Unruptured intracranial aneurysm treatment effects on cognitive function: a meta-analysis

OBJECT The treatment of an unruptured intracranial aneurysm (UIA) is not free of morbidity and mortality, and the decision is made by weighing the risks of treatment complications against the risk of aneurysm rupture. This meta-analysis quantitatively analyzed the literature on the effects of UIA treatment on cognition. METHODS MEDLINE, Embase, and PsycInfo were systematically searched for studies that reported on the cognitive status of UIA patients before and after aneurysm treatment. The search was restricted to prospective cohort and case-control studies published between January 1, 1998, and January 1, 2013. The analyses focused on the effect of treatment on general cognitive functioning, with an emphasis on 4 specific cognitive domains: executive functions, verbal and visual memory, and visuospatial functions. RESULTS Eight studies, with a total of 281 patients, were included in the meta-analysis. Treatment did not affect general cognitive functioning (effect size [ES] −0.22 [95% CI −0.78 to 0.34]). Executive functions and verbal memory domains trended toward posttreatment impairment (ES −0.46 [95% CI −0.93 to 0.01] and ES −0.31 [95% CI −1.24 to 0.61]), and performance of visual memory tasks trended toward posttreatment improvement (ES 1.48 [95% CI −0.36 to 3.31]). Lastly, treatment did not significantly affect visuospatial functions (ES −0.08 [95% CI −0.30 to 0.45]). CONCLUSIONS The treatment of an UIA does not seem to affect long-term cognitive function. However, definitive conclusions were not possible due to the paucity of studies addressing this issue.

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Abstract WP120: Readmission Trends Related to Unruptured Intracranial Aneurysm Treatment

Stroke ◽

10.1161/str.50.suppl_1.wp120 ◽

2019 ◽

Vol 50 (Suppl_1) ◽

Author(s):

Tapan Mehta ◽

Smit Patel ◽

Shailesh Male ◽

Andrew Zhang ◽

Adam Khan ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Unruptured Intracranial Aneurysm ◽

Aneurysm Treatment

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P.114 Headache outcomes after treatment of unruptured intracranial aneurysms: systematic review and meta-analysis

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2019.207 ◽

2019 ◽

Vol 46 (s1) ◽

pp. S43-S44

Author(s):

C Dandurand ◽

H Parhar ◽

F Naji ◽

S Prakash ◽

PA Gooderham

Keyword(s):

Systematic Review ◽

Intracranial Aneurysm ◽

Intracranial Aneurysms ◽

Rating Scale ◽

Meta Analysis ◽

Effect Estimate ◽

Significant Heterogeneity ◽

Unruptured Intracranial Aneurysm ◽

Standard Mean Difference ◽

Unruptured Intracranial Aneurysms

Background: Headaches are a major cause of disability and healthcare cost worldwide. When investigating headaches etiology, incidental unruptured intracranial aneurysms are often considered unrelated. We conducted a systematic review and meta-analysis to assess headaches outcomes (severity) after treatment of unruptured intracranial aneurysm. Methods: MEDLINE and EMBASE were systematically reviewed. Results: The data from eligible studies (n=7) was extracted and analyzed. 309 nonduplicated patients provided patient-level data for analysis. All studies used the 10-point numeric rating scale (NRS). 88% of patients were treated with endovascular technique. Overall, the observed effect estimate under a random effects model was found to be a standard mean difference in pre- and post-intervention headache severity of -0.448 (95% CI: -0.566 to -0.329). No significant heterogeneity was noted. No significant publication bias was demonstrated. Conclusions: This is the first and largest systematic review assessing postoperative headache outcomes after treatment of unruptured intracranial aneurysm. A significant reduction in headache intensity after treatment is observed in the current published literature. This study highlights an interesting clinical phenomenon that still warrants scientific effort before it can influence clinical practice. We encourage future study to stratify headache outcomes by aneurysm size, location and treatment modality.

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Letter to the editor: “Is the unruptured intracranial aneurysm treatment score (UIATS) sensitive enough to detect aneurysms at risk of rupture?”

Neurosurgical Review ◽

10.1007/s10143-020-01353-9 ◽

2020 ◽

Author(s):

Caleb Rutledge ◽

Daniel M. S. Raper ◽

Ethan A. Winkler ◽

Adib A. Abla

Keyword(s):

At Risk ◽

Intracranial Aneurysm ◽

Unruptured Intracranial Aneurysm ◽

Letter To The Editor ◽

Aneurysm Treatment ◽

Risk Of Rupture

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P.051 Validation of the unruptured intracranial aneurysm treatment score against “real-world” MDT decisions

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/cjn.2017.136 ◽

2017 ◽

Vol 44 (S2) ◽

pp. S26-S26

Author(s):

H Godbout ◽

J Jarrett ◽

GE Pickett

Keyword(s):

