| Background:Anterior Communicating Artery Aneurysms (AcoAA) are the most common intracranial aneurysms, which accounts for about 30% of the total number. With the development of diagnostic techniques, micro-neurosurgical techniques, interventional embolic materials and intension techniques, the diagnosis and surgical treatment of AcoAA have already come to mature. Commonly, the main treatments for AcoAA includes surgical craniotomy of aneurysms clipping and interventional embolization of aneurysms. With the rapid development of embolic materials and relevant equipments, the number of interventional embolization operation is increasing. Because some anterior communicating aneurysms of certain patients may rupture, which will form hematoma in the inner side of frontal lobe and the hematoma can extend to gyri orbitales and gyrus rectus, some of the patients still need surgical craniotomy for clipping to deal with the relevant problems. There is also part of patients who choose aneurysm clipping for other reasons such as being lack of money and so on. Because of the rupture of anterior communicating aneurysms, it may cause hematoma in gyri orbitales and gyrus rectus at the same side or both sides of patients’ brains lobe, which can also break into frontal eminence of the paracele of the same side. Commonly, we clear the hematoma around the gyrus rectus to get clear look of the aneurysms and the other tissues around when we do the aneurysm clipping. Even for those anterior communicating aneurysms which not yet rupture, especially for those who point backward and upward, to reduce the risk of re-rupture during operation, we often resect part of the gyrus rectus under the pia matter to get clear look of the aneurysms and relevant tissues around, which is good for clipping. It provides the possibility of full protection of the anterior communicating complex. Research found that among gyri orbitales, gyrus rectus, parahippocampal gyrus, amygdaloid nucleus, thalami and fornix, there is a very important system known as memory pathway of limbic system. Part of patients may develop anterior communicating syndrome after these parts get injured which shown as memory impairment, cognitive dysfunction, mental and personality changes. It’s commonly acknowledged that these symptoms arise because these tissues are injured. What’s more, for patients with anterior communicating aneurysms, because of subarachnoid hemorrhage and intraoperative harassment of cerebrovascular, preoperatively and postoperatively, there are different degrees of cerebral vasospasm which also can lead to ischemia and infarction for important structures at the bottom of the frontal nerve structure. So some scholars believe cerebral vasospasm is the most important reason of cognitive disorders after aneurysms clipping. Though ZF Wang found resection of gyrus rectus may cause cognitive disorder and memorial disorder after operation in domestic research. Whether the resection range size is relevant to the possibility of this kind of situation, or whether the resection range size is relevant to the degree of function disorder, are seldomly researched domestically and internationally. So the aim of our research is not only to find out different resection range size of gyrus rectus is helpful for operators to get a clear look on aneurysms point backward and upward during operation, but also and more importantly, to find out whether different resection range size of gyrus rectus will influence patients’cognitive function and their daily life, to provide evidence on the most proper scope of gyrus rectus resection which cause minimum effect on patients’ daily life. In our research, we evaluate patients’ cognitive function with MMSE and memory tests in different postoperative time periods to find out whether their cognitive function are influenced in different degrees after their gyrus rectus are resected in different scope, and whether their cognitive condition are improved as time passed by. Within this research, we can find out a certain-safe scope in gyrus rectus to resect during operation of aneurysm clipping craniotomy, in the meantime, we can provide a reference to the question:how to prevent cognitive disorder after operation of aneurysm clipping craniotomy.Methods:Retrospectively, we analyzed part-resection of gyrus rectus helps operators get a clear look on anterior communicating artery complex and aneurysms during operation of aneurysm clipping craniotomy. We graded 16 patients who standardly resected their gyrus rectus (the volume of which<1cm3),20 patients who subtotally resected their gyrus rectus (the volume of which>1cm3) and 18 normal people (as control), using MMSE and memory tests(WHO-UCLA AVLT and ROCFT) to evaluate on their cognitive function and memory ablitity, after 1 month,3 months,6 months after their operation.Results:1. It turns out that both standard and subtotal gyrus rectus resection have the same positive effect on the appearance of anterior communicating artery complex, both of them have no apparent difference in operation of aneurysm clipping craniotomy and anterior communicating artery complex appearance.2. After 1 month later, there are 27 people(75%) who has the cognitive dysfunction.20 patients received standardly resection of gyrus rectus and 16 people (80%) has the cognitive dysfunction. Whereas 16 patients received subtotally resection and 11 people (68.8%) shown descend cognitive founction. The differences of the two groups are not apparent (p>0.05). After 6 months, there are 18 people (50%) who have the cognitive dysfunction.13 person (65%) in the standard gyrus rectus resection group and 5 persons (31.3%) in the subtoal gyrus rectus resection group have the cognitive dysfunction. There are apparent difference between the standard and subtotal group(p<0.05).3. After the 1 month, the MMSE average score of the subtoal gyrus rectus resection group and the standard gyrus rectus resection group are 20.06±0.65 and 22.12±2.78, the differences between the two groups are not apparent (p>0.05). After the 3 month, the MMSE average score of the subtoal gyrus rectus resection group and the standard gyrus rectus resection group are 21.92±0.86 and 25.23±1.86, the differences between the two groups are not apparent (p>0.05). After 6 month, the MMSE average score of the subtoal gyrus rectus resection group and the standard gyrus rectus resection group are 23.24±0.96 and 28.13±2.56, there are apparent difference between the standard and subtotal group (p<0.05).4. Compared the standard gyrus rectus resection group and control, there are apparent difference in the cognitive dysfunction and memory test scores (p<0.05) after 1 and 3 month, while the difference is not remarkable (p>0.05) after 6 month. There are apparent difference between the subtoal gyrus rectus resection group and the control after 1,3,6 month (p<0.05).Conclusion:1. During operation of aneurysm clipping craniotomy for anterior communicating aneurysms, no matter how resect gyrus rectus standardly or subtotally, both will give anterior communicating artery complex an extended appearance, while both methods show no difference in appearance of aneurysms, which is good for clipping, or exposure of aneurysms complex.2. When the scope of gyrus rectus resection is less than 1cm3, the cognitive dysfunction of patients improve apparently 6 months after operation, while if the scope is bigger than lcm3, cognitive function disorder still exists 6 months after operation.3. During craniotomy of anterior communicating aneurysms, unless there is big hematoma around gyrus rectus, we’d better control the scope of gyrus rectus resection under 1 cm3, when we purely want to get a clear exposure of the complex and clip it.4. We need to expand further samples and make long-term follow-up, if we want to identify factors associated with the impairments of cognitive functions after the anterior communicating aneurysm rupture. |
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