The Different Influence On Cognitive Function Caused By Clipping Of Anterior Communicating Artery Aneurysms Via Supraorbital Keyhole Approach And Typical Pterional Approach

Objective: To explore the different influence on cognitive function caused by clipping of anterior communicating artery aneurysms via supraorbital keyhole approach and typical pterional approach.Methods: We analyzed 40 cases of anterior communicating artery aneurysms patients in the neurosurgical department of the second affiliated hospital of Soochow University from August, 2010 to January, 2015. The 40 patients was awake or drowsiness prior to the surgery, and the preoperative classification of Hunt-Hess and Fisher were less than or equal toⅡgrades. The 40 patients include 24 cases of supraorbital keyhole approach, 16 cases of typical pterional approach, and 40 cases of normal volunteers were considered as negative control. Montreal Cognitive Assessment(Mo CA) was used to test cognitive function of preoperative and a month after operation of the patients, and to compare the difference between treatment and the control group.Results:(1) The average Mo CA value of the 40 normal volunteers were 27.50±1.53 points,without cognitive dysfunction. The mean scores of Mo CA for the preoperative and a month after operation of the 40 patients were 25.54±2.36, 24.68±3.65 points, respectively. We concluded that ①The scores of preoperative and a month after operation Mo CA of 40 patients were less than the normal control group, P<0.01, t-test; ②The scores of a month after operation Mo CA of 40 patients were less than the preoperative, P<0.01, t-test; ③ the scores of visuospatial and ability to execute, attention, delayed recall and orientation Mo CA of 40 patients were decreased significantly.(2) ①The scores of a month after operation of supraorbital keyhole approach groupwere 25.67±3.16 points, while the typical pterional approach group were 23.19±3.92 points,P<0.01, t-test. ② There were 7 cases with the scores of Mo CA less than 26 points of supraorbital keyhole approach, while 9 cases of typical pterional approach. The cognitive dysfunction incidence of supraorbital keyhole approach group was 33.33%, while typical pterional approach group was 56.25%, P<0.05, the Chi-square test.(3) ①The scores of 16 patients with gyrus rectus removed were 21.93±3.43 points,while the remaining 24 patients were 26.50±2.48 points, P<0.01, t-test. ② The proportion of removal of gyrus rectus of supraorbital keyhole approach group was 29.17%, while typical pterional approach group was 56.25%, P<0.05, Chi-square test. It appears that the proportion in the group of gyrus rectus removal was significantly higher than supraorbital keyhole approach.(4) ① The scores of 5 of the 40 patients with intraoperative aneurysms ruptured were 23.80±2.86 points, while the remaining 35 patients were 24.80±3.76 points, P>0.05,t-test. ② The proportion of intraoperative aneurysms rupture of supraorbital keyhole approach group was as same as typical pterional approach group, both were 12.50%.Conclusions:(1) Some anterior communicating artery aneurysms patients may show certain cognitive dysfunction before operation, mainly in visuospatial and ability to execute,attention, delayed recall and orientation of the damage. And the surgical clipping procedure may also affect cognitive function.(2) For the anterior communicating artery aneurysms patients who are conscious,awake or drowsy, and who were classified as less than or equal toⅡgrades based on the preoperative of Hunt-Hess and Fisher the classical pterional approach was more likely to lead to cognitive dysfunction, which was mainly due to the removal of gyrus rectus. While the front to back perspective of supraorbital keyhole approach is helpful for the protection of gyrus rectus. These two approaches have no obvious significant difference on the intraoperative aneurysms rupture, suggesting the supraorbital keyhole approach was safer.The scores of Mo CA have no obvious difference between patients with intraoperative aneurysms ruptured and the other patients, indicating that it may not cause further damage to cognitive function, if the aneurysms were effectively controlled after rupturation...