Integrated neuropsychological assessment in patients undergoing neurosurgical and endovascular treatment of unruptured cerebral aneurysms: results of a prospective observational study.

[BACKGROUND] The treatment of unruptured cerebral aneurysms has evolved through new surgical and endovascular approaches. Its goal is to ensure the patient survival with a good quality of life, so cognitive outcome should be considered a critical factor in the decision-making analysis. This study aimed to investigate the impact of unruptured cerebral aneurysm treatment on cognitive function.

[METHOD] This prospective study enrolled 109 patients with unruptured cerebral aneurysms, 65 treated with microsurgery and 44 with endovascular procedures. Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) test, anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and quality of life by the SF-36 questionnaire. Potential risk factors influencing the neuropsychological assessment were recorded. Patients were evaluated before treatment, at discharge and at 6-months, 1-year and 2-years post treatment.

[RESULTS] Before treatment, 24 patients exhibited a cognitive impairment on the MoCA test. These 24 cases were significantly older and had higher incidence of anxiety or depression under treatment. At 6 months two patients with preoperatively normal cognitive function developed a new deficit: they presented transient post-surgical complications and investigated risk factors. These two patients recovered completely at 12 months. Among those with baseline impairment 10 patients recovered at 6 months and 4 more at 12 months. At 24 months, 99 patients presented with normal MoCA scores and 10 patients showed persistent preoperative deficit.

[CONCLUSIONS] Neither minimally invasive microsurgery nor endovascular treatment was associated with a decline in global cognitive function within two years of follow-up. Anxiety and depression symptoms tended to improve post treatment, while quality-of-life scores remained stable. Transient postoperative complications did not influence long term cognitive outcomes. These findings highlight the importance of recognizing patient and aneurysm related risk factors that may predispose to cognitive decline. Individualized planning and pre-treatment neuropsychological assessment are therefore essential.