Factors Influencing Cognitive Function And Clinical Prognosis After Surgery For Ruptured Anterior Communicating Artery Aneurysms

Objective: The clinical characteristics,different treatment strategies,and surgical outcomes of ruptured anterior communicating artery aneurysms have been extensively and intensively studied.However,in-depth studies on the factors influencing cognitive function and clinical prognosis of patients with ruptured anterior communicating artery aneurysms after surgery are scarce.Therefore,the aim of this study was to analyze the factors influencing the cognitive function and clinical prognosis of patients after treatment of ruptured anterior communicating artery aneurysms.Method: Data on demographic data,clinical data and aneurysm morphology of patients with anterior communicating artery dissection aneurysms from January 2017 to February 2020 in The Northern Theater Command General Hospital were retrospectively analyzed.The postoperative follow-up period interval was 22 to 46 months,with a mean of 33.7 ± 7.2 months.We used the Telephone Interview For Cognitive Status-Modified(TICS-M)functional scale and the modified Rankin(m RS)scale to assess the cognitive function and clinical prognosis of patients after surgery.At the last follow-up,TICS-m scores ≤27 were considered to have cognitive impairment and TICS-m scores >27 were considered to have no cognitive impairment.The m RS score of 0-2 is considered to be a good prognosis,and an m RS score >2 is considered to be a poor prognosis.Univariate and multivariate logistic regression models were applied to analyze the factors influencing cognitive function and clinical prognosis of postoperative patients.Results: Follow-up assessment of postoperative cognitive function and clinical prognosis was completed in 204 patients.Of these patients,57 had postoperative cognitive dysfunction,with an incidence of 27.9%,and 89 had a poor postoperative clinical prognosis,with an incidence of 43.6%.Univariate analysis of cognitive function in postoperative patients revealed statistically significant differences(P<0.05)in aneurysm morphology,admission Hunt-Hess classification,surgical approach,hypertensive disease,and level of education received by the patients.The results of multivariate logistic analysis showed that hypertensive disease,craniotomy,and college and higher education were independent influencing factors for the development of cognitive dysfunction after surgery(P<0.05).Univariate analysis of clinical prognosis of postoperative patients revealed statistically significant differences in patients’ hypertensive disease,admission Hunt-Hess grade,and surgical approach(P<0.05).The results of multivariate logistic analysis showed that hypertensive disease,admission Hunt-Hess grade III,and craniotomy were independent influencing factors affecting the poor clinical prognosis of postoperative patients(P<0.05).Conclusions: 1)In the treatment of ruptured anterior communicating artery aneurysms,intervention is preferred and the risk of postoperative cognitive dysfunction is lower than that of craniotomy,and the clinical prognosis of patients is also better than that of craniotomy.2)Hypertensive disease is strongly associated with poor clinical prognosis in patients with postoperative cognitive function and impairment after surgery.3)The level of education received is closely related to postoperative cognitive dysfunction of patients.The higher the education level,the lower the risk of postoperative cognitive dysfunction.4)Hunt-Hess grade at admission is closely related to the clinical prognosis of patients after surgery;the higher the Hunt-Hess grade,the worse the clinical prognosis of patients.