Supplementary Material for: Coiling vs clipping for the treatment of ruptured cerebral aneurysms: meta-analysis on the effects on post-intervention cognitive outcomes

Background: Cognitive impairment is a critical concern in patients after aneurysm repair. This meta-analysis aims to compare the cognitive outcomes following two common treatment modalities for ruptured cerebral aneurysms: endovascular coiling and microsurgical clipping. Methods: A systematic search of PubMed, Embase, Scopus, and the Cochrane Library was conducted, without language restriction at the search stage, to identify relevant studies up to October 2024. Studies of adults with aneurysmal subarachnoid hemorrhage treated by coiling or clipping and reporting quantitative cognitive outcomes were included, provided a full text (or sufficient extractable data) was available from randomized controlled trials or observational studies. The primary outcome was cognitive function, measured using standardized mean differences (SMD) across various domains such as memory, attention, and executive function. A random-effects model was applied to account for heterogeneity, and publication bias was assessed using Egger's regression and Begg and Mazumdar rank correlation tests. Results: Ten studies with a total of 1,044 participants were included. The pooled analysis demonstrated that coiling was associated with better short-term cognitive outcomes (SMD = 0.984, 95% CI = 0.639 to 1.330, p < 0.000), likely due to its minimally invasive nature. However, long-term cognitive outcomes were uncertain. Sensitivity and publication bias analyses confirmed the robustness of the findings, with no significant evidence of publication bias. Conclusion: This meta-analysis suggests that endovascular coiling is associated with better cognitive outcomes compared to microsurgical clipping in the treatment of ruptured cerebral aneurysms. Future research should focus on long-term follow-ups, standardized cognitive assessments, and investigating novel treatment strategies to further enhance cognitive outcomes after aneurysm repair.