Cognitive impairments after surgical repair of ruptured and unruptured aneurysms

Objectives-To determine the frequency and severity of neuropsychological im pairments associated with aneurysmal subarachnoid haemorrhage, and associat ed with repair of intracerebral aneurysms. Methods-Two groups of patients who underwent repair of intracerebral aneury sms were studied: patients with unruptured aneurysms (n=20) and patients wi th ruptured aneurysms (n=27). All patients were administered a battery of s tandardised neuropsychologoical tests about 3 months after surgery. A subse t of 12 patients with unruptured aneurysms were administered the battery bo th before and after elective repair of the aneurysm(s). A subset of six pat ients with ruptured aneurysms were given the test at both 3 months and 1 ye ar after surgery. Results-As previously reported for patients with ruptured aneurysms, patien ts with both ruptured and unruptured aneurysms performed, as a group, signi ficantly below published norms on many of the neuropsychological tests afte r surgery. However, there were significant differences between preoperative and postoperative performance in the unruptured aneurysm group only on a f ew tests: measures of word fluency, verbal recall, and frontal lobe functio n. Performance of patients with ruptured aneurysms was significantly below that of patients with unruptured aneurysms only on a few tests of verbal an d visual memory. In addition, group differences compared with published nor ms reflected severely impaired performance by a minority of patients, rathe r than moderately impaired performance in a majority of patients. Conclusions-Although patients who undergo repair of ruptured aneursyms perf orm, as a group, below published norms on many neuropsychological tests, si gnificant impairments are seen in a minority of patients. Some of the impai rments are associated with subarachnoid haemorrhage, whereas others (found In patients who underwent repair of unruptured aneurysms) are due to genera l effects of neurosurgery and perioperative management. Finally, some of th e postoperative deficits are merely a reflection of premorbid weaknesses.