Subarachnoid haemorrhage (SAH): long-term cognitive outcome in patients treated with surgical clipping or endovascular coiling

Abstract

Purpose: To compare long-term cognitive outcomes of patients treated with surgical clipping or endovascular coiling after subarachnoid haemorrhage (SAH). Method: Retrospective matched cohort study assessed neuropsychological functioning at least 12 months after aneurysmal SAH treatment. Fourteen patients treated by endovascular coiling and nine patients treated by surgical clipping participated. After gaining written consent, a comprehensive neuropsychological battery was completed. Standardised tests were employed to assess pre-morbid and current intellectual functioning (IQ), attention, speed of information processing, memory and executive function as well as psychosocial functioning and affect. Results: Treatment groups were not significantly different in terms of age, pre-morbid IQ, time from injury to treatment or time since injury. A significant effect of treatment on full-scale IQ score (p = 0.025), performance IQ (p = 0.045) and verbal IQ score (p = 0.029), all favouring the coiled group was observed. A medium effect size between groups difference in immediate memory (p = 0.19, partial η² = 0.08) was also observed. No significant between group differences on attention, executive functioning and speed of information processing measures or mood and psychosocial functioning were noted. Both groups reported increased anxiety and memory, attention and speed of information processing deficits relative to normative data. Conclusions: Study findings indicate fewer cognitive deficits following endovascular coiling. Cognitive deficits in the clipped group may be due in part to the invasive nature of neurosurgical clipping. Further prospective research with regard to long-term cognitive and emotional outcomes is warranted.

Implications of Rehabilitation

• Treatment of ruptured intracranial aneurysms by either endovascualar coiling or neurosurgical clipping can result in significant long-term physical disability as well as cognitive impairment.

• Observed cognitive impairment(s) tend to be less in patients following endovascular coiling.

• Following ruptured aneurysm, patients with cognitive impairment report reduced health related quality of life and increased anxiety.

• Those with identified cognitive impairment(s) may benefit from cognitive remediation.

Keywords::

• Aneurysmal subarachnoid haemorrhage (SAH)
• endovascular coiling
• neurosurgery
• neuropsychology outcomes

Acknowledgements

We would like thank all the participants who took the time to contribute to this research. Particular thanks go to Dr Ian Rennie and Mr John Gray who facilitated the recruitment of participants and provided useful guidance and advice.

Declaration of Interest: The authors report no declarations of interest.