Aneurysmal SAH - Cognitive outcome and structural damage after clipping orcoiling

Background: Aneurysmal subarachnoid hemorrhage (SAH) and surgical clipping of intracranial aneurysms are associated with substantial morbidity and mor tality. Objective: To compare cognitive outcome and structural damage in pa tients with aneurysmal SAH treated with surgical clipping or endovascular c oiling. Methods: Forty case-matched pairs of patients with aneurysmal SAH t reated by surgical clipping or endovascular coiling were prospectively asse ssed by use of a battery of cognitive tests. Twenty-three case-matched pair s underwent MRI 1 year after the procedure. Matching was based on grade of SAH on admission, location of aneurysm, age, and premorbid IQ. Results: Bot h groups were impaired in all cognitive domains when compared with age-matc hed healthy control subjects. Comparison of cognitive outcome between the t wo groups indicated an overall trend toward a poorer cognitive outcome in t he surgical group, which achieved significance in four tests. MRI showed fo cal encephalomalacia exclusively in the surgical group. This group also had a significantly higher incidence of single or multiple small infarcts with in the vascular territory of the aneurysm, but both groups had similar inci dence of large infarcts and global ischemic damage. Conclusion: Endovascula r treatment may cause less structural brain damage than surgery and have a more favorable cognitive outcome. However, cognitive outcome appears to be dictated primarily by the complications of SAH.