Neuropsychological Sequelae of Patients Treated with Microsurgical Clipping or Endovascular Embolization for Anterior Communicating Artery Aneurysm

Abstract

Background and Purpose: While microsurgical clipping has been the choice of treatment for anterior communicating artery (ACoA) aneurysm, endovascular embolization is increasingly popular for treating intracranial aneurysms. Previous studies showed that in terms of mortality (i.e., death) and morbidity (i.e., functional outcome, independent living, rebleeding) rates, the clinical outcomes of coil embolization for intracranial aneurysms are as good as or even better than those of surgical clipping. However, little is known about the impact of these treatments on the cognitive functions of those survived after the treatment. Thus, the present study is designed to examine the cognitive deficits of patients treated with either surgical clipping or coil embolization. Method: Eighteen patients with a ruptured ACoA aneurysm were recruited. Half of them had undergone surgical clipping and the other half had endovascular embolization. Standardized neuropsychological tests were employed to assess their memory, executive function, motor ability, language and visual perceptual abilities. Results: The performance of the patients was in general poorer than that of the normal control subjects on tests of verbal memory, flexible thinking, ability to resist interference and motor control. However, in terms of severity, the patients who received surgical clipping demonstrated more severe impairment than those had endovascular embolization on these cognitive domains. In addition, while 33% of patients in the clipping group showed impairments on memory and executive function, no patient in the embolization group demonstrated these impairments. Conclusions: Patients with ACoA aneurysm demonstrated impaired verbal memory, executive function and motor abilities while their language and visual perception abilities remained relatively intact. However, when comparing the effect of treatment choice on the cognitive functions of these patients, the present results favored the coil embolization as the patients treated with coil embolization demonstrated significantly fewer severe cognitive deficits than patients who had undergone surgical clipping.

Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment

“…It seems that the cog nitive outcome of patients treated by endovascular coiling was more favorable than that in those treated by micro surgical clipping. 4,10,18,25 Hadjivassiliou et al 25 reported a prospective series of 40 patients with ruptured aneurysms in different loca tions that were treated using microsurgical clipping. They matched these patients to 40 patients treated during the same period by using endovascular coiling.…”

“…These differences could be explained by further frontotemporal structural damage in the surgical group. Chan et al 10 reported that 9 patients with ACoA aneurysms treated with clips had a significantly worse outcome than the 9 patients with endovascular occlusion regarding verbal memory (43 vs 14%, respectively) and executive functions (67 vs 22%, respectively). The deficit in the cliptreated group may be attributed to an encoding deficit, whereas in the coiling group it was related to a re trieval deficit.…”

“…However, most of these studies did not take aneurysm location into con sideration, 9,11,25,26,30,37,40,44,45,47,52 or rarely did they focus on the ACoA. 4,5,10,18,19 For this location, essentially verbal memory, executive functions, and QOL are affected.…”

“…The results regarding cogni tive function remain limited, and the studies analyzing the cognitive results according to the treatment procedure are rare. 10,18,25 The authors of these studies have reported more favorable cognitive outcomes after endovascular treatment without taking into account the aneurysm location. Thus, our series provides a unique opportunity to evaluate the cognitive outcome for the ACoA location depending on the aneurysm exclusion procedure.…”

Anterior communicating artery aneurysm clipping versus coiling: a comparative study of 50 cases

“…[25] The only study that compares the cognitive outcome between surgically and endovascular treated patients was published by Chan et al on 18 patients with ruptured Acommm aneurysm. [26] Half of them had undergone surgical clipping and the other half had endovascular embolization. Endovascular treatment showed significantly fewer severe cognitive deficits than those with surgical clipping.…”