the human brain. In: Cowan WM, Shooter EM, Stevens CF, Thompson RF (eds) Annual review of neuroscience, Vol 13. Annual Reviews, Palo Alto, pp 25–42

  47. Rauchfleisch U (1983) Zur Rehabilität und Validität des Aufmerksamkeits-Belastungs Tests (Test d2) bei Patienten mit hirndiffusem Psychosyndrom und neurotischen Störungen. Diagnostica 24: 247–255

    Google Scholar 

  48. Richardson JT (1989) Performance in free recall following rupture and repair of intracranial aneurysm. Brain Cogn 9: 210–226

    PubMed  Google Scholar 

  49. Scheurer H, Quast A, Richter P, Erbacher H, Kröber HL (1994) Testtheoretische Analyse des Benton Tests aufgrund einer Stichprobe männlicher Gewalttäter. Diagnostica 40: 363–374

    Google Scholar 

  50. Schramm J, Koht A, Schmidt G, Pechstein U, Taniguchi M, Fahlbusch R (1990) Surgical and electrophysiological observations during clipping of 134 aneurysms with evoked potential monitoring. Neurosurgery 26: 61–70

    PubMed  Google Scholar 

  51. Schubö J (1990) SPSS Handbuch der Programmversionen SPSS 4.0 und SPSSx 3.0. Gustav Fischer, Stuttgart

    Google Scholar 

  52. Seifert V, Stolke D, Trost HA, Brüning A, Schäffer J (1989) Incidence, management and outcome of patients with premature rupture of cerebral aneurysms during surgery. In: Frowein RA, Brock M, Klinger M (eds) Advances in neurosurgery, Vol 17. Springer, Berlin Heidelberg New York Tokyo, pp 203–207

    Google Scholar 

  53. Sonesson B, Säveland H, Ljunggren B, Brandt L (1989) Cognitive functioning after subarachnoid haemorrhage of unknown origin. Acta Neurol Scand 80: 400–410

    PubMed  Google Scholar 

  54. Steck P, Beer U, Frey A, Frühschütz HG, Körner A (1990) Testkritische Überprüfung einer 30-Item Version des Visual Retention Tests nach AL Benton. Diagnostica 36: 38–49

    Google Scholar 

  55. Tidswell P, Dias PS, Sagar HJ, Mayes AR, Battersby RDE (1995) Cognitive outcome after aneurysm rupture: relationship to aneurysm site and perioperative complications. Neurology 45: 875–882

    PubMed  Google Scholar 

  56. Vilkki J, Holst P, Öhman J, Servo A, Heiskanen O (1990) Social outcome related to cognitive performance and computed tomographic findings after surgery for a ruptured intracranial aneurysm. Neurosurgery 26: 579–585

    PubMed  Google Scholar 

  57. Wassmann H, Werner C, Stockert A (1989) Temporary vessel occlusion by microvascular clips. In: Frowein RA, Brock M, Klinger M (eds) Advances in neurosurgery, Vol 17. Springer, Berlin Heidelberg New York Tokyo, pp 208–213

    Google Scholar 

  58. Yaşargil MG (1984) Microneurosurgery, Vol II. Thieme, Stuttgart

    Google Scholar 

  59. Zimmermann P, Fimm B (1992) Testbatterie zur Aufmerksamkeitsprüfung (TAP) Version 1.02. Psytest, Freiburg

    Google Scholar 

  60. Zubrick S, Smith A (1978) Factors affecting BVRT performance in adults with acute focal cerebral lesions. Paper presented at the sixth International Neuropsychological Society meeting in Minneapolis

Download references

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Technical University (RWTH) Aachen, Germany

    B. O. Hütter & J. -M. Gilsbach

Authors
  1. B. O. Hütter
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. -M. Gilsbach
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hütter, B.O., Gilsbach, J.M. Early neuropsychological sequelae of aneurysm surgery and subarachnoid haemorrhage. Acta neurochir 138, 1370–1379 (1996). https://doi.org/10.1007/BF01411114

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01411114

Keywords

Search

Navigation