Relationship between Deep White Matter Hyperintensities on Magnetic Resonance Imaging and Postoperative Cognitive Function Following Clipping of Unruptured Intracranial Aneurysm

Abstract

To evaluate the effects on cognitive function of deep white matter hyperintensities (DWMHs) on magnetic resonance imaging (MRI) in patients treated surgically for unruptured intracranial aneurysms (UIAs). The subjects were 106 patients in whom a Wechsler adult intelligence scale-revised (WAIS-R) examination was performed 1 week before and 1 month after clipping surgery for asymptomatic UIAs. DWMH severity was evaluated on preoperative MR images by Fazekas scale, as follows: none (absence), mild (punctate foci), moderate (beginning confluence of foci), or severe (large confluent areas). A decrease of 7 or more points in intelligence quotient (IQ) postoperatively was considered deterioration. Fazekas score was none in 41 (none group), mild in 42 (mild group), moderate in 21, and severe in 2 patients (moderate/severe group). Patient characteristics, surgical factors, IQ change, and abnormal findings on postoperative MRI were compared among the groups. Although there was no statistically significant deterioration in IQ postoperatively in any group, the percentage of deteriorated patients was significantly higher in the moderate/severe group (34.8%) than in the other groups (4.9% in the none group, 7.1% in the mild group; p <0.01, p <0.05, respectively). Brain injury was observed more frequently on postoperative MR images in the moderate/severe group (17.4%) compared with the none group (2.4%; p = 0.052). The presence of moderate/severe DWMHs was an independent prognostic factor for postoperative cognitive dysfunction. In conclusion, the presence of moderate/severe DWMHs was a prognostic factor for postoperative cognitive dysfunction after surgery for UIAs.

Unruptured cerebral aneurysms in elderly patients: key challenges and management

“…Particularly vulnerable are patients with baseline chronic ischaemic small vessel disease. In a study of 106 patients who underwent clipping of unruptured cerebral aneurysms, Kumon et al found moderate to severe deep white matter hyperintensities on preoperative MRI independently associated with post-operative neurocognitive impairment [ 26 ]. Additional reports describe neurocognitive dysfunction associated with specific surgical approaches, aneurysm locations and age.…”

The association of pre-operative biomarkers of endothelial dysfunction with the risk of post- operative neurocognitive disorders: Results from BioCog study

“…These studies have also been limited by small sample sizes and have focused on individual ED biomarkers rather than concurrently assessing several ED biomarkers for direct comparison and evaluation of their interdependence in the associations with POD. On the other hand, previous ndings indicate an association between elevated levels of ED biomarkers with the presence or progression of white matter hyperintensities (WMH) (34,35) and white matter lesions (24,(36)(37)(38), while white matter lesions are associated with an increased risk of POD (39) and POCD (40). These ndings suggest a possible mediatory role for the presence of WMH and white matter lesions in the association of ED with POD and POCD risk.…”

Unruptured intracranial aneurysms in older adults: special considerations for treatment and management

“…Inoue et al [33] reported a significant association between changes in T2 images and decreased cognitive function after clip surgery. Moreover, hyperintensities in the deep white matter are a risk factor for decreased postoperative cognitive function [34]. In a study investigating the age and surgical approach based on the location of an aneurysm among 43 patients aged ≥ 65 years with anterior communicating artery aneurysms, 17 patients experienced a decline in cognitive function following microsurgical clipping [35].…”