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ORIGINAL RESEARCH article

Front. Surg.
Sec. Neurosurgery
Volume 12 - 2025 | doi: 10.3389/fsurg.2025.1428311

Effect of epileptiform discharges and hippocampal volume on cognitive dysfunction following clipping of ruptured aneurysms in the anterior circulation

Provisionally accepted
Kunitoshi Otsuka Kunitoshi Otsuka 1*Shigeki Sunaga Shigeki Sunaga 1Hiroyuki Jimbo Hiroyuki Jimbo 1Yoshinori Suzuki Yoshinori Suzuki 1Michihiro Kohno Michihiro Kohno 2
  • 1 Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
  • 2 Tokyo Medical University Hospital, Tokyo, Japan

The final, formatted version of the article will be published soon.

    Cognitive dysfunction after aneurysmal subarachnoid hemorrhage (aSAH) remains unclear due to various neurological impairments. This study aimed to evaluate the changes in hippocampal volume, cognitive function, and interictal epileptiform discharges after clipping in patients with aSAH of anterior circulation. Methods: Patients with modified Rankin Scale scores of 0-3 points who underwent clipping were evaluated. Aneurysmal locations were classified as middle cerebral artery (MCA), internal carotid artery (ICA), and anterior cerebral artery (ACA). Surgery was performed using the transsylvian approach or interhemispheric approach. Hippocampal volume measurement, neuropsychological assessments, and interictal electroencephalogram evaluations were performed postoperatively at the subacute phase. Epileptiform discharges were assessed using the spike index (SI). Results: We included 60 patients (23 men, 37 women; median age, 57.4 years). Aneurysmal locations were found in the MCA, ICA, and ACA in 23, 19, and 18 patients, respectively. The postoperative hippocampal volume was significantly reduced on the clipping approach side in the MCA and ICA groups (MCA, p<.001; ICA, p<.001). There was no correlation between hippocampal volume and cognitive function. A significant difference was noted in elevated SI on the approach side of the MCA (p<.001), ICA (p<.001), and ACA (p<.001) in the transsylvian approach group. The elevated SI on the left approach side showed significant differences in some neuropsychological assessments (performance intellectual quotient, p=.028; perceptual organization, p=.045; working memory, p=.003). Discussion: Cognitive dysfunction in the subacute phase after clipping for aSAH was not correlated with hippocampal volume reduction but was correlated with interictal epileptiform discharges.

    Keywords: Aneurysmal clipping, cognitive dysfunction, interictal epileptiform discharges, hippocampal volume, spike index, Subarachnoid Hemorrhage

    Received: 09 May 2024; Accepted: 08 Jan 2025.

    Copyright: © 2025 Otsuka, Sunaga, Jimbo, Suzuki and Kohno. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Kunitoshi Otsuka, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan

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