Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment

Abstract

Object For anterior communicating artery (ACoA) aneurysms, endovascular coil embolization constitutes a safe alternative therapeutic procedure to microsurgical clip occlusion. The authors' aim in this study was to evaluate the quality of life (QOL), cognitive function, and brain structure damage after the treatment of ruptured ACoA aneurysms in a group of patients who underwent microsurgical clipping (36 patients) compared with a reference group who underwent endovascular coiling (14 patients). Methods At 14 months posttreatment all patients underwent evaluations by independent observers. These observers evaluated global efficacy, executive functions using a frontal assessment battery of tests (Trail making test, Stroop tasks, dual task of Baddeley, verbal fluency, and Wisconsin Card Sorting test), behavior dysexecutive syndrome (the Inventaire du Syndrome Dysexécutif Comportemental questionnaire [ISDC]), and QOL by using the Reintegration To Normal Living Index. Brain damage was analyzed using MR imaging. Results In the microsurgical clipping and endovascular coiling groups, the distribution on the modified Rankin Scale (p = 0.19) and mean QOL score (85.4 vs 83.4, respectively) were similar. Moreover, the proportion of executive dysfunctions (19.4 vs 28.6%, respectively) and the mean score on the ISDC questionnaire (8.9 vs 8.5, respectively) were not significant, but verbal memory was more altered in the microsurgical clipping group (p = 0.055). Magnetic resonance imaging revealed that the incidence of local encephalomalacia and the median number of lesions per patient increased significantly in the microsurgical clipping group (p = 0.003). Conclusions In the 2 groups, no significant difference was observed regarding QOL, executive functions, and behavior. Despite the significant decrease in verbal memory after microsurgical clipping, the interdisciplinary approach remains a safe and useful strategy.

MR Imaging of Subcallosal Artery Infarct Causing Amnesia after Surgery for Anterior Communicating Artery Aneurysm

“…Although it may be possible to perform the same analysis by using conventional 2D 2-or 3-mm coronal imaging with/without axial images, we presume that 3D MR imaging by using MPR could more easily identify small structures in the basal forebrain. Indeed, a recent neuropsychological study by Proust et al 5 revealed the high prevalence of verbal memory deficits (58.3%) among 36 patients with variably decreased intellectual function after ACoA clipping. Regarding verbal memory deficits, Guglielmi 14 stated, in his letter to the editor, that ACoA syndrome is likely due to occlusion of the subcallosal artery.…”

“…[1][2][3][4][5][6] On the basis of descriptions from the 1970s of the perforating branches from the ACoA, 7 much indirect evidence indicates that the amnesia is caused by damage or occlusion of the perforators of the ACoA, and this is known as ACoA syndrome. 2,8,9 Gade 10 linked vascular damage of the perforators from the ACoA during surgery with postoperative amnesia not directly, but clearly.…”

“…17 Meanwhile, in the reports that provided imaging findings in cases with postoperative amnesia of an ACoA aneurysm, most used CT scans and/or 2D MR imaging (with relatively thick section thickness) and did not clarify the exact location of the infarcts inside the basal forebrain, probably because of low image resolution and metallic artifacts from clips placed during surgery. 2,3,5 Our purpose was to test the hypothesis that 3D MR imaging can detect subcallosal artery infarction in patients with amnesia after ACoA aneurysm surgery.…”

Endovascular Treatment of Anterior Communicating Artery Aneurysms: A Systematic Review and Meta-Analysis

“…1,[6][7][8][9][10] In the past 2 decades, the inherently less invasive endovascular approach has emerged as a feasible and acceptable treatment option for AcomA aneurysms. [11][12][13][14] Continual advancements in endovascular technique and adjuvant devices have led to an enlarging proportion of patients with AcomA aneurysms who are successfully treated with coil embolization. 10,11,15,16 A limited number of case series have detailed the clinical outcomes, angiographic results, and procedure-related complications specific for endovascular treatment in this location.…”

Comparison of Cerebral Artery Angle in Adults and Fetuses

“…Approximately 30-35% of the intracranial aneurysms were located in ACoA (Osborn, 1994). Needless to emphasize, endovascular embolization occupies a very important position in the treatment of aneurysms (Proust et al, 2009). The therapeutic microcatheter must be negotiated through the ICA and across the A1 portion of the anterior cerebral artery to reach the disease site in the ACoA.…”