Aneurysmal SAH: cognitive outcome and structural damage after clipping or coiling.
BACKGROUND
Aneurysmal subarachnoid hemorrhage (SAH) and surgical clipping of intracranial aneurysms are associated with substantial morbidity and mortality.


OBJECTIVE
To compare cognitive outcome and structural damage in patients with aneurysmal SAH treated with surgical clipping or endovascular coiling.


METHODS
Forty case-matched pairs of patients with aneurysmal SAH treated by surgical clipping or endovascular coiling were prospectively assessed by use of a battery of cognitive tests. Twenty-three case-matched pairs underwent MRI 1 year after the procedure. Matching was based on grade of SAH on admission, location of aneurysm, age, and premorbid IQ.


RESULTS
Both groups were impaired in all cognitive domains when compared with age-matched healthy control subjects. Comparison of cognitive outcome between the two groups indicated an overall trend toward a poorer cognitive outcome in the surgical group, which achieved significance in four tests. MRI showed focal encephalomalacia exclusively in the surgical group. This group also had a significantly higher incidence of single or multiple small infarcts within the vascular territory of the aneurysm, but both groups had similar incidence of large infarcts and global ischemic damage.


CONCLUSIONS
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.
Hadjivassiliou
M
M
University Department of Clinical Neurology, Royal Hallamshire Hospital, Sheffield, UK.
Tooth
C L
CL
Romanowski
C A
CA
Byrne
J
J
Battersby
R D
RD
Oxbury
S
S
Crewswell
C S
CS
Burkitt
E
E
Stokes
N A
NA
Paul
C
C
Mayes
A R
AR
Sagar
H J
HJ
D003071:Cognition / Q000502:physiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D013345:Subarachnoid Hemorrhage / Q000473:pathology / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery*; D013525:Surgical Instruments