Unruptured intracranial aneurysm treatment effects on cognitive function: a meta-analysis

Bonares, Michael; Egeto, Peter; Manoel, Airton Leonardo de Oliveira; Veselý, K; Macdonald, R. Loch; Schweizer, Tom A.

doi:10.3171/2014.12.jns141625

Cited by 17 publications

(16 citation statements)

References 37 publications

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“…The long-term cognitive sequelae of the lesions observed following endovascular procedures have not been well studied. In a meta-analysis of eight studies (281 patients) of mixed clipping and coiling cohorts, treatment did not affect general cognitive functioning, although there was a suggestion of impaired executive functions and verbal memory domains 29…”

Section: Discussionmentioning

confidence: 96%

Antiplatelet therapy for prevention of thromboembolic complications in coiling-only procedures for unruptured brain aneurysms

Almekhlafi

Sultan

Kuczynski

et al. 2019

J NeuroIntervent Surg

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Background and purposeThromboembolic events are recognized complications of aneurysm coiling.ObjectiveTo identify any protective effects of antiplatelet therapy use before coiling of unruptured aneurysms.MethodsWe conducted a meta-analysis of clinical studies published up to February 2019. We included studies reporting symptomatic thromboembolic events (defined as clinical stroke or transient ischemic attacks) in patients who received antiplatelet therapy before coiling of unruptured aneurysms using unassisted coiling, balloon assistance, or multiple microcatheters. We excluded ruptured aneurysms and those treated with stent coiling or flow diverters.ResultsWe identified 14 studies (2486 patients). All were single-center studies and four were prospective. In three studies with a control (no treatment) arm, the pooled risk ratio for symptomatic thromboembolic events with versus without antiplatelet therapy was 0.33 (95% CI 0.17 to 0.92, p= 0.035). The cumulative risk of symptomatic thromboembolic events with single antiplatelet agents was 5.0% ‘56/1122’ (95% CI 1.6% to 8.4%, I283.63%), and with dual or multiple agents 2.7% ‘33/1237’ (95% CI 1.0% to 3.0%, I239.9%). The incidence of diffusion lesions was reported in seven studies. It was 50.5% ‘96/190’ (95% CI 7.3% to 93.9%, I294.4%) with single agents compared with 43.9% ‘196/446’ (95% CI 25.9% to 61.9%, I273.4%) with dual or multiple agents.ConclusionPeriprocedural antiplatelet therapy was associated with a low symptomatic thromboembolic event after coiling-only for unruptured aneurysms. However, available evidence is of limited quality with significant heterogeneity, requiring evidence from randomized controlled trials.

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Section: Discussionmentioning

confidence: 96%

Antiplatelet therapy for prevention of thromboembolic complications in coiling-only procedures for unruptured brain aneurysms

Almekhlafi

Sultan

Kuczynski

et al. 2019

J NeuroIntervent Surg

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“…On the other hand, Bonares and associates in their systematic review cited that although treatment for unruptured intracranial aneurysms allays anxiety, it also results in an ob-servable decline in cognition and daily functioning, and that the decision to treat an unruptured intracranial aneurysm ought to add more weight to the neuropsychological, psychosocial, and functional profiles of these patients [46]. Regarding to that, Bonares and associates did the meta-analysis on the effects of unruptured intracranial aneurysms (UIA) treatment on general cognition with an emphasis on 4 specific cognitive functions: verbal and visual memory, visuospatial functions, and executive functions [47]. The results showed that the treatment of an UIA does not seem to affect long-term cognitive functions.…”

Section: Discussionmentioning

confidence: 99%

Verbal Memory Functions in Patients after the Ruptured and Unruptured Cerebral Aneurysm Surgery

Pačić-Turk

Hauptfeld

Maljković

et al. 2020

Arch. Psychiatry Res.

