Introduction: Neurocognitive changes post-surgical clipping (SC) or endovascular coiling (EC) of unruptured aneurysms is not well studied. We aim to understand whether patients who undergo EC perform better on neurocognitive assessments as compared to patients who undergo SC, and if such a difference exists how long the difference persists.
Methods: This is a single-center, prospective, longitudinal study with patients divided into the microsurgical, endovascular, and healthy control (HC) groups. All three groups underwent baseline neurocognitive assessments as well as post-procedure evaluations at 2-3 weeks, 3 months, 6 months, and 12 months. Two mixed effects models (post procedure decline and subsequent recovery) were computed for each dependent variable and controlling for age, IQ, sex, and complications.
Results: Included were 50 clipped, 36 coiled, and 43 control patients. ACOM and MCA aneurysms comprised 64% of the clipped patients while 86.1% of the coiled aneurysms were located within the posterior circulation or paraclinoid region. Symptomatic stroke occurred within one patient in the clipped group and none within the coiled group. At 2 weeks post procedure, the SC group showed significantly greater decline than the HC group on measures of verbal learning/memory, fine motor dexterity and executive functioning. The SC group also demonstrated significantly greater decline than the EC group on measures of executive functioning and flexibility. The SC group showed greater decline than both other groups on measures of simple reaction time, verbal fluency, working memory, and executive functioning. At 3-6 months post procedure, the SC group no longer exhibited these neurocognitive deficits.
Conclusions: The SC group had greater decline in neurocognitive functioning however were generally able to return to baseline functioning within 3-6 months.
Patient Care: This study is the first to describe differences in neurocognitive outcome as well as the rate of recovery for patients undergoing clipping vs. coiling for unruptured intracranial aneurysms. The results allow us to better counsel patients for the possibility of neurocognitive decline and rate of recovery post clipping or coiling of unruptured intracranial aneurysms. In addition, future studies will aim at strategies (e.g. preconditioning) of preventing such cognitive decline.
Learning Objectives: By the conclusion of this session participants should be able to: 1) Describe neurocognitive measures in the evaluation of patients undergoing treatment of unruptured aneurysms. 2) Describe differences in neurocognitive outcome of those patients undergoing clipping vs. coiling for unruptured cerebral aneurysms. 3) Describe the rate of recovery of neurocognitive deficits post coiling or clipping of unruptured cerebral aneurysms.