Cognitive outcome after surgical clipping versus endovascular coiling in patients with subarachnoid hemorrhage due to ruptured anterior communicating artery aneurysm

  • Kurt BeeckmansEmail author
  • Cleo L. Crunelle
  • June Van den Bossche
  • Eva Dierckx
  • Karla Michiels
  • Patrick Vancoillie
  • Henri Hauman
  • Bernard Sabbe
Original article


Ruptured anterior communicating artery aneurysms are commonly associated with deficits in memory and executive functions. However, little studies are available on the effect of surgical clipping (SC) and endovascular coiling (EC) on cognitive functioning. This study evaluates cognitive functioning in 35 patients with subarachnoid hemorrhage after ruptured anterior communicating artery aneurysm (ACoA) compared to 20 healthy controls (HC) and assesses the effect of SC (n = 19) compared to EC (n = 16) on cognitive performances. All participants were investigated with an extensive neuropsychological test battery assessing attention, memory and visuospatial and executive functions. The strength of this study is an in-depth investigation of several cognitive domains together and several memory functions together within the auditory–verbal and visuospatial memory domain for unrelated and related information. The ACoA group was significantly more deficient in attention, auditory–verbal and visuospatial memory and executive functions compared to HCs. No significant differences were found between both groups concerning visuospatial functions. Within the patient group, the SC group, as compared to the EC group, showed a significantly worse performance for auditory–verbal and visuospatial memory. No significant differences could be detected between both groups with regard to attention and visuospatial and executive functions. In conclusion, this study provides evidence for the advantage of EC in ACoA patients over SC in terms of cognitive outcome.


Anterior communicating artery aneurysm Endovascular coiling Surgical clipping Cognitive functions 


Compliance with ethical standards

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Written informed consent was obtained from all individual participants included in the study.


