Ruptured Cerebral Aneurysm Patients Treated by Clipping or Coiling: Comparison of Long-term Neuropsychological and Personality Outcomes

Abstract

Background and Purpose: A prospective study was conducted to compare the neuropsychological outcome of surgical versus endovascular treatment in patients with cerebral aneurysms.

Methods: From April 2001 to 2005, 211 patients with ruptured cerebral aneurysms were treated at the senior author's institution. Of these 211 patients, 75 that were able and willing to undergo neuropsychological assessment 1 year after treatment of their aneurysm were enrolled in the study. Thirty-five patients were treated surgically and 40 by endovascular therapy. Standardized neuropsychological and personality tests were employed to assess cognitive and personality functions. One neurosurgical team using the same treatment protocols treated all patients.

Results: The two groups of patients did not differ significantly with respect to age, gender, concurrent diseases, Hunt and Hess grade, Fisher grade, frequency of complications, vasospasms and hydrocephalus development. No differences in performance on neuropsychological and cognitive tests (AVLT, TMT and WAIS-III) and personality variables and mood scales (TCI, BDI and SMS) were found one year postoperatively. If a full IQ as defined by WAIS-III and 1SD below the mean is considered as the main measure of cognitive deficits, 5.4% of the sample suffered from cognitive deficits. There were no differences between clipped and coiled patients (t=0.03; p=0.97).

Conclusions: The differences in the neuropsychological assessment of patients treated by either coiling or clipping were small and non-significant. Given the small number of patients in the study, however, we suggest the need for further research with a larger sample size and the use of a randomized design before drawing any firm conclusions.

Zusammenfassung

Ziel: Eine prospektive Studie wurde durchgeführt mit dem Ziel, das neuropsychologische Ergebnis von chirurgischer versus endovaskulärer Behandlung bei Patienten mit zerebralen Aneurysmen zu vergleichen.

Methoden: Von April 2001 bis April 2005 wurden 211 Patienten mit zerebralen Aneurysmen in der Institution des Seniorautors behandelt. Von diesen 211 Patienten waren 75 in der Lage und gewillt eine neuropsychologische Untersuchung 1 Jahr nach der Behandlung mitzumachen und wurden deswegen in die Studie eingeschlossen. 35 Patienten wurden chirurgisch behandelt und 40 endovaskulär. Standardisierte neuropsychologische und Persönlichkeitstests wurden angewendet um kognitive und Persönlichkeitsfunktionen zu untersuchen. Alle Patienten wurden von dem gleichen neurochirurgischen Team, das dieselben Behandlungsprotokolle verwendete, behandelt.

Ergebnisse: Die beiden Gruppen unterschieden sich nicht signifikant in Alter, Geschlecht, Begleiterkrankungen, Hunt & Hess Grad, Fisher Grad, Häufigkeit von Komplikationen, Vasospasmus und Hydrozephalusentwicklung. Ein Jahr postoperativ wurden keine Unterschiede bei der Ableistung von neuropsychologischen und kognitiven Tests (AVLT, TMT, WAIS-III) und Persönlichkeitsvariablen und Stimmungsskalen (TCI, BDI und SMS) gefunden. Falls der IQ von WAIS-III und ISD unterhalb des Mittelwertes als das Hauptmaß eines kognitiven Defizits betrachtet wird, würden 5,4% des Untersuchungsguts an einem kognitiven Defizit leiden. Es fanden sich keine Unterschiede zwischen geclippten und gecoilten Patienten (t=0,03; p=0,97).

Schlussfolgerungen: Die Unterschiede in der neuropsychologischen Untersuchung bei Patienten, die entweder mit Coiling oder Clippung behandelt wurden, sind klein und nicht signifikant. Da die Anzahl der Patienten in der Studie gering war, schlagen wir vor, weitere Untersuchungen mit einer größeren Patientenanzahl und dem Gebrauch eines randomisierten Studiendesigns durchzuführen, bevor endgültige Schlussfolgerungen gezogen werden können.

Key words

aneurysm - clipping - coiling - neuropsychology - subarachnoid hemorrhage - cognitive outcome

Schlüsselwörter

Aneurysma - Clippung - Coiling - Neuropsychologie - Subarachnoidalblutung - kognitives Ergebnis

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