Factors affecting global neurocognitive status and frontal executive functions in the early stage after surgical clipping of unruptured anterior circulation aneurysms with respect to keyhole clipping and conventional clipping

Yoshifumi Higashino; Makoto Isozaki; Kenzo Tsunetoshi; Osamu Komori; Yoshinori Shibaike; Satoshi Kawajiri; Shinsuke Yamada; Ayumi Akazawa; Masamune Kidoguchi; Toshiaki Kodera; Hidetaka Arishima; Takuro Inoue; Takanori Fukushima; Kenichiro Kikuta

doi:10.1007/s00701-022-05266-y

Factors affecting global neurocognitive status and frontal executive functions in the early stage after surgical clipping of unruptured anterior circulation aneurysms with respect to keyhole clipping and conventional clipping

Acta Neurochir (Wien). 2022 Aug;164(8):2219-2228. doi: 10.1007/s00701-022-05266-y. Epub 2022 Jun 22.

Affiliations

¹ Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan.
² Department of Computer and Information Science, Faculty of Science and Technology, Seikei University, Musashino, Tokyo, Japan.
³ Department of Neurosurgery, Koto Memorial Hospital, Shiga, Japan.
⁴ Division of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
⁵ Department of Neurosurgery, Division of Medicine, Faculty of Medical Sciences, University of Fukui, 23-3 Matsuokashimoaizuki, Eiheiji-cho, Yoshida-gun, Fukui, 910-1193, Japan. kikuta@u-fukui.ac.jp.

PMID: 35729278
DOI: 10.1007/s00701-022-05266-y

Abstract

Purpose: This study investigated the most significant factor for the preservation of the global neurocognitive status and frontal executive functions in the surgical clipping of unruptured anterior circulation aneurysms, specifically in keyhole and conventional clipping procedures.

Methods: The prospective study that was performed to examine the effects of aneurysm surgery on the patient's global neurocognitive status and frontal executive functions started on April 2016. After exclusion posterior circulation aneurysms, anterior communicating aneurysms treated by interhemispheric approach, giant aneurysms, and paraclinoid aneurysms, 23 patients who were enrolled before May 2017 were treated by conventional clipping, and 18 patients who were enrolled after June 2017 were treated by keyhole clipping. Two patients were excluded from each group due to missing data. Finally, 21 and 16 patients in each group were analyzed, respectively. Three-tesla magnetic resonance imaging was performed before and after surgery to detect the presence of perioperative cerebral infarctions and brain edema. The Mini-Mental State Examination, Frontal Assessment Battery, and Self-Rating Depression Scale scores were obtained before and 1 month after surgery.

Results: Logistic regression analyses indicated that anterior communicating and internal carotid artery aneurysms were the most significant factors for poor outcomes and that keyhole clipping for these two types of aneurysm was the most significant factor for the preservation of patient global neurocognitive status. Keyhole clipping was also the most significant factor for the preservation of frontal executive functions in patients.

Conclusions: Keyhole clipping may be more favorable than conventional clipping for the preservation of the global neurocognitive status and frontal executive functions. Moreover, it may be the most effective factor for preservation of global neurocognitive status when it is indicated for anterior communicating or internal carotid artery aneurysms.

Keywords: Anterior circulation aneurysm; Frontal executive functions; Global neurocognitive status; Keyhole clipping.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Executive Function
Humans
Intracranial Aneurysm* / diagnostic imaging
Intracranial Aneurysm* / surgery
Neurosurgical Procedures / adverse effects
Neurosurgical Procedures / methods
Prospective Studies
Treatment Outcome