• Mohamed Nasra, Dumindu Weerakkody, Julian Tam Maingard, Jonathan Hall, Goran Mitreski, Hong Kuan Kok, SmithPaul DPDDepartment of Neurosurgery, St Vincent's Hospital, Fitzroy, Victoria, Melbourne, Australia.Melbourne Medical School, The University of Melbourne, Parkville, Victoria, Melbourne., Jeremy H Russell, Ashu Jhamb, Duncan Mark Brooks, and Hamed Asadi.
• Monash Health, Clayton, Victoria, Australia.
• Neurosurgery. 2022 Dec 1; 91 (6): 831841831-841.

BackgroundAneurysmal subarachnoid hemorrhage is a cause of profound morbidity and mortality. Its effects extend beyond functional neurological status to neurocognitive and psychological functioning. Endovascular treatment is becoming more prevalent after increasing evidence for its safety and efficacy; however, there is a relative paucity of evidence specific to neurocognitive status after treatment.ObjectiveTo assess and compare neuropsychological outcomes after the treatment of ruptured and unruptured intracranial aneurysms.MethodsA systematic review of the literature was conducted searching for articles assessing the neuropsychological and cognitive outcomes after the treatment of ruptured and unruptured intracranial aneurysms. Inclusion criteria were English language, publication between January 2000 and October 2020, and discussion of neuropsychological outcomes in adequate detail. Outcomes were categorized into 8 domains: 5 Neurocognitive (Language, Executive Function, Complex Attention, Memory and Learning, and Perceptual motor function), Intelligence Quotient, Affect, and Quality of Life.ResultsTwenty-four articles were included comprising 2236 patients (924 surgical clipping, 1095 endovascular coiling, and 217 controls). These studies reported that most tests revealed no significant difference [n = 356/421 (84.56%)] between treatment modalities. More studies reported significantly superior test scores in the fields of language, executive function, and memory and learning after coiling [n = 53/421 tests (12.59%)] compared with clipping [n = 12/421 tests (2.85%)].ConclusionThe current available data and published studies demonstrate a trend toward improved neurocognitive and psychological outcomes after endovascular treatment. Although these findings should be considered when deciding on the optimal treatment method for each patient, drawing definitive conclusions is difficult because of heterogeneity between patients and studies.Copyright © Congress of Neurological Surgeons 2022. All rights reserved.

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