Treatment of unruptured intracranial aneurysms: microsurgical clipping ver-sus endovascular occlusion and effects on cognitive outcome
The prevalence of unruptered intracranial aneurysm(s) in the Danish population is relatively high. In the event of aneurysm rupture, mortality and morbidity rate are as high as 60% and 30%, respectively.
Neurological and physical outcomes from unruptured aneurysm intervention has been thoroughly investigated, but the knowledge of outcomes in relation to cognitive functions is sparse.
Therefore, we investigate the effect of intervention and choice of treatment modality on cognitive functions.
The prevalence for unruptured intracranial aneurysms (UIAs) in a population is estimated at 0.4-6.0%. Aneurysm rupture, resulting in a subarachnoid haemorrhage, is associated with a 60% mortality rate and a 30% morbidity rate, which is a key important factor for prophylactic treatment of asymptomatic UIAs.
Recent meta studies and systematic reviews have shown lack of consensus regarding whether the UIA-treatment affects patients' cognitive function.
Furthermore, some of the prospective studies comparing both microsurgical clipping and endovascular coiling do not distinguish between UIAs located in the anterior or posterior circulation, respectively. Based on existing studies, more extensive research is needed before it is possible to de-termine, whether treatment of UIAs affect cognitive functions.
This study aims to examine, whether the treatment of unruptured intracranial aneurysms in the anterior circulation is associated with postinterventional cognitive deficits. It also investigates if cognitive outcome following UIA-treatment differs between patients treated with endovascular coiling or microsurgical clipping, respectively, by use of carefully se-lected neuropsychological tests intended to evaluate both general cognitive function and domain-specific cognition.
Description of the cohort
The study is designed as a prospective clinical trial and includes patients with unruptured intracranial aneurysms in the anterior circulation planned for either microsurgical clipping or endovascular coiling at Department of Neurosurgery, Odense University Hospital. In total, 200 patients are expected to be included; 100 patients selected for microsurgical clipping, and 100 patients selected for endovascular coiling.
The study will compare the treatment modalities with regards to the location of the an-eurysm; meaning patients undergoing microsurgical clipping for an aneurysm located at the middle cerebral artery, will be compared to patients undergoing endovascular coiling for an aneurysm located at the middle cerebral artery. The same applies to patients with aneurysms at other locations in the anterior circulation.
Data and biological material
No biological materail will be collected.
Data will include results from the neuropsychological tests, demographic data, diagnosis, aneurysms characteristics, comorbidities, medications, treatment modality, data about the intervention and adverse outcomes.
The neuropsychological tests are conducted as interviews. Other data will be collected from the current patient journal systems in Region of Southern Denmark: EPJ Syd and Cosmic.