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 our 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 our 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 neurologic examination.