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Basal brain injury in aneurysm surgery
R P Kivisaari1, O Salonen, J Ohman
1Department of Neurosurgery, Helsinki University Central Hospital, Finland. riku.kivisaari@huch.fi
Neurosurgery
|May 12, 2000
Summary
Brain surgery for ruptured aneurysms may cause basal frontotemporal lesions in one-third of patients. The clinical significance of this surgical brain damage is currently unknown.
Area of Science:
- Neurosurgery
- Neuroradiology
- Neurology
Background:
- Ruptured intracranial aneurysms require prompt surgical intervention.
- The pterional approach is a common surgical technique for accessing the anterior circulation.
- Long-term consequences of neurosurgical interventions, particularly subtle brain tissue damage, require further investigation.
Purpose of the Study:
- To investigate the frequency of basal frontotemporal lesions following surgical treatment for ruptured intracranial aneurysms.
- To determine if these lesions are attributable to surgical damage.
- To explore potential predictors and clinical significance of these lesions.
Main Methods:
- Prospective study of 101 patients with ruptured intracranial aneurysms.
- High-field magnetic resonance imaging (MRI) performed 2-6 years post-surgery.
- Comparison of MRI findings with pre- and post-operative computed tomography (CT) scans and angiograms.
Main Results:
- Lesions in the basal frontotemporal region were identified in 36% of patients, predominantly on the side of the pterional approach.
- These lesions were not detectable on CT scans or early post-hemorrhage.
- No significant correlation was found between lesion occurrence and patient age, hypotension, hemorrhage burden, vasospasm, or clinical outcome (Glasgow Outcome Scale).
Conclusions:
- Surgical treatment for ruptured intracranial aneurysms is associated with basal frontotemporal brain tissue damage in a significant proportion of patients.
- The clinical relevance and long-term impact of these MRI-detected lesions remain to be elucidated.