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Journal of Neurosurgical Sciences 2000 Giugno;44(2):61-7

lingua: Inglese

Neuropsychological and neurophysiological evaluation after anterior communicating artery (ACoA) aneurysm surgery

Fontanella M. M. 1, Bergamasco L. 2, Perozzo P. 3, Priano L. 3, Vighetti S. 3, Griva F. 1, Pagni C. A. 1

1 Department of Neurological Sciences - Neurosurgery, University of Torin, Italy;
2 Department of Veterinary. Morphology and Physiology, University of Torin, Italy;
3 Department of Neurological Sciences-Neurology, University of Torin, Italy


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Back­ground. We eval­u­at­ed ­high cere­bral func­tions 6 ­months ­after sur­gery ­for bleed­ing ­ACoA aneu­rysms com­par­ing neu­ro­phys­io­log­i­cal ­and neu­ro­psy­co­log­i­cal ­tests.
Meth­ods. ­Twelve ­patients ­were cho­sen ­among a ­series of cas­es oper­at­ed on in ­the ­first 48 ­hours ­after ­ACoA aneu­rysm bleed­ing. ­All of ­them ­were in ­Hunt-­Hess ­grade I or II. We exclud­ed ­patients ­over 65 ­years, or ­with intra­cra­ni­al hae­mat­o­mas, intra­ven­tric­u­lar hae­mor­rhage, hydro­ceph­a­lus, or ­with mul­ti­ple or ­giant aneu­rysms. ­All of ­them under­went neu­ro­phys­io­log­i­cal eval­u­a­tion ­with record­ing ­and map­ping of ­long laten­cy (P300) audi­to­ry ­and vis­u­al ­event-relat­ed poten­tials (­ERPs) ­and a neu­ro­psy­co­log­i­cal assess­ment ­for mem­o­ry, intel­li­gence, fron­tal ­lobe func­tions ­and lan­guage.
­Results. Neu­ro­psy­cho­log­i­cal assess­ment: ­All ­patients ­were severe­ly dam­aged on pho­nem­ic fluen­cy. In a ­first ­group (­group A: 3 cas­es) ­tests ­were ­all in a nor­mal ­range. In a sec­ond (­group B: 3 cas­es) ­the ­tests ­showed ­severe impair­ment on learn­ing ­and ­long ­term mem­o­ry. In a ­third (­group C: 6 cas­es) ­tests ­showed mem­o­ry ­and “fron­tal ­lobe” def­i­cits. Neu­ro­phys­io­log­i­cal assess­ment: ­The ­whole ­group of ­patients ­showed sig­nif­i­cant ­delay in ­ERPs record­ings com­pared to con­trols. ­ERPs of ­patients in ­group A ­and B ­showed no sig­nif­i­cant dif­fer­enc­es ­from con­trols, ­while ­being sig­nif­i­cant­ly ­delayed in 5 ­patients ­out of 6 of ­group C.
Con­clu­sions. ­All ­patients ­had dif­fi­cul­ties in ­the pho­nem­ic ­task in ­which a not­able cog­ni­tive ­effort is nec­es­sary, ­while intel­li­gence, ­short ­term mem­o­ry, atten­tion ­and lan­guage ­were with­in nor­mal lim­its. ­Patients in ­group C ­showed ­severe fron­tal ­lobe ­type cog­ni­tive impair­ment. ­Those ­ones in ­groups A ­and B ­did ­not ­present cog­ni­tive derange­ments (A) or ­only mem­o­ry ­and learn­ing impair­ment (B). ­ERPs ­may be an objec­tive param­e­ter in ­the fol­low-up of cas­es ­with cog­ni­tive impair­ment, ­even if neu­ro­phys­io­log­i­cal ­tests can­not be ­replaced.

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