{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T12:04:53Z","timestamp":1788609893409,"version":"build-2803163510"},"reference-count":25,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2014,4]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>The mechanisms underlying neurocognitive changes after surgical clipping of unruptured intracranial aneurysms (UIAs) are poorly understood. The aim of this study was to investigate factors that determine postoperative cognitive decline after UIA surgery.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Data from 109 patients who underwent surgical clipping of a UIA were retrospectively evaluated. These patients underwent neuropsychological examinations (NPEs), including assessment by the Wechsler Adult Intelligence Scale-Third Edition and the Wechsler Memory Scale-Revised before and 6 months after surgical clipping of the UIA. Results of NPEs were converted into z scores, from which pre- and postoperative cognitive composite scores (CS<jats:sub>pre<\/jats:sub> and CS<jats:sub>post<\/jats:sub>) were obtained. The association between the change in CS between pre- and postoperative NPEs (that is, CS<jats:sub>post<\/jats:sub> \u2212 CS<jats:sub>pre<\/jats:sub> [CS<jats:sub>post \u2212 pre<\/jats:sub>]) and various variables was assessed. These latter variables included surgical approach (anterior interhemispheric approach or other approach), structural change evidenced on T2-weighted imaging at 6 months, somatosensory evoked potential amplitude decrease greater than 50% during aneurysm manipulation, preexisting multiple ischemic lesions in the lacunar region detected on preoperative T2-weighted imaging, and total microsurgical time. Paired t-tests of the NPE scores were performed to determine the net effect of these factors on neurocognitive function at 6 months.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>A significant CS<jats:sub>post \u2212 pre<\/jats:sub> decrease was observed in patients with a structural change on postoperative T2-weighted imaging when compared with those without such a change on postoperative T2-weighted imaging (\u22120.181 vs 0.043, p = 0.012). Multiple regression analysis demonstrated that postoperative T2-weighted imaging change independently and negatively correlated with CS<jats:sub>post \u2212 pre<\/jats:sub> (p = 0.0005). In group-rate analysis, postoperative NPE scores were significantly improved relative to preoperative scores.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Minimal structural damage visualized on T2-weighted images at 6 months as a result of factors such as pial\/microvascular injury and excessive retraction during surgical manipulation could cause subtle but significant negative effects on postoperative neurocognitive function after surgical clipping of a UIA. However, this detrimental effect was small, and based on the group-rate analysis, the authors conclude that successful and meticulous surgical clipping of a UIA does not adversely affect postoperative cognitive function.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.12.jns131790","type":"journal-article","created":{"date-parts":[[2014,1,31]],"date-time":"2014-01-31T15:05:53Z","timestamp":1391180753000},"page":"937-944","source":"Crossref","is-referenced-by-count":18,"title":["Subtle structural change demonstrated on T2-weighted images after clipping of unruptured intracranial aneurysm: negative effects on cognitive performance"],"prefix":"10.3171","volume":"120","author":[{"given":"Tomohiro","family":"Inoue","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Fuji Brain Institute and Hospital, Shizuoka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuhiro","family":"Ohwaki","sequence":"additional","affiliation":[{"name":"Department of Hygiene and Public Health, Teikyo University School of Medicine;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Tamura","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fuji Brain Institute and Hospital, Shizuoka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazuo","family":"Tsutsumi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Showa General Hospital; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isamu","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Fuji Brain Institute and Hospital, Shizuoka;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhito","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns131790","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"867","DOI":"10.1007\/s00701-003-0111-5","article-title":"Neuropsychological assessment after microsurgical clipping or endovascular treatment for anterior communicating artery aneurysm","volume":"145","author":"Fontanella","year":"2003"},{"key":"b2-jns131790","series-title":"Japanese Wechsler Adult Intelligence Scale","author":"Fujita","year":"2006"},{"key":"b3-jns131790","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1023","DOI":"10.3171\/2013.1.JNS121668","article-title":"Subclinical ischemia verified by somatosensory evoked potential amplitude reduction during carotid endarterectomy: negative effects on cognitive performance. Clinical article","volume":"118","author":"Inoue","year":"2013"},{"key":"b4-jns131790","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.surneu.2005.11.064","article-title":"Effectiveness of suturing training with 10-0 nylon under fixed and maximum magnification (x 20) using desk type microscope","volume":"66","author":"Inoue","year":"2006"},{"key":"b5-jns131790","series-title":"Surg Neurol","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1016\/j.surneu.2006.03.035","article-title":"Training of A3-A3 side-to-side anastomosis in a deep corridor using a box with 6.5-cm depth: technical note","volume":"66","author":"Inoue","year":"2006"},{"key":"b6-jns131790","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.1056\/NEJM199812103392401","article-title":"Unruptured intracranial aneurysms\u2014risk of rupture and risks of surgical intervention","volume":"339","author":"International Study of Unruptured Intracranial Aneurysms