Clinical Scorecard: Comprehensive Neuropsychological Evaluation in Patients Receiving Neurosurgical and Endovascular Interventions for Unruptured Cerebral Aneurysms: Findings from a Prospective Observational Study

At a Glance

Key Highlights

• Advances in microsurgical and endovascular techniques have improved survival and functional outcomes in unruptured cerebral aneurysm treatment.
• Cognitive impact of unruptured aneurysms and their treatment remains insufficiently studied with heterogeneous results.
• This prospective study uses standardized neuropsychological assessments longitudinally to evaluate cognitive outcomes post-treatment.

Guideline-Based Recommendations

Diagnosis

• Use comprehensive neuropsychological assessment including MoCA for cognitive domains and HADS for emotional distress.
• Evaluate clinical condition with Modified Rankin Scale (mRS) at admission.
• Consider multidisciplinary evaluation of aneurysm morphology and patient clinical status to guide treatment choice.

Management

• Select treatment modality (microsurgical clipping vs. endovascular occlusion) based on aneurysm characteristics and patient factors.
• Employ minimally invasive surgical approaches and advanced intraoperative monitoring to minimize cognitive morbidity.
• Use flow diverter stents, stent-assisted coiling, or coiling alone tailored to aneurysm location and morphology.

Monitoring & Follow-up

• Perform longitudinal neuropsychological testing pre- and post-treatment to assess cognitive function and emotional symptoms.
• Use standardized, validated tools with age- and education-adjusted normative data for accurate interpretation.
• Monitor anxiety and depression symptoms using HADS to interpret cognitive test results in context of emotional distress.

Risks

• Potential cognitive deficits may vary by treatment modality, with some evidence suggesting fewer deficits after endovascular coiling compared to clipping.
• Anxiety and depression symptoms may improve following treatment but require monitoring.
• Heterogeneity in patient populations and aneurysm locations can influence cognitive outcomes.

Patient & Prescribing Data

109 patients with unruptured cerebral aneurysms; 65 underwent microsurgical clipping, 44 received endovascular treatment.

Endovascular treatment often involved flow diverter stents (59.1%), stent-assisted coiling (31.8%), or coiling alone (9.1%). Surgical clipping was more common for smaller aneurysms.

Clinical Best Practices

• Discuss cases in a multidisciplinary team including interventional neuroradiologists to determine optimal treatment strategy.
• Use standardized neuropsychological tests administered by trained personnel to ensure consistency.
• Adjust cognitive test scores for age and education to improve diagnostic accuracy.
• Incorporate emotional distress assessment to contextualize cognitive findings.
• Implement longitudinal follow-up to detect delayed cognitive changes post-treatment.

References

• Modified Rankin Scale (mRS)
• Montreal Cognitive Assessment (MoCA)
• Hospital Anxiety and Depression Scale (HADS)