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Aneurysmal SAH: cognitive outcome and structural damage after clipping or coiling
M Hadjivassiliou1, C L Tooth, C A Romanowski
1University Department of Clinical Neurology, Royal Hallamshire Hospital, Sheffield, UK.
Neurology
|June 27, 2001
Summary
Endovascular coiling for brain aneurysms may lead to better cognitive function and less brain damage compared to surgical clipping. However, subarachnoid hemorrhage complications significantly impact cognitive outcomes for both treatments.
Area of Science:
- Neurosurgery
- Neurology
- Interventional Radiology
Background:
- Aneurysmal subarachnoid hemorrhage (SAH) poses significant risks.
- Surgical clipping of intracranial aneurysms is linked to high morbidity and mortality.
Purpose of the Study:
- To compare cognitive outcomes after surgical clipping versus endovascular coiling for aneurysmal SAH.
- To assess and compare structural brain damage in patients treated with either method.
Main Methods:
- Prospective assessment of 40 case-matched pairs of patients with aneurysmal SAH.
- Cognitive testing and MRI scans (at 1 year) were used for evaluation.
- Matching criteria included SAH grade, aneurysm location, age, and premorbid IQ.
Main Results:
- Both treatment groups showed cognitive impairments compared to controls.
- A trend towards poorer cognitive outcomes was observed in the surgical clipping group.
- MRI revealed focal encephalomalacia and more small infarcts in the surgical group, while large infarcts and global damage were similar.
Conclusions:
- Endovascular coiling may result in less structural brain damage and better cognitive function.
- The primary determinant of cognitive outcome appears to be the complications of SAH itself.