SPECT with technetium-99m-HMPAO in relation to late cognitive outcome after surgery for ruptured cerebral aneurysms.

Fifteen patients with a good neurological outcome after aneurysmal SAH and surgery were collected prospectively. Six months after surgery neurological examination and a SPECT study for evaluation of the three dimensional CBF distribution as well as an extensive neuropsychological test were performed. In all patients with pathological SPECT findings the location of the reduced regional CBF correlated with the location of the ruptured aneurysm and/or side of surgical approach. The volume of the brain tissue with reduced rCBF showed a great variety, from 9-112 cm(3) (mean: 33 cm(3)). Similarly, the maximum flow reduction in the affected areas also varied considerably from 17-95% (mean: 39%). In general, the neuropsychological functioning of the patients post SAH was favourable. Seven individuals had a presumably normal neuropsychological appearance with respect to estimates of premorbid levels of functioning. Another four patients were slightly impaired and the remaining four were moderately affected. Only in five cases did the location of SPECT pathology and the site of neuropsychological impairment appear to coincide, whereas this was not the case in the remaining 10 patients. In general, the extent of SPECT pathology did not differ in the three neuropsychological outcome groups (normal, slight and moderate disability).