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A cerebral aneurysm is a bulge in the wall of a brain blood vessel with a risk to rupture. It occurs in about 2% of the population, somewhat more often in women. Most aneurysms are located in the anterior circulation area. Aneurysm rupture is relatively rare and accounts for 5% of all cerebrovascular brain incidents. Ruptured and asymptomatic/unruptured aneurysms are often treated surgically at the Department of Neurosurgery, Medical School University of Zagreb. The study included 134 patients after cerebral aneurysm surgery during the last 10 years, and neuropsychological testing was performed on average 77 days after surgery. The average age was 52 years and they completed an average of 12 years of education. In the group of patients included in this study, 40.3% of them were operated after ruptured, and 59.7% for unruptured cerebral aneurysm. Most aneurysms were located in the middle cerebral and anterior communicating arteries. With regard to lateralization, there was an equal number of aneurysms located in the right and left hemisphere and bilaterally (on the anterior communicating artery). As part of regular neuropsychological assessment, tests of verbal learning and memory (numerical, logical and mechanical memory) were applied. The aims of the study were to find out whether patients operated for ruptured cerebral aneurysms show greater verbal memory impairments than patients operated for unruptured cerebral aneurysms and whether there was the significant effect of lateralization of aneurysm (to check the interaction effect of both rupture and lateralization on those functions). The results obtained show that, even though there are no statistically significant differences between groups of patients that underwent surgery for ruptured and unruptured brain aneurysm, patients show a trend of somewhat better results on most of the verbal memory functions after surgery for unruptured brain aneurysm. The results show statistically significant difference between groups of patients that underwent surgery for ACoA aneurysm and those with right lateralized cerebral aneurysms on most of the trails on AVLT test. Also, patients with operated ACoA aneurysm have significantly worse scores in learning process (AVLT 3 and AVLT 4) and especially on short-term and long-term verbal memory than the patients who were operated for left or right lateralized aneurysm.

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“…Change in general cognitive function after UIA treatment is controversial; some authors do not think that UIA treatment changes a patient's cognitive function after surgery. 3,14,44,53 The functional outcome of patients with UIAs treated using surgical clipping was reported to have progressively improved at the high-volume centers in the late 2000s to 2010s. 8,9,23 Furthermore, clipping surgery performed by experienced neurosurgeons with meticulous procedures results in preservation of cognitive functions as well as memory after the operation.…”

Section: Discussionmentioning

confidence: 99%

Validation of effectiveness of keyhole clipping in nonfrail elderly patients with unruptured intracranial aneurysms

Mori

Wada

Otani

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Advanced age is known to be associated with a poor prognosis after surgical clipping of unruptured intracranial aneurysms (UIAs). Keyhole clipping techniques have been introduced for less invasive treatment of UIAs. In this study, the authors compared the complications and clinical and radiological outcomes after keyhole clipping between nonfrail elderly patients (≥ 70 years) and nonelderly patients. METHODS Keyhole clipping (either supraorbital or pterional) was performed to treat 260 cases of relatively small (≤ 10 mm) anterior circulation UIAs. There were 62 cases in the nonfrail elderly group (mean age 72.9 ± 2.6 years [± SD]) and 198 cases in the nonelderly group (mean age 59.5 ± 7.6 years). The authors evaluated mortality and morbidity (modified Rankin Scale score > 2 or Mini-Mental State Examination [MMSE] score < 24) at 3 months and 1 year after the operation, the general cognitive function by MMSE at 3 months and 1 year, anxiety and depression by the Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HAM-D) at 3 months, and radiological abnormalities and recurrence at 1 year. RESULTS Basic characteristics including comorbidities, frailty, and BDI and HAM-D scores were not significantly different between the 2 groups, whereas the MMSE score was slightly but significantly lower in the elderly group. Aneurysm location, largest diameter, type of keyhole surgery, neck clipping rate, and hospitalization period were not significantly different between the 2 groups. The incidence of chronic subdural hematoma was not significantly higher in the elderly group than in the nonelderly group (8.1% vs 4.5%, p = 0.332); rates of other complications including stroke and epilepsy were not significantly different. Lacunar infarction occurred in 3.2% of the elderly group and 3.0% of the nonelderly group. No patient in the elderly group required re-treatment or demonstrated recurrence of clipped aneurysms. The MMSE score at 3 months significantly improved in the nonelderly group but did not change in the elderly group. The BDI and HAM-D scores at 3 months were significantly improved in both groups. No patient died in either group. The morbidity at 3 months and 1 year in the elderly group (1.6% and 4.8%, respectively) was not significantly different from that in the nonelderly group (2.0% and 1.5%, respectively). CONCLUSIONS Keyhole clipping for nonfrail elderly patients with relatively small anterior circulation UIAs did not significantly increase the complication, mortality, or morbidity rate; hospitalization period; or aneurysm recurrence compared with nonelderly patients, and it was associated with improvement in anxiety and depression. Keyhole clipping to treat UIAs in the nonfrail elderly is an effective and long-lasting treatment.

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Unruptured intracranial aneurysm treatment effects on cognitive function: a meta-analysis

Cited by 17 publications

References 37 publications

Antiplatelet therapy for prevention of thromboembolic complications in coiling-only procedures for unruptured brain aneurysms

Antiplatelet therapy for prevention of thromboembolic complications in coiling-only procedures for unruptured brain aneurysms

Verbal Memory Functions in Patients after the Ruptured and Unruptured Cerebral Aneurysm Surgery

Validation of effectiveness of keyhole clipping in nonfrail elderly patients with unruptured intracranial aneurysms

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