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Cognitive Outcomes After Anterior Communicating Artery Aneurysm Repair

  • Farshad Nassiri (a1), Adriana M. Workewych (a1), Jetan H. Badhiwala (a1) and Michael D. Cusimano (a1)

Abstract

Background The long-term cognitive and quality-of-life (QoL) outcomes after treatment of ruptured anterior communicating artery (ACoA) aneurysms are unknown. Methods Potential participants were all consecutive patients with ruptured ACoA aneurysms who were treated at one institution from July 1992 to December 2008. All potential participants were asked to complete the Cognitive Failures Questionnaire (CFQ), Center for Epidemiology Studies-Depression (CES-D) questionnaire, Short Form 36 (SF-36) questionnaire, and Telephone Interview for Cognitive Status-Modified (TICS-M). Patient charts were retrospectively reviewed for baseline demographics and clinical status, intra-operative details, and post-operative course. Reporting of cognitive and QoL assessment results was stratified by treatment method (endovascular coil embolization and surgical clipping by pterional craniotomy or orbitocranial craniotomy). Results In total, 82 patients (18 treated with coiling, 27 by orbitocranial craniotomy, and 37 by pterional craniotomy) were included in this study. In total, 32 patients (9 treated by coiling, 11 by orbitocranial craniotomy, and 16 by pterional craniotomy) completed follow-up cognitive and QoL questionnaires. The mean follow-up for patients who completed the questionnaires was 8.64±3.81 years. The three groups did not differ in questionnaires assessing cognitive status (TICS-M p=0.114, CFQ p=0.111). Moreover, there were no observed differences in QoL or depression scores between the three groups. Conclusions At long-term follow-up, QoL, cognitive, and depression test scores of patients with ruptured ACoA aneurysms are similar across open surgery and coiling modalities. Our results emphasize the importance of considering long-term outcomes with validated daily measures of functioning when reporting on outcomes after treatment for ruptured intracranial aneurysms. Larger prospective studies are required to further explore the results.

Évolution des facultés cognitives après la réparation d’anévrismes de l’artère communicante antérieure. Contexte: L’évolution à long terme des facultés cognitives et de la qualité de vie des patients ayant bénéficié d’un traitement à la suite d’une rupture d’anévrisme de l’artère communicantes antérieure demeure méconnue. Méthodes: Les participants potentiels à cette étude sont tous des patients s’étant présentés par ordre consécutif après avoir été victimes d’une rupture d’anévrisme de l’artère communicante antérieure. Fait à souligner, ils ont été traités dans un seul établissement de juillet 1992 à décembre 2008. On a demandé à tous ces participants de remplir une série de questionnaires : le Cognitive Failures Questionnaire (CFQ), celui du Center for Epidemiology Studies-Depression (CES-D), le SF 36 (de l’anglais Short Form 36 Health Survey) et le Telephone Interview for Cognitive Status-Modified (TICS-M). Les dossiers des patients ont ensuite fait l’objet d’une analyse rétrospective en tenant compte de leurs caractéristiques démographiques de base, de leur état clinique respectif, de considérations peropératoires et de leur évolution postopératoire. Le compte-rendu de l’évaluation de leurs facultés cognitives et de leur qualité de vie a été ensuite segmenté selon la méthode de traitement employée (l’embolisation par voie endovasculaire au moyen de spirales ou coils et le clippage chirurgical selon une crâniotomie ptérionale ou orbito-crânienne). Résultats: Au total, 82 patients (18 traités au moyen de spirales; 27, au moyen de la crâniotomie orbito-crânienne ; 37, au moyen de la crâniotomie ptérionale) ont été inclus dans cette étude. Sur ces 82 patients, 36 (soit 9 traités au moyen de spirales ; 11, au moyen de la crâniotomie orbito-crânienne; 16, au moyen de la crâniotomie ptérionale) ont rempli les questionnaires de suivi en lien avec leur qualité de vie et leurs facultés cognitives. La période moyenne de suivi pour les patients ayant rempli ces questionnaires a été de 8,64±3,81 ans. On n’a pas noté de grandes différences entre les trois groupes en ce qui regarde leur état cognitif (TICS-M p=0,114 ; CFQ p=0,111). Qui plus est, aucune différence n’a été observée en ce qui a trait à leur qualité de vie ou à leurs scores de dépression. Conclusions: Dans le cas d’un suivi à long terme de patients victimes d’une rupture d’anévrisme de l’artère communicante antérieure, on peut noter que tant leur qualité de vie, le maintien de leurs facultés cognitives que leurs scores à des test mesurant l’incidence de dépression sont semblables, et ce, peu importe qu’ils aient été traités en vertu d’une chirurgie ouverte ou de méthodes faisant appel à l’embolisation par voie endovasculaire au moyen de spirales. À la suite d’un traitement pour des ruptures d’anévrismes intrâcraniens, nos résultats mettent donc l’accent sur l’importance de prendre en considération l’évolution clinique à long terme de ces patients à l’aide d’indicateurs quotidiens et validés mesurant, au moment de leur récupération, leurs capacités à fonctionner. Des études prospectives plus importantes sont ainsi nécessaires pour effectuer une analyse plus approfondie de ces résultats.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence to: Michael D. Cusimano, St. Michael’s Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada. Email: injuryprevention@smh.ca

