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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2025; 44(01): e15-e23
DOI: 10.1055/s-0045-1805016
Original Article

Visuospatial Changes after Clipping of Anterior Communicating Artery Aneurysms

Alterações visuoespaciais após clipagem de aneurismas da artéria comunicante anterior
Camila Santos Cechi
1   Department of Neurological Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
,
Leonardo B. Oliveira
2   Department of Medicine, State University of Ponta Grossa, Ponta Grossa, PR, Brazil
,
Ibero Ramazini Martin
1   Department of Neurological Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
,
Ana Paula Micieli
1   Department of Neurological Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
,
Jessica de Oliveira D. Vismara
1   Department of Neurological Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
,
Guilherme Melo Silva
3   Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
,
Sávio Batista
4   Department of Neurology, Grady Memorial Hospital, Emory University, Atlanta, GA, United States
,
Raphael Bertani
1   Department of Neurological Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
,
Cristiano Pedroso 
5   Instituto de Psicologia Experimental da USP, University of São Paulo, São Paulo, SP, Brazil
,
Eberval Gadelha Figueiredo
1   Department of Neurological Surgery, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, SP, Brazil
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Abstract

Introduction A series of symptoms are commonly seen after anterior communicating artery (ACoA) aneurysm clipping. Previous studies designated it as ACoA syndrome, a condition in which symptoms like amnesia, confabulation, and personality changes are observed. The present study investigates visuospatial impairments associated with ACoA aneurysm rupture followed by subarachnoid hemorrhage (SAH) and clipping procedure.

Methods 31 patients who underwent surgical clipping of the ACoA after SAH were evaluated prospectively at three, six, and twelve months after the surgery. Hooper Visual Organization test (HVOT), Judgment of Line Orientation test (JLOT), and Stroop-I test were used to evaluate visual organization, visual orientation perception, and visual attention, respectively.

Results Regarding the HVOT, the mean score observed in each observation was at three, six, and twelve months, respectively: 20.2 (SD ± 4.4), 21.5 (SD ± 4.7), and 20.9 (SD ± 4.6). The JLOT, in turn, presented the following results at the same respective time frames: 19.0 (SD ± 4.9); 19.7 (SD ± 4.3); 21.2 (SD ± 4.7). Finally, for the Stroop-I test, a similar pattern was found: 18.35 (SD ± 5.8); 18.00 (SD ± 6); 17.00 (SD ± 4.4). Of all the tests above, only Stroop-I test scores did not follow a normal distribution.

Conclusion Visuospatial and visuoperceptual abilities can also present impairments after SAH following ACoA aneurysm rupture and clipping, although it is commonly a mild symptom. Therefore, diffuse symptomatology, rather than the stricter ACoA syndrome described in the literature, may be seen. Moreover, positive outcomes are expected twelve months after postoperatively.

Resumo

Introdução Uma série de sintomas é comumente observada após a clipagem de aneurismas da artéria comunicante anterior (ACoA). Estudos anteriores denominaram essa condição como síndrome da ACoA, em que sintomas como amnésia, confabulação e alterações de personalidade são frequentemente observados. O presente estudo investiga os déficits visuoespaciais associados à ruptura de aneurisma da ACoA, seguida por hemorragia subaracnoide (HSA) e clipagem.

Método 31 pacientes que foram submetidos à clipagem cirúrgica da ACoA após HSA foram avaliados prospectivamente aos três, seis e doze meses após a cirurgia. Foram utilizados o Teste de Organização Visual de Hooper (HVOT), o Teste de Julgamento de Orientação de Linhas (JLOT) e o Stroop-I para avaliar, respectivamente, a organização visual, a percepção de orientação visual e a atenção visual.

Resultados Em relação ao HVOT, a pontuação média observada em cada momento foi de três, seis e doze meses, respectivamente: 20,2 (DP ± 4,4), 21,5 (DP ± 4,7) e 20,9 (DP ± 4,6). O JLOT, por sua vez, apresentou os seguintes resultados nos mesmos períodos: 19,0 (DP ± 4,9); 19,7 (DP ± 4,3); 21,2 (DP ± 4,7). Finalmente, para o Stroop-I, foi encontrado um padrão semelhante: 18,35 (DP ± 5,8); 18,00 (DP ± 6); 17,00 (DP ± 4,4). De todos os testes mencionados, apenas os escores do Stroop-I não seguiram uma distribuição normal.

Conclusão Habilidades visuoespaciais e visuoperceptivas também podem apresentar comprometimentos após HSA decorrente da ruptura de aneurisma da ACoA e sua subsequente clipagem, embora sejam comumente sintomas leves. Portanto, uma sintomatologia difusa, em vez da síndrome da ACoA mais restrita descrita na literatura, pode ser observada. Além disso, são esperados desfechos positivos doze meses após o procedimento cirúrgico.

Keywords

subarachnoid hemorrhage - anterior communicating artery - intracranial aneurysm - visuospatial changes - visuospatial abilities - visual impairment

Palavras-chave

hemorragia subaracnóidea - artéria comunicante anterior - aneurisma intracraniano - alterações visuoespaciais - habilidades visuoespaciais - deficiência visual


Publication History

Received: 14 October 2024

Accepted: 27 December 2024

Article published online:
27 March 2025

© 2025. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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