Does Partial Removal of the Rectal Gyrus during Clipping Surgery for Anterior Communicating Artery Aneurysm Cause Postoperative Cognitive Dysfunction?

Abstract

Whether partial resection of the rectal gyrus during anterior communicating artery (AcomA) aneurysmal clipping can cause cognitive dysfunction remains under debate. We examined this issue using data from patients with AcomA aneurysms who underwent partial (approximately 1 cm) subpial removal of the rectal gyrus during dissection of the aneurysmal complex. All procedures were performed by a single operator using the supraorbital keyhole approach. Sixty-three consecutive patients with AcomA aneurysms underwent aneurysmal clipping with rectal gyrus aspiration through the right (n=50) or left (n=13) side. Their Revised Hasegawa’s Dementia Scale (HDS-R) and Mini-Mental State Examination (MMSE) scores were assessed immediately preoperative and 3 months postoperative to evaluate their cognitive function. The Beck Depression Inventory (Beck) and Hamilton Depression Rating Scale (HAM) were also used to evaluate depression severity, which can interfere with executive function. No patient exhibited perforator infarctions or brain contusions postoperatively. The patients’ cognitive functions, according to the HDS-R and MMSE, were unchanged after surgery, whereas depression severity, according to Beck and HAM, was significantly improved after clipping surgery. Multiple linear regression analysis showed that the treated side was not a significant predictor of any psychological change. As long as perforator compromise does not occur and no contusions occur in the orbitofrontal cortex, partial resection of the rectal gyrus itself does not adversely affect cognitive function or depression.