References

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1. Hernesniemi, J, Dashti, R, Lehecka, M, et al. Microneurosurgical management of anterior communicating artery aneurysms. Surg Neurol. 2008;70(1):8-28; discussion 29.
2. Alshafai, N, Falenchuk, O, Cusimano, MD. International differences in the management of intracranial aneurysms: implications for the education of the next generation of neurosurgeons. Acta Neurochir (Wien). 2015;157(9):1467-1475.
3. Molyneux, AJ, Kerr, RSC, Yu, L-M, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and. Lancet (London, England). 2005;366(9488):809-817.
4. Spetzler, RF, McDougall, CG, Zabramski, JM, et al. The Barrow Ruptured Aneurysm Trial: 6-year results. J Neurosurg. 2015;123(3):609-617.
5. Haug, T, Sorteberg, A, Sorteberg, W, Lindegaard, K-F, Lundar, T, Finset, A. Cognitive functioning and health related quality of life after rupture of an aneurysm on the anterior communicating artery versus middle cerebral artery. Br J Neurosurg. 2009;23(5):507-515.
6. Ravnik, J, Starovasnik, B, Sesok, S, et al. Long-term cognitive deficits in patients with good outcomes after aneurysmal subarachnoid hemorrhage from anterior communicating artery. Croat Med J. 2006;47(2):253-263.
7. Ruan, C, Long, H, Sun, H, et al. Endovascular coiling vs. surgical clipping for unruptured intracranial aneurysm: A meta-analysis. Br J Neurosurg. 2015;29(4):485-492.
8. Papagno, C, Rizzo, S, Ligori, L, Lima, J, Riggio, A. Memory and executive functions in aneurysms of the anterior communicating artery. J Clin Exp Neuropsychol. 2003;25(1):24-35.
9. Kreiter, KT, Rosengart, AJ, Claassen, J, et al. Depressed mood and quality of life after subarachnoid hemorrhage. J Neurol Sci. 2013;335(1):64-71.
10. D’Esposito, M, Alexander, MP, Fischer, R, McGlinchey-Berroth, R, O’Connor, M. Recovery of memory and executive function following anterior communicating artery aneurysm rupture. J Int Neuropsychol Soc. 1996;2(6):565-570.
11. Broadbent, DE, Cooper, PF, FitzGerald, P, Parkes, KR. The Cognitive Failures Questionnaire (CFQ) and its correlates. Br J Clin Psychol. 1982;21(Pt 1):1-16.
12. Hays, RD, Sherbourne, CD, Mazel, RM. The RAND 36-Item Health Survey 1.0. Health Econ. 1993;2(3):217-227.
13. Radloff, LS. The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1(3):385-401.
14. Brandt, J, Welsh, KA, Breitner, JC, Folstein, MF, Helms, M, Christian, JC. Hereditary influences on cognitive functioning in older men. A study of 4000 twin pairs. Arch Neurol. 1993;50(6):599-603.
15. Knopman, DS, Roberts, RO, Geda, YE, et al. Validation of the telephone interview for cognitive status-modified in subjects with normal cognition, mild cognitive impairment, or dementia. Neuroepidemiology. 2010;34(1):34-42.
16. Hunt, WE, Hess, RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968;28(1):14-20.
