J. Neurosurg. / Vol 110 / January, 2009 J Neurosurg 110:19–29, 2009 19 T he ACoA is the most common location of cerebral aneurysms and accounts for as many as 36% of an- eurysms. 6 Among patients admitted to the hospital in good clinical status, 80% have attained favorable re- sults. 46 Nevertheless, as many as 46% of survivors after SAH may experience cognitive dysfunction, 6,55 and 62% of patients with a GOS score of 1 may suffer cognitive impairment. 29 During the past decade, there have been many studies reporting functional evaluation (that is, cognitive function or QOL) after SAH. However, most of these studies did not take aneurysm location into con- sideration, 9,11,25,26,30,37,40,44,45,47,52 or rarely did they focus on the ACoA. 4,5,10,18,19 For this location, essentially verbal memory, executive functions, and QOL are affected. Currently, endovascular coil embolization appears to be a safe alternative to microsurgical clip occlusion 37,38 in treating aneurysms with a morphological confguration Quality of life and brain damage after microsurgical clip occlusion or endovascular coil embolization for ruptured anterior communicating artery aneurysms: neuropsychological assessment Clinical article François Proust , M.D., Ph.D., 1 olivier MartinauD, M.D., 3 eMManuel GérarDin, M.D., 2 stéPhane Derrey , M.D., 1 soPhie levèque, M.D., 1 sanDrine Bioux, M.D., 3 eléonore tollarD, M.D., 2 erick clavier, M.D., 2 olivier lanGlois, M.D., 1 olivier GoDeFroy , M.D., 4 DiDier hannequin, M.D., Ph.D., 3 anD Pierre FréGer, M.D. 1 1 Departments of 1 Neurosurgery, 2 Neuroradiology, and 3 Neurology, Rouen University Hospital, Rouen; and 4 Department of Neurology, Amiens University Hospital, Amiens, France Object. For anterior communicating artery (ACoA) aneurysms, endovascular coil embolization constitutes a safe alternative therapeutic procedure to microsurgical clip occlusion. The authors’ aim in this study was to evaluate the quality of life (QOL), cognitive function, and brain structure damage after the treatment of ruptured ACoA an- eurysms in a group of patients who underwent microsurgical clipping (36 patients) compared with a reference group who underwent endovascular coiling (14 patients). Methods. At 14 months posttreatment all patients underwent evaluations by independent observers. These ob- servers evaluated global effcacy, executive functions using a frontal assessment battery of tests (Trail making test, Stroop tasks, dual task of Baddeley, verbal fuency, and Wisconsin Card Sorting test), behavior dysexecutive syn- drome (the Inventaire du Syndrome Dysexécutif Comportemental questionnaire [ISDC]), and QOL by using the Reintegration To Normal Living Index. Brain damage was analyzed using MR imaging. Results. In the microsurgical clipping and endovascular coiling groups, the distribution on the modifed Rankin Scale (p = 0.19) and mean QOL score (85.4 vs 83.4, respectively) were similar. Moreover, the proportion of executive dysfunctions (19.4 vs 28.6%, respectively) and the mean score on the ISDC questionnaire (8.9 vs 8.5, respectively) were not signifcant, but verbal memory was more altered in the microsurgical clipping group (p = 0.055). Magnetic resonance imaging revealed that the incidence of local encephalomalacia and the median number of lesions per pa- tient increased signifcantly in the microsurgical clipping group (p = 0.003). Conclusions. In the 2 groups, no signifcant difference was observed regarding QOL, executive functions, and behavior. Despite the signifcant decrease in verbal memory after microsurgical clipping, the interdisciplinary ap- proach remains a safe and useful strategy. (DOI: 10.3171/2008.3.17432) key WorDs • anterior communicating artery • cerebral aneurysm • frontal lobe injury • neuropsychological test • quality of life 19 Abbreviations used in this paper: ACoA = anterior communicat- ing artery; GBVLT = Grober and Buschke verbal learning test; GOS = Glasgow Outcome Score; GREFEX = Groupe de Réflexion sur les Fonctions Exécutives; ISDC = Inventaire du Syndrome Dysexécutif Comportemental; MADRS = Montgomery–Asberg Depression Rating Scale; mRS = modified Rankin Scale; QOL = quality of life; RNL = Reintegration to Normal Living; SAH = sub- arachnoid hemorrhage; SD = standard deviation; SF-36 = 36-Item Short Form Health Survey; WCST = Wisconsin Card Sorting Test.