Psychiatric Symptoms in Cases with Ruptured Anterior Communicating Aneurysm before and after Surgery

Abstract

Many reports about psychiatric symptoms in cases with anterior communicating aneurysm were published, but there were few reports describing the correlation between postoperative appearance of psychiatric symptoms and surgical techniques, and those describing long-term follow-up results. We examined psychiatric symptoms in consecutive 95 patients with ruptured anterior communicating aneurysm before and after the operation. Thirty-eight out of 95 cases were operated on using microsurgical techniques. Before the operation, psychiatric changes were observed in 56 cases (59%) and those symptoms were mild in 30 cases, moderate in 10 cases and severe in 16 cases. A high frequency of moderate and severe changes was found in cases which had multiple bleeding episodes, those which had shown prolonged disturbance of consciousness, and those which had various neurological deficits after SAH. After the surgery, psychiatric symptoms were observed in 67 cases (71%), including 4 deaths after the operation and those changes were mild in 26 cases, moderate in 14 cases and severe in 22 cases. In the apperance of deteriorated psychiatric symptoms after the surgery, there was statistically significant difference (p<0.02) between macroscopical group (24 out of 57 cases) and microscopical group (7 out of 38 cases). In macroscopical group, a high frequency of psychiatric morbidity rate was found in cases with upward projection of aneurysm. In 87 cases, long-term follow-up (3 months to 9 years) were carried out and 11 deaths were found during foolow-up period. Psychiatric symptoms were observed in 26 cases out of 76 cases (34%) and those changes were mild in 14 cases, moderate in 7 cases and severe in 5 cases. There were 62 cases out of 76 cases (82%) returned to their former social life. There was obvious positive correlation between psychiatric symptoms after surgery and those at long-term follow-up. Vasospasm and injury of anterior cerebral arteries and fine perforating arteries at SAH and during the operation were considered responsible in producing psychiatric symptoms in cases with anterior communicating aneurysm. Microsurgical techniques were necessary to prevent those changes during operation.