ABSTRACT
OBJECTIVE: Recent advances in neuroimaging techniques have resulted in more frequent detection of unruptured intracranial aneurysms. Regardless of the method employed, most interventions to treat lesions have low morbidity and mortality rates. Recently, some studies have suggested that changes in cognitive status are one complication of microsurgical treatments. However, no study to date has performed any behavioral analysis. Moreover, cognitive assessment beyond 12 months after surgical intervention is missing. The current study sought to evaluate the long-term impact of clipping on the behavioral and cognitive functions of patients with unruptured intracranial aneurysms. METHOD: A within-subjects prospective clinical trial was performed to evaluate 40 patients who underwent microsurgical clipping for incidental unruptured intracranial aneurysms. The participants underwent a full neuropsychological evaluation during the preoperative period, at 3 months after surgery and at 3 years after surgery. Paired Student's t tests and an ANOVA, followed by a Bonferroni post hoc test, were used to examine group differences. RESULTS: The cognitive and behavioral test performance of the patients did not deteriorate during either the short or the long term following intervention. Moreover, the patients' clinical and demographic characteristics did not predict behavioral or cognitive changes, and neither the surgical approach nor the topography, multiplicity, or size of the aneurysms affected the results. CONCLUSIONS: In either the short or the long term following clipping for patients with incidental unruptured intracranial aneurysms, behavioral and cognitive functions had no significant change from baseline. The intervention demonstrated high efficacy and was associated with a low morbidity rate.
Subject(s)
Cognition , Intracranial Aneurysm/surgery , Female , Humans , Intracranial Aneurysm/diagnosis , Male , Middle Aged , Prospective Studies , Treatment OutcomeABSTRACT
OBJECTIVE: It is a consensus that most unruptured intracranial aneurysms (UIA) can be treated with acceptably low morbidity. However, some studies recently reported postoperative cognitive impairment, suggesting that it could be attributable to surgical damage. Our goal is to evaluate cognitive function before and after microsurgical clipping in patients with UIA. METHOD: A consecutive series of 40 patients who underwent microsurgical clipping for UIA were studied. The cognitive assessment (Mini Mental State Examination, MMSE) was performed immediately before and at least one month after surgery. Paired Student's "t" test and analysis of variance (ANOVA) were used for statistical purposes. RESULTS: The mean MMSE score in the preoperative analysis was 28.12 (SD, 1.34). In the postoperative period the mean MMSE score was 28.40 (SD, 1.46). Paired Student's "t" test was applied to the scores and no significant difference was found (p = 0.315). ANOVA did not find independent associations between MMSE scores and age, hypertension, smoking, dyslipidemia, education, aneurysm location, number, laterality or size. CONCLUSION: The present study suggests that microsurgical clipping for UIA does not result in major cognitive dysfunction as determined by the MMSE.
Subject(s)
Cognition Disorders/etiology , Intracranial Aneurysm/surgery , Microsurgery/methods , Postoperative Complications/etiology , Surgical Instruments , Adult , Aged , Cognition Disorders/diagnosis , Female , Humans , Male , Microsurgery/adverse effects , Middle Aged , Neuropsychological Tests , Postoperative Complications/diagnosis , Surgical Instruments/adverse effects , Treatment Outcome , Young AdultABSTRACT
OBJECTIVE: It is a consensus that most unruptured intracranial aneurysms (UIA) can be treated with acceptably low morbidity. However, some studies recently reported postoperative cognitive impairment, suggesting that it could be attributable to surgical damage. Our goal is to evaluate cognitive function before and after microsurgical clipping in patients with UIA. METHOD: A consecutive series of 40 patients who underwent microsurgical clipping for UIA were studied. The cognitive assessment (Mini Mental State Examination, MMSE) was performed immediately before and at least one month after surgery. Paired Student's "t" test and analysis of variance (ANOVA) were used for statistical purposes. RESULTS: The mean MMSE score in the preoperative analysis was 28.12 (SD, 1.34). In the postoperative period the mean MMSE score was 28.40 (SD, 1.46). Paired Student's "t" test was applied to the scores and no significant difference was found (p=0.315). ANOVA did not find independent associations between MMSE scores and age, hypertension, smoking, dyslipidemia, education, aneurysm location, number, laterality or size. CONCLUSION: The present study suggests that microsurgical clipping for UIA does not result in major cognitive dysfunction as determined by the MMSE.
