Neuropsychological Changes in Patients Undergoing Treatment of Unruptured Intracranial Aneurysms

Caveney, Angela F.; Langenecker, Scott A.; Pandey, Aditya S.; Farah, Laura B; Ortiz, J. Alexis; Huq, Nadia; Bhaumik, Runa; Thompson, B. Gregory; Giordani, Bruno; Auer, Donna L.; Morgenstern, Lewis B.

doi:10.1093/neuros/nyy077

Cited by 14 publications

(14 citation statements)

References 41 publications

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“…Only Pietrantonio et al 17 demonstrated long-term cognitive changes favoring coiling, whereas both Caveney et al 5 and Preiss et al 18 found no significant differences in outcome measures in the long term (>12 months). Furthermore, Caveney et al 5 and Brundl et al 3 demonstrated that in the short term, endovascular patients outperformed microsurgical patients in memory and learning, executive function, and complex attention. This suggests that there may be effects of surgical intervention on neurocognition which need further elucidation.…”

Section: Resultsmentioning

confidence: 98%

“…Healthy controls most commonly outperformed patients receiving either treatment. 2,5,6,8,9,11,15,22 Thirteen of the 24 studies included demonstrated statistically significant neuropsychological outcomes favoring endovascular coiling. Proust et al 21 demonstrated outcomes favoring endovascular coiling approaching statistical significance ( P = .055) with the study possibly underpowered (n = 50).…”

Section: Resultsmentioning

confidence: 99%

“…Caveney et al 5 and Frazer et al 10 took sequential neuropsychological assessments at multiple time points following the same population. Both studies initially found a large, clinically significant difference of outcome favoring endovascular coiling.…”

Section: Discussionmentioning

confidence: 99%

“…Healthy controls most commonly outperformed patients receiving either treatment. 2,5,6,8,9,11,15,22 WAIS-R: vocabulary (P = .02), complex figure recall (P = .04), semantic fluency (P = .05), CANTAB: extradimensional shift stage of ID/ED shift (P = .01) Koivisto et al 12 RCT <1 mo 0/9 (0%) No significant differences between clipping and coiling treatments Koivisto et al 12 RCT 3 mo 0/18 (0%) No significant differences between clipping and coiling treatments Koivisto et al 12 RCT 12 mo 0/18 (0%) No significant differences between clipping and coiling treatments Ladowski et al 13 Prospective cohort >12 mo 4/4 (100%) Favors coiling: Semantic fluency (animals): (T(15), P = .010), (T(45) P = .008); phonetic fluency (F,A and S): T(15) P = .014, T(45) (P = .039) Latimer et al 14 Retrospective cohort >12 mo 3/18 (16.7%) Favors coiling: Full scale IQ (P = .025), verbal IQ (P = .029), performance IQ (P = .045) Mukerji et al 15 Retrospective cohort 12 mo 0/12 (0%) No significant differences between clipping and coiling treatments Nassiri et al 16 Retrospective cohort >12 mo 0/13 (0%) No significant differences between clipping and coiling treatments demonstrated outcomes favoring endovascular coiling apstatistical significance (P = .055) with the study possibly underpowered (n = 50). The results of a prospective cohort study conducted by Frazer et al 10 initially favored coiling at 2 weeks but favored clipping at 6 months.…”

Section: Treatment Modalitymentioning

confidence: 99%

“…Neuropsychological deficits have been identified after the treatment of ruptured and unruptured intracranial aneurysms with several studies comparing differences in outcomes between the 2 interventions. 1-24 Fewer studies have examined cognitive function post-SAH as most emphasize morbidity, mortality, and functional independence.…”

mentioning

confidence: 99%

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A Systematic Review of Neuropsychological Outcomes After Treatment of Intracranial Aneurysms

Nasra

Weerakkody²,

Maingard

et al. 2022

Neurosurgery

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BACKGROUND: Aneurysmal subarachnoid hemorrhage is a cause of profound morbidity and mortality. Its effects extend beyond functional neurological status to neurocognitive and psychological functioning. Endovascular treatment is becoming more prevalent after increasing evidence for its safety and efficacy; however, there is a relative paucity of evidence specific to neurocognitive status after treatment. OBJECTIVE: To assess and compare neuropsychological outcomes after the treatment of ruptured and unruptured intracranial aneurysms. METHODS: A systematic review of the literature was conducted searching for articles assessing the neuropsychological and cognitive outcomes after the treatment of ruptured and unruptured intracranial aneurysms. Inclusion criteria were English language, publication between January 2000 and October 2020, and discussion of neuropsychological outcomes in adequate detail. Outcomes were categorized into 8 domains: 5 Neurocognitive (Language, Executive Function, Complex Attention, Memory and Learning, and Perceptual motor function), Intelligence Quotient, Affect, and Quality of Life. RESULTS: Twenty-four articles were included comprising 2236 patients (924 surgical clipping, 1095 endovascular coiling, and 217 controls). These studies reported that most tests revealed no significant difference [n = 356/421 (84.56%)] between treatment modalities. More studies reported significantly superior test scores in the fields of language, executive function, and memory and learning after coiling [n = 53/421 tests (12.59%)] compared with clipping [n = 12/421 tests (2.85%)]. CONCLUSION: The current available data and published studies demonstrate a trend toward improved neurocognitive and psychological outcomes after endovascular treatment. Although these findings should be considered when deciding on the optimal treatment method for each patient, drawing definitive conclusions is difficult because of heterogeneity between patients and studies.

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