Neuropsychological function after endovascular and neurosurgical treatment of subarachnoid hemorrhage: a systematic review and meta-analysis

Abstract

OBJECTIVE Subarachnoid hemorrhage (SAH) is treated with either surgical clipping or endovascular coiling, though the latter is the preferred treatment method given its more favorable functional outcomes. However, neuropsychological functioning after treatment is rarely taken into account. In this meta-analysis, the authors synthesized relevant data from the literature and compared neuropsychological functioning in patients after coiling and clipping of SAH. They hypothesized that the coiled patients would outperform the clipped patients; that group differences would be greater with higher posterior circulation rupture rates, in older patients, and in more recent publications; that group differences would be smaller with greater rates of middle cerebral artery (MCA) rupture; and that anterior communicating artery (ACoA) rupture rates would not influence effect sizes. METHODS The MEDLINE, Embase, and PsycINFO databases were searched for clinical studies that compared neuropsychological functioning after either endovascular coiling or surgical clipping for SAH. Hedge's g and 95% confidence intervals were calculated using random effects models. Patients who had undergone coiling or clipping were compared on test performance in 8 neuropsychological domains: executive functions, language, attention/processing speed, verbal memory, visual memory, spatial memory, visuospatial functions, and intelligence. Patients were also compared with healthy controls, and meta-regressions were used to explore the relation between effect sizes and publication year, delay between treatment and neuropsychological testing, mean patient age, and rates of posterior circulation, ACoA, and MCA ruptures. RESULTS Thirteen studies with 396 clipped cases, 314 coiled cases, and 169 healthy controls were included in the study. The coil-treated patients outperformed the clip-treated patients on executive function (g = 0.17, 95% CI 0.08-0.25) and language tests (g = 0.23, 95% CI 0.07-0.39), and all patients were impaired relative to healthy controls (g ranged from -0.93 to -0.29). Coiled patients outperformed clipped patients to a greater degree in more recent publications, over longer posttreatment testing delays, and among older patients. Higher rates of posterior circulation and MCA aneurysms were associated with smaller group differences, while ACoA rupture rates did not influence effect sizes. CONCLUSIONS Coiling of SAH may promote superior neuropsychological functioning under certain circumstances and could have applications for the specialized care of SAH patients.

Cognitive function, depression, and quality of life in patients with ruptured cerebral aneurysms

“…Several studies reported better cognitive function and neuropsychological functioning in patients treated by endovascular methods than patients treated by clipping. 37 , 38 However, we did not find any difference between these two methods of treatment. Frontotemporal lobe damage during surgery could explain the difference between microsurgical and endovascular group.…”

mRNA Expression Profiles from Whole Blood Associated with Vasospasm in Patients with Subarachnoid Hemorrhage

“…Synaptic long-term depression and synaptic long-term potentiation were among the significant pathways associated with vasospasm. This could indicate alteration of these pathways in hippocampus and could contribute to the memory problems seen in SAH patients particularly those with vasospasm [44,45]. Depletion of neutrophils decreased inflammation and vasospasm, preserved Long Term potentiation and N-methyl-d-aspartate function, and improved memory function in experimental SAH [46].…”

Clinical Factors Contributing to Cognitive Function in the Acute Stage after Treatment of Intracranial Aneurysms: A Cross-Sectional Study

“…In some studies, the cognitive function at long-term follow-up was noted to have recovered significantly from its status at the acute stage follow-up [ 12 , 15 ]; however, many existing studies have only investigated the cognitive function after 3 months, i.e., after the acute stage. In most cases, the assessment comprised a general cognitive assessment [ 1 , 16 , 17 , 18 ]. Therefore, the domain-specific cognitive function during the acute phase after the treatment remains unclear.…”