Investigators","year":"1998"},{"key":"b7-jns131790","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1007\/BF01728859","article-title":"The microsurgical anterior interhemispheric approach suitably applied to ruptured aneurysms of the anterior communicating artery in the acute stage","volume":"63","author":"Ito","year":"1982"},{"key":"b8-jns131790","series-title":"No Shinkei Geka","first-page":"691","article-title":"[Changes in proton magnetic resonance spectroscopy and Wechsler adult intelligence scale revised after clipping of unruptured aneurysms.]","volume":"28","author":"Kobayashi","year":"2000"},{"key":"b9-jns131790","series-title":"World Neurosurg","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1016\/j.wneu.2010.01.001","article-title":"Cognitive function and anxiety before and after surgery for asymptomatic unruptured intracranial aneurysms in elderly patients","volume":"73","author":"Kubo","year":"2010"},{"key":"b10-jns131790","series-title":"J Vasc Surg","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/j.jvs.2011.03.253","article-title":"Cognitive changes after surgery vs stenting for carotid artery stenosis","volume":"54","author":"Lal","year":"2011"},{"issue":"3 Suppl Operative","key":"b11-jns131790","series-title":"Neurosurgery","first-page":"ons277","article-title":"Brain retraction and thickness of cerebral neocortex: an automated technique for detecting retraction-induced anatomic changes using magnetic resonance imaging","volume":"67","author":"Little","year":"2010"},{"key":"b12-jns131790","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"2474","DOI":"10.1056\/NEJMoa1113260","article-title":"The natural course of unruptured cerebral aneurysms in a Japanese cohort","volume":"366","author":"Morita","year":"2012"},{"key":"b13-jns131790","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"224","DOI":"10.1227\/01.NEU.0000148897.28828.85","article-title":"Morbidity and mortality from surgical treatment of unruptured cerebral aneurysms at Research Institute for Brain and Blood Vessels-Akita","volume":"56","author":"Moroi","year":"2005"},{"key":"b14-jns131790","series-title":"Surg Neurol","first-page":"269","article-title":"Importance of neuropsychological evaluation after surgery in patients with unruptured cerebral aneurysms","volume":"59","author":"Ohue","year":"2003"},{"key":"b15-jns131790","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1161\/01.STR.0000149925.36914.4e","article-title":"Cognitive function before and after surgery in patients with unruptured intracranial aneurysm","volume":"36","author":"Otawara","year":"2005"},{"key":"b16-jns131790","series-title":"Arq Neuropsiquiatr","doi-asserted-by":"publisher","first-page":"770","DOI":"10.1590\/S0004-282X2010000500018","article-title":"Microsurgical clipping in forty patients with unruptured anterior cerebral circulation aneurysms: an investigation into cognitive outcome","volume":"68","author":"Pereira-Filho","year":"2010"},{"key":"b17-jns131790","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1531","DOI":"10.1161\/01.STR.29.8.1531","article-title":"Mortality and morbidity of surgery for unruptured intracranial aneurysms: a meta-analysis","volume":"29","author":"Raaymakers","year":"1998"},{"key":"b18-jns131790","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1743","DOI":"10.1161\/STROKEAHA.110.585240","article-title":"Improved cognitive outcomes with endovascular coiling of ruptured intracranial aneurysms: neuropsychological outcomes from the International Subarachnoid Aneurysm Trial (ISAT)","volume":"41","author":"Scott","year":"2010"},{"key":"b19-jns131790","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"677","DOI":"10.1227\/NEU.0b013e3182195509","article-title":"Cerebral blood flow after surgery for unruptured cerebral aneurysms: effects of surgical manipulation and irrigation fluid","volume":"69","author":"Shimizu","year":"2011"},{"key":"b20-jns131790","series-title":"[Japanese Wechsler Memory Scale-Revised.]","author":"Sugishita","year":"2001"},{"key":"b21-jns131790","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.1161\/01.STR.30.6.1181","article-title":"Risk of subarachnoid hemorrhage after surgical treatment of unruptured cerebral aneurysms","volume":"30","author":"Tsutsumi","year":"1999"},{"key":"b22-jns131790","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"2195","DOI":"10.1161\/01.STR.0000087787.38080.B8","article-title":"Craniotomy for treatment of unruptured aneurysms is not associated with long-term cognitive dysfunction","volume":"34","author":"Tuffiash","year":"2003"},{"key":"b23-jns131790","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.1227\/NEU.0b013e31823f5cf7","article-title":"Impact of changes in intraoperative somatosensory evoked potentials on stroke rates after clipping of intracranial aneurysms","volume":"70","author":"Wicks","year":"2012"},{"key":"b24-jns131790","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/S0140-6736(03)13860-3","article-title":"Unruptured intracranial aneurysms: natural history, clinical outcome, and risks of surgical and endovascular treatment","volume":"362","author":"Wiebers","year":"2003"},{"key":"b25-jns131790","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.3171\/JNS-07\/12\/1086","article-title":"Postoperative quality of life of patients treated for asymptomatic unruptured intracranial aneurysms","volume":"107","author":"Yamashiro","year":"2007"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/120\/4\/article-p937.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/120\/4\/article-p937.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/120\/4\/article-p937.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,24]],"date-time":"2022-07-24T13:14:34Z","timestamp":1658668474000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/120\/4\/article-p937.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2014,4]]},"references-count":25,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2013.12.jns131790","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,4]]}}}