Intracranial Aneurysm ◽

Clinical Outcomes ◽

Real World ◽

Aneurysm Rupture ◽

Case Control Studies ◽

Clinical Tool ◽

Unruptured Intracranial Aneurysm ◽

Aneurysm Treatment ◽

Elective Treatment ◽

Aneurysm Repair

Background: Intracranial aneurysms are relatively common and often incidentally detected. Elective treatment may eliminate the risk of future hemorrhage, but carries risks of permanent deficit or death. Case-control studies have suggested factors predisposing to aneurysm rupture as well as risks of elective aneurysm repair. A clinical tool was recently developed to weigh benefits of repair against treatment risks. We evaluate its performance against real-world clinical decisions made by a cerebrovascular multidisciplinary team (MDT). Methods: Chart review of all patients with unruptured intracranial berry aneurysms (UIA) discussed at cerebrovascular MDT rounds 2008-2015. Management decisions and clinical outcomes were recorded. The Unruptured Intracranial Aneurysm Treatment Score (UIATS) was calculated for each patient (each aneurysm in the case of multiple UIA). Results: We identified 240 patients with a total of 279 aneurysms. UIATS recommended aneurysm repair in 79 cases, conservative management in 88 cases, and was equivocal in 112 cases. Where the UIATS gave a clear decision, that decision was concordant with the MDT decision in 119/167 cases (71%). Discordant decisions often related to the presence of comorbidities. Clinical outcomes did not differ in cases where the recommendations were clearly concordant vs. discordant. Conclusions: The UIATS may provide guidance to non-expert clinicians. It did not outperform the MDT.

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Validation of the unruptured intracranial aneurysm treatment score: comparison with real-world cerebrovascular practice

Journal of Neurosurgery ◽

10.3171/2017.4.jns17548 ◽

2018 ◽

Vol 129 (1) ◽

pp. 100-106 ◽

Cited By ~ 9

Author(s):

Vijay M. Ravindra ◽

Adam de Havenon ◽

Timothy C. Gooldy ◽

Jonathan Scoville ◽

Jian Guan ◽

...

Keyword(s):

Intracranial Aneurysm ◽

Real World ◽

Roc Curve ◽

Academic Medical Center ◽

Treatment Recommendation ◽

Unruptured Intracranial Aneurysm ◽

The Real ◽

Aneurysm Treatment ◽

Unruptured Intracranial Aneurysms ◽

Sensitivity Specificity

OBJECTIVEThe purpose of this study was to compare the unruptured intracranial aneurysm treatment score (UIATS) recommendations with the real-world experience in a quaternary academic medical center with a high volume of patients with unruptured intracranial aneurysms (UIAs).METHODSAll patients with UIAs evaluated during a 3-year period were included. All factors included in the UIATS were abstracted, and patients were scored using the UIATS. Patients were categorized in a contingency table assessing UIATS recommendation versus real-world treatment decision. The authors calculated the percentage of misclassification, sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve.RESULTSA total of 221 consecutive patients with UIAs met the inclusion criteria: 69 (31%) patients underwent treatment and 152 (69%) did not. Fifty-nine (27%) patients had a UIATS between −2 and 2, which does not offer a treatment recommendation, leaving 162 (73%) patients with a UIATS treatment recommendation. The UIATS was significantly associated with treatment (p < 0.001); however, the sensitivity, specificity, and percentage of misclassification were 49%, 80%, and 28%, respectively. Notably, 51% of patients for whom treatment would be recommended by the UIATS did not undergo treatment in the real-world cohort and 20% of patients for whom conservative management would be recommended by UIATS had intervention. The area under the ROC curve was 0.646.CONCLUSIONSCompared with the authors’ experience, the UIATS recommended overtreatment of UIAs. Although the UIATS could be used as a screening tool, individualized treatment recommendations based on consultation with a cerebrovascular specialist are necessary. Further validation with longitudinal data on rupture rates of UIAs is needed before widespread use.

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MO966COGNITIVE FUNCTIONING AMONG VARIOUS MODALITIES OF RENAL REPLACEMENT THERAPY- ROLE OF RENAL TRANSPLANT

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab110.0045 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Anupma Kaul ◽

Manas Behera

Keyword(s):

Cognitive Function ◽

Renal Transplant ◽

Verbal Memory ◽

Visual Memory ◽

Spatial Reasoning ◽

Graft Function ◽

Cognitive Status ◽

Motor Speed ◽

Post Transplant ◽

Esrd Patients

Abstract Background and Aims Evidences have shown diverse responses on thedescription of cognitive function in patients who have undergone renaltransplantation. The present study examined the changes in cognitive functionamong ESRD patients on maintenance haemodialysis or on CAPD and followingthey post renal transplant. We also looked into the ccognitive status among frailand non frail ESRD patients and their performance in the post transplant period Method 67 patients who were stable ESRD on thrice a week haemodialysis or onCAPD were investigated 6 months pre and post transplant using a battery ofneurophysiologic testing. Transplant function was assessed on regular interval andfollowing a stable graft function and on stable doses of immunosuppressive medication 6 months post transplant. Results CAPD compared to HD had better preservation of cognitive functionsassessed 6 months after initiation of dialysis. There was statistically significantimprovement in general cognitive status performance (P < 0.001), motor speed,spatial reasoning, verbal memory and visual memory post transplant compared tothe pre transplant state. However, non-significant improvements were observed indomains of attention, executive functioning, language and verbal fluency. Theanxiety and depression scores did not show significant improvement despitetransplant. On the basis of fraility, frail individuals experienced less improvement in cognitive function as compared to non frail recipients in our study. Conclusion The data demonstrate improvements in cognition following kidneytransplant and emphasize the reversibility of the memory problems evidencedamong patients on dialysis.Focus should be made for interventions in terms ofprevention of cognitive decline among frail patients very early in pre-end stage thus helping in overall outcomes post transplant.

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