Evaluation of outcome after intracranial aneurysm surgery: the neuropsychiatric approach.

BACKGROUND: With the reduction of mortality and gross neurologic morbidity of patients undergoing intracranial aneurysm surgery, the interest in outcome is shifting towards more subtle aspects such as cognitive deficits and psychosocial adjustment. METHODS: We discuss two different ways of measuring outcome in a sample of 20 patients who had intracranial aneurysm surgery. Patients were evaluated at discharge using the Karnofsky Scale and the Glasgow Outcome Scale. Six months after discharge we conducted a neuropsychiatric evaluation including cognitive, behavioral, and mood status assessment. RESULTS: Although 13 of out patients had a "good recovery, " 18 had some neuropsychiatric impairment. Comparing patients with "good recovery" with the remainder, patients with poorer outcomes tended to have a left pterional approach, a poorer "drive", and language disorders (p < 0.05). There was no correlation between out cognitive, mood, and behavioral assessment and the results of the Karnofsky and Glasgow Outcome Scales ( p > 0.05). CONCLUSIONS: we conclude that neuropsychiatric deficits are common after intracranial aneurysm surgery and that for our study the Karnofsky Scale and Glasgow Outcome Scale were not sensitive enough to detect residual impairment. therefore, it is important to develop brief tests and scales able to identify these problems and to complement the standard clinical neurological examination.

Microsurgical anatomy of the atlantal part of the vertebral artery.

BACKGROUND: Microanatomy of the vertebral artery has been the subject of multiple studies. However, none of them has covered every aspect of microvascular anatomy of the atlantal part of the vertebral artery. MATERIALS AND METHODS: Microsurgical anatomy of the atlantal part of the vertebral artery was studied in 14 cadaveric specimens. The artery was dissected using the standard microsurgical technique under operative microscope magnification. The atlantal part of the vertebral artery was divided into five segments: the foraminal, sagittal, transverse, medial condylar, and dural. The length of each segment was measured, as was the diameter of the artery. The branches of this part of the artery were identified and the distance between the point of dural entry of the artery and the midline of the atlanto-occipital dura was measured. Distance between the mastoid tip and the artery and the distance between the mastoid tip and the tip of C1 transverse process were measured. RESULTS: Results of all measurements are summarized in tables and text. We discuss various anomalies, branches, and lesions of the vertebral artery and surgical approaches with new methods of managing diseases in this area.

Microsurgical anatomy of the trigeminal nerve.

We studied the trigeminal nerve in the middle cranial fossa in 20 cadaveric specimens (10 fixed skull base). Specifically, we analysed the relationships among the gasserion or trigeminal ganglion (herein referred to as the gasserion ganglion), the internal carotid artery, and the petrous bone. The dimensions of the trigeminal ganglia, the length from the ganglia to the exit foramina, and the width of the ophthalmic, maxillary, and manidibular nerves were also studied. The foramina of the middle cranial fossa were measured for their diameter and their distance from each other. Our paper compares our study to previous studies and the measurements taken in those studies. The lesions affecting the ganglion and the nerves are discussed and the surgical approaches to the middle cranial fossa, the petrous bone, and the upper clivus are also reviewed.