Neurocognitive outcomes after treatment of unruptured anterior communicating artery aneurysms - a systematic review

Cognitive changes after treatment of ruptured anterior communicating artery (AComA) aneurysms have been recognized for decades. Whether such deficits occur after elective treatment of unruptured aneurysms remains uncertain. A systematic search in MEDLINE (via PubMed and via Ovid), Embase, Scopus, Web of Science, CENTRAL and PsycINFO was conducted from inception to 31 August 2025, in accordance with PRISMA guidelines. Duplicate records were removed prior to screening. Studies were eligible if they included adult patients undergoing elective treatment of at least 1 unruptured AComA aneurysm, reported pre- and post-treatment neurocognitive testing across at least one cognitive subdomain, and differentiated outcomes from other aneurysm locations. Critical appraisal was performed using the Newcastle-Ottawa Scale, and certainty of evidence was assessed using the GRADE framework. Eight studies comprising 95 patients were included. In most studies, patients underwent surgical clipping (n = 82), with a minority treated endovascularly (n = 13). In five out of eight studies, patients who underwent elective treatment of an AComA aneurysm had worse cognitive outcomes than patients with aneurysms at non-AComA locations. Neurocognitive deficits may be detected in a substantial proportion of patients undergoing elective treatment of unruptured AComA aneurysms when sensitive neuropsychological assessment is applied. However, the current evidence base is limited by small sample sizes, heterogeneity in neuropsychological assessment, and a predominance of surgically treated cases.