Does Temporary Clipping during Intracranial Aneurysm Surgery Influence Cognitive Outcome?

Introduction After surgery for ruptured intracranial aneurysm, significant number of patients, whose recovery were assessed by generally accepted scales considered good outcome, suffers from subtle cognitive impairment.

Objective The aim of this study was to explore the possible effects of temporary clip applications on preservation of cognitive function in surgically treated patients after subarachnoid hemorrhage caused by rupture of intracranial aneurysms.

Material and Methods Study group were 40 patients chosen among a series of patients who were surgically treated for ruptured intracranial aneurysm. Outcome of all patients were assessed by Modified Rankin scale as grades 0 and 1. Of the 40 patients, temporary clipping was used in 5 (12.5%) patients up to 10 minutes (group A), 14 (35%) patients for 10 to 20 minutes (group B), whereas it was not used in 21 patients (group C). These three groups were compared with 30 volunteers without neurologic or psychiatric disorders (group D).

Results The study demonstrated poorer performance of the study group in the areas of executive functions and divergent thinking. In the group of patient with temporary clip (groups A and B), there is no difference in cognitive outcome comparing with group C.

Conclusion Negative effects of temporary vessel occlusion as alone on cognitive function is not clear. It has to be assessed according to preoperative neurological condition, vessel temporary occluded, ischemia, and other variables. Possible negative effects of temporary clipping on cognitive functions should not be neglected by surgeons during surgery.

Keywords subarachnoid hemorrhage; aneurysm; temporary clipping; cognitive outcome