17. Fisher, CM, Kistler, JP, Davis, JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery. 1980;6(1):1-9.
18. Drake, C. Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg. 1988;68(6):985-986.
19. van Swieten, JC, Koudstaal, PJ, Visser, MC, Schouten, HJ, van Gijn, J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke. 1988;19(5):604-607.
20. van Furth, WR, Agur, AMR, Woolridge, N, Cusimano, MD. The orbitozygomatic approach. Neurosurgery. 2006;58(1 Suppl.):ONS103-ONS107; discussion ONS103–7.
21. Koso, M, Dizdarevic, K, Sose-Selimotic, J. Everyday memory in microsurgically treated patients after subarachnoid hemorrhage. J Clin Med Res. 2015;7(4):225-231.
22. Mortimer, AM, Steinfort, B, Faulder, K, et al. Rates of local procedural-related structural injury following clipping or coiling of anterior communicating artery aneurysms. J Neurointerv Surg. 2016;8(3):256-264.
23. DeLuca, J. Cognitive dysfunction after aneurysm of the anterior communicating artery. J Clin Exp Neuropsychol. 1992;14(6):924-934.
24. Jung, H, Shah, A. A comparison of risks of treating anterior communicating aneurysms via surgical clipping or endovascular coiling. Clin Neurol Neurosurg. 2016;147:115-116.
25. Escartin, G, Junqué, C, Juncadella, M, Gabarrós, A, de Miquel, MA, Rubio, F. Decision-making impairment on the Iowa Gambling Task after endovascular coiling or neurosurgical clipping for ruptured anterior communicating artery aneurysm. Neuropsychology. 2012;26(2):172-180.
26. Fontanella, M, Perozzo, P, Ursone, R, Garbossa, D, Bergui, M. Neuropsychological assessment after microsurgical clipping or endovascular treatment for anterior communicating artery aneurysm. Acta Neurochir (Wien). 2003;145(10):867-872; discussion 872.
27. von Vogelsang, A-C, Burström, K, Wengström, Y, Svensson, M, Forsberg, C. Health-related quality of life 10 years after intracranial aneurysm rupture: a retrospective cohort study using EQ-5D. Neurosurgery. 2013;72(3):397-405-6.
28. Proust, F, Martinaud, O, Gérardin, E, et al. Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment. J Neurosurg. 2009;110(1):19-29.
29. Preiss, M, Koblihova, J, Netuka, D, Klose, J, Charvat, F, Benes, V. Ruptured cerebral aneurysm patients treated by clipping or coiling: comparison of long-term neuropsychological and personality outcomes. Zentralblatt für Neurochir. 2007;68(4):169-175.
30. Katati, MJ, Santiago-Ramajo, S, Pérez-García, M, et al. Description of quality of life and its predictors in patients with aneurysmal subarachnoid hemorrhage. Cerebrovasc Dis. 2007;24(1):66-73.
31. O’Connor, MG, Lafleche, GMC. Retrograde amnesia in patients with rupture and surgical repair of anterior communicating artery aneurysms. J Int Neuropsychol Soc. 2004;10(2):221-229.

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