OBJETIVO: É consenso que a maioria dos aneurismas intracranianos não-rotos (AINR) podem ser tratados com aceitável taxa de morbidade. Entretanto, alguns estudos reportaram déficits cognitivos no pós-operatório, sugerindo que poderiam ser atribuídos ao dano cirúrgico. O objetivo desse estudo é avaliar a função cognitiva antes e após clipagem microcirúrgica em pacientes com AINR. MÉTODO: Uma série de 40 pacientes com AINR submetidos à clipagem microcirúrgica foi estudada. A avaliação cognitiva (Mini Exame do Estado Mental, MEEM) foi realizada antes e após a intervenção cirúrgica. A análise estatística foi realizada com teste "t" de Student e análise de variância (ANOVA). RESULTADOS: A média dos escores do MEEM na análise pré-operatória foi 28,12 (DP, 1,34). No período pós-operatório, a média dos escores foi 28,40 (DP, 1,46). Não houve diferença estatística (teste "t" de Student; p=0,315). A ANOVA não encontrou associações independentes entre os escores de MEEM e idade, hipertensão, tabagismo, dislipidemia, educação e características dos aneurismas (topografia, número, lado e tamanho). CONCLUSÃO: O presente estudo sugere que a clipagem microcirúrgica não está associada a danos cognitivos maiores em pacientes com AINR.
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Young Adult , Cognition Disorders/etiology , Intracranial Aneurysm/surgery , Microsurgery/methods , Postoperative Complications/etiology , Surgical Instruments , Cognition Disorders/diagnosis , Microsurgery/adverse effects , Neuropsychological Tests , Postoperative Complications/diagnosis , Surgical Instruments/adverse effects , Treatment Outcome , Young AdultABSTRACT
Meningiomas in children account for less than 2% of all meningiomas, and their location in the spinal region is even less common. The authors present a case of a 20-month-old female who presented with lumbar back pain, neurogenic bladder and progressive paraparesis 6 months after she started to walk. Magnetic resonance imaging demonstrated an intradural extramedullary neoplasm extending from the tenth thoracic vertebra to the third lumbar vertebra. Complete excision of the tumor was performed by means of laminoplasty and the patient had a satisfactory postoperative recovery. Pathology and immunohistochemical studies diagnosed psammomatous meningioma.
Subject(s)
Meningeal Neoplasms/diagnosis , Meningeal Neoplasms/surgery , Meningioma/diagnosis , Meningioma/surgery , Female , Humans , InfantABSTRACT
Apesar de na literatura o hipotireoidismo estar classicamente associado a distúrbios do humor, na prática clínica nem sempre esse fato recebe a devida atençäo. Com o intuito de confirmar esta assertiva, foram revisados prontuários de 117 pacientes adultos, consultando em ambu-latório de Endocrinologia, com diagnóstico de hipotireoidismo primário. A amostra é constituída por 9 homens (idade média 53,4 anos) e 108 mulheres (44,9 anos), com hipotireoidismo: pós-cirúrgico (n= 37), espontâneo clássico (n= 45) ou subclínico (n= 35). Os sintomas psiquiátricos pesquisados foram os utilizados no diagnóstico de transtornos depressivos pelo DSM-IV. Foram caracterizados 3 grupos de pacientes: com diagnóstico de depressäo em acompanhamento psiquiátrico com ou sem antidepressivos (n= 15); sem sintomas psiquiátricos (n= 34) e com sintomas sugestivos de depressäo (n= 68). Desses 68 pacientes, 15, 23, 21, 7 e 2 apresentaram, respectivamente, 1, 2, 3, 4 e 5 sintomas psiquiátricos. Dois indivíduos apresentavam 5 sintomas psiquiátricos e 28 apresentavam 3 ou 4 sintomas, números esses respectivamente associados com depressäo maior e distimia. Os dados atuais chamam a atençäo para a possibilidade de muitos casos näo diagnosticados de transtornos depressivos na populaçäo de hipotireóideos, os quais poderiam ser beneficiados com avaliaçäo e atendimento psiquiátrico adequados.
