1Department of Psychology, Ryerson University.
2Keenan Research Centre for Biomedical Science and.
J Neurosurg. 2018 Mar;128(3):768-776. doi: 10.3171/2016.11.JNS162055. Epub 2017 Apr 14.
OBJECTIVE Subarachnoid hemorrhage (SAH) is treated with either surgical clipping or endovascular coiling, though the latter is the preferred treatment method given its more favorable functional outcomes. However, neuropsychological functioning after treatment is rarely taken into account. In this meta-analysis, the authors synthesized relevant data from the literature and compared neuropsychological functioning in patients after coiling and clipping of SAH. They hypothesized that the coiled patients would outperform the clipped patients; that group differences would be greater with higher posterior circulation rupture rates, in older patients, and in more recent publications; that group differences would be smaller with greater rates of middle cerebral artery (MCA) rupture; and that anterior communicating artery (ACoA) rupture rates would not influence effect sizes. METHODS The MEDLINE, Embase, and PsycINFO databases were searched for clinical studies that compared neuropsychological functioning after either endovascular coiling or surgical clipping for SAH. Hedge's g and 95% confidence intervals were calculated using random effects models. Patients who had undergone coiling or clipping were compared on test performance in 8 neuropsychological domains: executive functions, language, attention/processing speed, verbal memory, visual memory, spatial memory, visuospatial functions, and intelligence. Patients were also compared with healthy controls, and meta-regressions were used to explore the relation between effect sizes and publication year, delay between treatment and neuropsychological testing, mean patient age, and rates of posterior circulation, ACoA, and MCA ruptures. RESULTS Thirteen studies with 396 clipped cases, 314 coiled cases, and 169 healthy controls were included in the study. The coil-treated patients outperformed the clip-treated patients on executive function (g = 0.17, 95% CI 0.08-0.25) and language tests (g = 0.23, 95% CI 0.07-0.39), and all patients were impaired relative to healthy controls (g ranged from -0.93 to -0.29). Coiled patients outperformed clipped patients to a greater degree in more recent publications, over longer posttreatment testing delays, and among older patients. Higher rates of posterior circulation and MCA aneurysms were associated with smaller group differences, while ACoA rupture rates did not influence effect sizes. CONCLUSIONS Coiling of SAH may promote superior neuropsychological functioning under certain circumstances and could have applications for the specialized care of SAH patients.
蛛网膜下腔出血（SAH）的治疗方法为手术夹闭或血管内介入治疗，尽管后者因其更有利的功能结果而成为首选治疗方法。然而，很少考虑治疗后的神经心理学功能。在这项荟萃分析中，作者综合了文献中的相关数据，并比较了 SAH 患者血管内介入治疗和手术夹闭后的神经心理学功能。他们假设，血管内介入治疗的患者表现优于手术夹闭的患者；如果后循环破裂率较高、患者年龄较大或发表时间较近，则组间差异会更大；如果大脑中动脉（MCA）破裂率较高，则组间差异会更小；而前交通动脉（ACoA）破裂率不会影响效应大小。方法：检索 MEDLINE、Embase 和 PsycINFO 数据库，以查找比较 SAH 血管内介入治疗或手术夹闭后神经心理学功能的临床研究。使用随机效应模型计算 Hedge's g 和 95%置信区间。比较接受血管内介入治疗或手术夹闭的患者在 8 个神经心理学领域的测试表现：执行功能、语言、注意力/处理速度、言语记忆、视觉记忆、空间记忆、视空间功能和智力。还将患者与健康对照组进行比较，并进行元回归分析，以探讨效应大小与发表年份、治疗与神经心理学测试之间的时间延迟、患者平均年龄以及后循环、ACoA 和 MCA 破裂率之间的关系。结果：纳入了 13 项研究，包括 396 例手术夹闭患者、314 例血管内介入治疗患者和 169 例健康对照组。血管内介入治疗的患者在执行功能（g = 0.17，95%置信区间 0.08-0.25）和语言测试（g = 0.23，95%置信区间 0.07-0.39）方面优于手术夹闭的患者，所有患者的表现均逊于健康对照组（g 值范围为-0.93 至-0.29）。在更近的出版物中、在更长的治疗后测试延迟时间以及在老年患者中，血管内介入治疗的患者比手术夹闭的患者表现出更大的优势。较高的后循环和 MCA 动脉瘤率与较小的组间差异相关，而 ACoA 破裂率不影响效应大小。结论：在某些情况下，血管内介入治疗 SAH 可能会促进更好的神经心理学功能，并且可以应用于 SAH 患者的专科护理。
