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Aneurysmal SAH

Cognitive outcome and structural damage after clipping or coiling

From the University Department of Clinical Neurology (Drs. Hadjivassiliou, Mayes, Sagar, and C. Tooth) and the Departments of Neuroradiology (Dr. Romanowski) and Neurosurgery (Dr. Battersby), Royal Hallamshire Hospital, Sheffield, UK; and the Departments of Neuroradiology (Dr. Byrne) and Neuropsychology (S. Oxbury, C. Creswell, E. Burkitt, N. Stokes, and C. Paul), The Radcliffe Infirmary, Oxford, UK.

Address correspondence and reprint requests to Dr. Marios Hadjivassiliou, Department of Neurology, The Royal Hallamshire Hospital, Glossop Road, Sheffield, S102JF, UK.

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.

CONCLUSION: 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.

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