Neuropsychological Outcomes After Surgery and Endovascular Treatment of Unruptured Cerebral Aneurysms

Overview

This prospective observational study evaluated cognitive and emotional outcomes in 109 patients treated for unruptured cerebral aneurysms via microsurgical clipping or endovascular occlusion. Results showed no significant baseline differences between groups, with aneurysm size differing by treatment modality, and comprehensive neuropsychological assessments were performed longitudinally.

Background

Treatment of unruptured cerebral aneurysms has advanced with minimally invasive surgical and evolving endovascular techniques, improving survival and functional outcomes. While ruptured aneurysms are known to impair cognition, the cognitive impact of unruptured aneurysms and their treatment remains unclear. Previous studies have been limited by heterogeneous populations, inconsistent assessment timing, and small sample sizes, necessitating prospective longitudinal evaluations. This study addresses these gaps by systematically assessing cognitive and emotional function before and after treatment.

Data Highlights

Key Findings

• No statistically significant differences in baseline demographic or clinical characteristics, including psychiatric history and epilepsy treatment, between surgical and endovascular groups.
• Aneurysms treated surgically were significantly smaller than those treated endovascularly (median 6 mm vs 7 mm, p=0.0073).
• The standard Pterional surgical approach was used selectively for larger middle cerebral artery aneurysms and complex cases.
• Endovascular treatment predominantly utilized flow diverter stents (59.1%), with stent-assisted coiling (31.8%) and coiling alone (9.1%) applied based on aneurysm location and morphology.
• All patients underwent uniform, comprehensive neuropsychological testing including MoCA and HADS, administered by the same investigator to ensure consistency.

Clinical Implications

The study highlights the importance of multidisciplinary decision-making tailored to aneurysm characteristics and patient condition to optimize treatment strategy. Comprehensive neuropsychological assessment is feasible and essential for monitoring cognitive and emotional outcomes longitudinally. Understanding differential impacts of surgical versus endovascular approaches can guide clinicians in counseling patients regarding expected cognitive trajectories and emotional well-being post-treatment.

Conclusion

This prospective study provides valuable longitudinal data on cognitive and emotional outcomes following treatment of unruptured cerebral aneurysms, emphasizing the need for standardized neuropsychological evaluation in this population. Further analyses will clarify the comparative cognitive effects of surgical and endovascular interventions.

References

1. Montreal Cognitive Assessment (MoCA) Italian Version Validation Studies
2. Hospital Anxiety and Depression Scale (HADS) Original Description
3. Meta-Analysis on Cognitive Outcomes in Unruptured Cerebral Aneurysm Treatment