The Quality of Life and Cognitive Deficits According to Treatment Modality of Anterior Communicating Artery Aneurysm: Surgery and GDC Embolization Group.

Jung, Myung Hoon; Song, Kwan Young; Lee, Sang Koo; Choi, Sun Wook; Kang, Dong Soo; Kim, Young Joon

Original Article

Journal of Korean Neurosurgical Society 2002;31(4): 311-318.

Myung Hoon Jung, Kwan Young Song, Sang Koo Lee, Sun Wook Choi, Dong Soo Kang, Young Joon Kim

¹Department of Neurosurgery, Kangnam General Hospital Public Corporation, Seoul, Korea.
²Department of Neurosurgery, College of Medicine, Dankook University, Cheonan, Korea.

ABSTRACT

OBJECTIVE
The authors present the difference of cognitive outcome of good recovery patients between direct surgery and Guglioma detachable coil(GDC) embolization group among anterior communicating artery aneurysm patients.
METHODS
The clinical records of 21 patients who can be followed up and be answered questionnaires among good recovery patients fter ACoA(anterior communicating artery) aneurysm operation from 1990 to 1999 in our hospital were reviewed as surgery group. On the other hand, 20 good recovery patients after embolization of ACoA aneurysm in the other hospital from 1996 to 1999 are seleted as GDC embolization group. In the surgery group, the degree of brain swelling, the existence of rectus gyrus removal, existence of immediate post operative transient neurological deficit and the post operative brain CT findings are examined. In GDC embolization group, problem during embolization, existence of immediate post operative transient neurological deficit and the post operative brain CT findings are also investigated. After this investigation, patients and their family are questioned with Tidwell's cognitive outcome paper. The total records below 50 were considered as poor outcome.
RESULTS
Ages, sex, Hunt and Hess grade, Fisher grade and size of aneurysm in two groups are similar conditions. The more patients get old, the cognitive outcome is worse in both group. In surgery group, those patients who have giant aneurysm, are removed rectus gyrus, are happened immediate post-operative transient neurological deficits and hypodense area in post operative brain CT are poor cognitive outcome. In the embolization group, Fisher grade III and post operative transient neurological deficit are happened, outcome was poor. In comparison with cognitive outcome between surgery and GDC embolization group, the embolization group has generally good result.
CONCLUSION
The cognitive outcome is decided by age and the degree of brain injury according to aneurysmal rupture. Direct surgery method can make cognitive outcome poor due to perforator injury, brain retraction injury and removal of rectus gyrus during surgery, in the neuropsychological side and the GDC embolization is the better way than the direct surgery method.

Key Words: ACoA aneurysm; Cognitive; Microsurgery; GDC embolization; Good recovery