  1. 1.
    Keedy A (2006) An overview of intracranial aneurysms. McGill J Med 9:141–146PubMedPubMedCentralGoogle Scholar
  2. 2.
    Brisman J, Song J, Newell D (2006) Cerebral aneurysms. N Engl J Med 355:928–939CrossRefGoogle Scholar
  3. 3.
    DeLuca J, Prestigiacomo C (2009) Cerebral aneurysms and subarachnoid hemorrhage. In: Festa J, Lazar R (eds) Neurovascular neuropsychology. Springer, New YorkGoogle Scholar
  4. 4.
    Chan A, Ho S, Poon W (2002) Neuropsychological sequelae of patients treated with microsurgical clipping or endovascular embolization for anterior communicating artery aneurysm. Eur Neurol 47:37–44CrossRefGoogle Scholar
  5. 5.
    DeLuca J, Diamond B (1995) Aneurysm of the anterior communicating artery: a review of neuroanatomical and neuropsychological sequelae. J Clin Exp Neuropsychol 17:100–121CrossRefGoogle Scholar
  6. 6.
    Diamond B, DeLuca J, Kelley S (1997) Memory and executive functions in aneurysms of the anterior communicating artery. Brain 120:1015–1025CrossRefGoogle Scholar
  7. 7.
    Nassiri F, Workewych A, Badhiwala J, Cusimano M (2018) Cognitive outcomes after anterior communicating artery aneurysm repair. Can J Neurolog Sci 45:415–423CrossRefGoogle Scholar
  8. 8.
    Papagno C, Rizzo S, Ligori L, Lima J, Riggio A (2003) Memory and executive functions in aneurysms of the anterior communicating artery. J Clin Exp Neuropsychol 25:24–35CrossRefGoogle Scholar
  9. 9.
    Parkin A, Leng N (1993) Neuropsychology of the amnesic syndrome. Lawrence Erlbaum Associates, HoveGoogle Scholar
  10. 10.
    Ravnik J, Starovasnik B, Sesok S, Pirtosek Z, Svigeij V, Bunc G, Bosnjak R (2006) Long-term cognitive deficits in patients with good outcomes after aneurysmal subarachnoid hemorrhage from anterior communicating artery. Croat Med J 47:253–263PubMedPubMedCentralGoogle Scholar
  11. 11.
    Simard S, Rouleau I, Brosseau J, Laframboise M, Bojanowsky M (2003) Impact of executive dysfunctions on episodic memory abilities in patients with ruptured aneurysm of the anterior communicating artery. Brain Cogn 53:354–358CrossRefGoogle Scholar
  12. 12.
    Borsutzky S, Fujiwara E, Brand M, Markowitsch HJ (2010) Susceptibility to false memories in patients with ACoA aneurysm. Neuropsychologia 48:2811–2823CrossRefGoogle Scholar
  13. 13.
    Hanley J, Davies A, Downes J, Roberts J, Gong Q, Mayes A (2001) Remembering and knowing in a patient with preserved recognition and impaired recall. Neuropsychologia 39:1003–1010CrossRefGoogle Scholar
  14. 14.
    Beeckmans K, Vancoillie P, Michiels K (1998) Neuropsychological deficits in patients with an anterior communicating artery syndrome: a multiple case study. Acta Neurol Belg 98:266–278PubMedGoogle Scholar
  15. 15.
    Escartin G, Junqué C, Juncadella M, Gabarros A, Angels de Miquel M, Rubio F (2012) Decision-making impairment on the Iowa Gambling Task after endovascular coiling or neurosurgical clipping for ruptured anterior communicating artery aneurysm. Neuropsychology 26:172–180CrossRefGoogle Scholar
  16. 16.
    Fontanella M, Bergamasco L, Perozzo P, Priano L, Vighetti S, Griva F, Pagni C (2000) Neuropsychological and neurophysiological evaluation after anterior communicating artery (ACoA) aneurysm surgery. J Neurosurg Sci 44:61–67PubMedGoogle Scholar
  17. 17.
    Martinaud O, Perin B, Gérardin E, Proust F, Bioux S, Gars DL, Hannequin D, Godefroy O (2009) Anatomy of executive deficit following ruptured anterior communicating artery aneurysm. Eur J Neurol 16:595–601CrossRefGoogle Scholar
  18. 18.
    Mortimer A, Steinfort B, Faulder K, Erho T, Scherman D, Rao P, Harrington T (2016) Rates of local procedural-related structural injury following clipping or coiling of anterior communicating artery aneurysms. J Neurointerv Surg 8:256–264CrossRefGoogle Scholar
  19. 19.
    Harrigan M, Deveikis J (2012) Handbook of cerebrovascular disease and neurointerventional technique, 2nd edn. Springer Science and Business Media, BerlinGoogle Scholar
  20. 20.
    Bederson J, Conolly S, Batjer H, Dacey R, Dion J, Diringer M, Duldner J, Harbaugh R, Patel A, Rosenwasser R (2009) Guidelines for the management of aneurysmal subarachnoid hemorrhage. Stroke 40:994–1025CrossRefGoogle Scholar
  21. 21.
    Fontanella M, Perozzo P, Ursone R, Garbossa D, Bergui M (2003) Neuropsychological assessment after microsurgical clipping or endovascular treatment for anterior communicating artery aneurysm. Acta Neurochir 145:867–872CrossRefGoogle Scholar
  22. 22.
    Pietrantonio A, Trungu S, Raco A (2017) Clinical and neuropsychological outcome after microsurgical and endovascular treatment of ruptured and unruptured anterior communicating artery aneurysms: a single-enter experience. Acta Neurochirurgica 124:173–177CrossRefGoogle Scholar
  23. 23.
    Proust F, Martinaud O, Gérardin E, Derrey S, Levèque S, Bioux S, Tollard E, Clavier E, Langlois O, Godefroy O, Hannequin D, Fréger P (2009) Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment. J Neurosurg 110:19–29CrossRefGoogle Scholar
  24. 24.
    Bendel P, Koivisto T, Niskanen E, Kononen M, Aikia M, Hanninen T, Koskenkorva P, Vanninen R (2009) Brain atrophy and neuropsychological outcome after treatment of ruptured anterior cerebral artery aneurysms: a voxel-based morphometric study. Neuroradiology 51:711–722CrossRefGoogle Scholar
  25. 25.
    Hadjivassiliou M, Tooth C, Romaowski C, Byrne J, Battersby R, Oxbury S, Crewswell C, Burkitt E, Stokes N, Paul C, Mayes A, Sagar H (2001) Aneurysmal SAH: cognitive outcome and structural damage after clipping or coiling. Neurology 56:1672–1677CrossRefGoogle Scholar
  26. 26.
    Bouma A, Mulder J, Lindeboom J, Schmand B (2012) Handboek neuropsychologische diagnostiek. Pearson, AmsterdamGoogle Scholar
  27. 27.
    Wechsler D (2012) Wechsler Adult Intelligence Scale (4th Edition) Nederlandstalige bewerking. Pearson Assessment and Information, AmsterdamGoogle Scholar
  28. 28.
    Lezak M, Howieson D, Bigler E, Tranel D (2012) Neuropsychological assessment. Oxford University Press, New YorkGoogle Scholar
  29. 29.
    Miatton M, Wolters M, Lannoo E, Vingerhoets G (2004) Updated and extended Flemish normative data of commonly used neuropsychological tests. Psychologica Belgica 44:189–216Google Scholar
  30. 30.
    Strauss E, Sherman E, Spreen O (2006) A compendium of neuropsychological tests administration, norms, and commentary, 3rd edn. Oxford University Press, New YorkGoogle Scholar
  31. 31.
    Meyers J, Meyers K (1995) Rey complex figure test and recognition trial. Psychological Assessment Resources (PAR), LutzGoogle Scholar
  32. 32.
    Benton A, Hamsher K, Varney NR, Spreen O (1983) Contributions to neuropsychological assessment: a clinical manual. Oxford University Press, New YorkGoogle Scholar
  33. 33.
    Mulder J, Dekker P, Dekker R (2014) Woord-fluencytest en figuur-fluencytest. Hogrefe Uitgevers, AmsterdamGoogle Scholar
  34. 34.
    Wetzel L, Boll T (1987) Short category test, booklet format. Western Psychological Services, Los AngelesGoogle Scholar
  35. 35.
    Chapuis F (1992) Labyrinthtest. Hogreve, GöttingenGoogle Scholar

Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  1. 1.Center for Epilepsy and Acquired Brain Injury (CEPOS)DuffelBelgium
  2. 2.Department of Biological Psychology, Faculty of Psychology and Educational SciencesVrije Universiteit Brussel (VUB)BrusselsBelgium
  3. 3.Department of PsychiatryVrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel)BrusselsBelgium
  4. 4.Toxicological CenterAntwerp UniversityWilrijkBelgium
  5. 5.Faculty of Psychology and Educational Sciences, Vrije Universiteit Brussel (VUB)BrusselsBelgium
  6. 6.Department of Clinical and Lifespan Psychology, Faculty of Psychology and Educational SciencesVrije Universiteit Brussel (VUB)BrusselsBelgium
  7. 7.Department of Physical Medicine and RehabilitationUniversity Hospital LouvainPellenbergBelgium
  8. 8.Collaborative Antwerp Psychiatric Research Institute (CAPRI)Antwerp UniversityWilrijkBelgium

Personalised recommendations