Endovascular treatment may cause less structural brain damage than surgery and have a more favorable cognitive outcome. However, cognitive outcome appears to be dictated primarily by the complications of SAH.

The incidence and severity of cognitive deficits after surgery for aneurysmal subarachnoid haemorrhage and their relationship to aneurysm site remains controversial. The aim of this study was to investigate the pattern of regional cerebral blood flow which exists in patients one year post-surgery and to identify whether different patterns exist which may be related to the type of cognitive deficit or the location of the aneurysm. 62 patients underwent cognitive assessment and HMPAO SPECT imaging at a mean time of 12 months following surgery. Results were compared to those from healthy control subjects (n = 55 for neuropsychological testing; n = 14 for SPECT imaging). In the patient group, significant stable cognitive deficits occurred in all cognitive domains but no cognitive measure differentiated aneurysm site. On SPECT images, statistical parametric mapping identified a large common area of subcortical hypoperfusion in the patient group as a whole. The findings of this study suggest a possible link between reduced subcortical function and the extent and severity of cognitive deficits.

The relative contribution to cognitive outcome of haemorrhage and surgery following aneurysmal subarachnoid haemorrhage has been assessed using a battery of cognitive tests and magnetic resonance imaging one year after the procedure. To tease out the effect of surgery we have used 40 case-matched patients treated with endovascular coiling as controls. Surgery resulted in greater areas of structural damage than endovascular coiling. Both the surgical and the coiled groups were cognitively impaired on a broad range of cognitive tasks. When comparing the coiled and clipped groups there is a trend towards a poorer cognitive outcome amongst the surgically treated patients. Cognitive outcome following aneurysmal subarachnoid haemorrhage is primarily dictated by the haemorrhage. This first comparison of the two techniques, however, suggests that endovascular coiling may be more advantageous than surgery in the treatment of aneurysmal subarachnoid haemorrhage.

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