Rehabilitation potential of surgical patients with posterior communicating artery aneurysms: current capabilities and artificial intelligence

Posterior communicating artery (PСоA) aneurysms represent a serious medical problem associated with a high risk of rupture leading to severe neurologic deficits, disability, and, in some cases, death. Despite the advances in microsurgical and endovascular treatment, the recovery of patients requires long-term, comprehensive, and multidisciplinary neurorehabilitation aimed at correcting motor, cognitive, and psychosocial disorders. The present review examines current approaches to rehabilitation, including early initiation, as well as the use of specialized scales and neuropsychological tests in combination with promising methods of hyperbaric oxygenation and neuromodulation. Particular attention is paid to artificial intelligence (AI) technologies in neurorehabilitation: the use of adaptive game systems, robotic exoskeletons, brain-computer interfaces, and gamification to personalize and increase the effectiveness of recovery programs. The integration of AI into the rehabilitation process opens up new opportunities for improving the functional outcomes and quality of life in patients with PСоA aneurysms. However, further research and a systematic approach in care management are required.

1. Morreale V.M., Meissner I. Intracranial aneurysms. In: Yanagihara T., Piepgras D.G., Atkinson J.L.D. (Eds) Subarachnoid hemorrhage: medical surgical management. New York: CRC Press; 1997: 584 pp.

2. Krylov V.V. (Ed.) Microsurgery of brain aneurysms. Moscow; 2011: 536 pp. (in Russ.).

3. Bromberg J.E., Rinkel G.J., Algra A., et al. Subarachnoid hemorrhage in first and second degree relative of patients with subarachnoid hemorrhage. Br Med J. 1995; 311 (7000): 288–9. https://doi.org/10.1136/bmj.311.7000.288.

4. Wang P.S., Longstreth W.T. Jr, Koepsell T.D. Subarachnoid hemorrhage and family history: a population-based case-control study. Arch Neurol. 1995; 52: 202–4.

5. Schievink W.I. Genetics of intracranial aneurisms. Neurosurgery. 1997; 40 (4): 615–62. https://doi.org/10.1097/00006123-199704000-00001.

6. Lebedeva E.R., Sakovich V.P. Headaches in patients with intracranial aneurysms in the prehemorrhagic period. Ural Medical Journal. 2006; 20 (1): 8–11 (in Russ.).

7. Campos-Fernández D., Montes A., Thonon V., et al. Early focal electroencephalogram and neuroimaging findings predict epilepsy development after aneurysmal subarachnoid hemorrhage. Epilepsy Behav. 2024; 156: 109841. https://doi.org/10.1016/j.yebeh.2024.109841.

8. Association of Neurosurgeons of Russia. Clinical guidelines for the treatment of unruptured cerebral aneurysms. Available at: https://www.ruans.org/Documents (in Russ.) (accessed 12.01.2025).

9. Morita A., Kirino T., Hashi K., et al. The natural course of unruptured cerebral aneurysms in a Japanese cohort. N Engl J Med. 2012; 366 (26): 2474–82. https://doi.org/10.1056/NEJMoa1113260.

10. Tanaka K., Furukawa K., Ishida F., Suzuki H. Hemodynamic differences of posterior communicating artery aneurysms between adult and fetal types of posterior cerebral artery. Acta Neurochir. 2023; 165 (12): 3697–706. https://doi.org/10.1007/s00701-023-05840-y.

11. Chung J., Cheong J.H., Kim J.M., et al. Is fetal-type posterior cerebral artery a risk factor for recurrence in coiled internal carotid arteryincorporating posterior communicating artery aneurysms? Analysis of conventional statistics, computational fluid dynamics, and random forest with hyper-ensemble approach. Neurosurgery. 2023; 93 (3): 611–21. https://doi.org/10.1227/neu.0000000000002458.

12. Makri O.E., Tsekouras I.K., Mastronikolis S.N., et al. Terson's syndrome with Roth spot-resembling features and third nerve palsy without radiologically diagnosed subarachnoid haemorrhage. Vision. 2024; 8 (4): 61. https://doi.org/10.3390/vision8040061.

13. Mishra S., Mishra S., Regmi S., et al. Isolated ipsilateral abducens nerve palsy and contralateral homonymous hemianopsia associated with unruptured posterior cerebral artery aneurysm: a rare neurological finding. J Cerebrovasc Endovasc Neurosurg. 2024; 26 (3): 318–23. https://doi.org/10.7461/jcen.2024.E2023.07.002.

14. Abo Kasem R., Cunningham C., Elawady S.S., et al. Oculomotor nerve palsy recovery following microsurgery vs. endovascular treatment of posterior communicating artery aneurysms: a comparative metaanalysis of short- and long-term outcomes. Neurosurg Rev. 2024; 47 (1): 904. https://doi.org/10.1007/s10143-024-03149-7.

15. Lovelock C.E., Rinkel G.J., Rothwell P.M. Time trends in outcome of subarachnoid hemorrhage: population-based study and systematic review. Neurology. 2010; 74 (19): 1494–1501. https://doi.org/10.1212/WNL.0b013e3181dd42b3.

16. Taufique Z., May T., Meyers E., et al. Predictors of poor quality of life 1 year after subarachnoid hemorrhage. Neurosurgery. 2016; 78 (2): 256–64. https://doi.org/10.1227/NEU.0000000000001042.

17. Dombovy M.L., Drew-Cates J., Serdans R. Recovery and rehabilitation following subarachnoid haemorrhage: Part II. Long-term follow-up. Brain Inj. 1998; 12 (10): 887–94. https://doi.org/10.1080/026990598122106.

18. Lynch E.A., Luker J.A., Cadilhac D.A., Hillier S.L. Rehabilitation assessments for patients with stroke in Australian hospitals do not always reflect the patients’ rehabilitation requirements. Arch Phys Med Rehabil. 2015; 96 (5): 782–9. https://doi.org/10.1016/j.apmr.2014.12.009.

19. Chen Y.T., Wu M.R., Li Z.X., et al. Assessment of rehabilitation following subarachnoid haemorrhage in China: findings from the Chinese Stroke Center Alliance. BMC Neurol. 2023; 23: 291. https://doi.org/10.1186/s12883-023-03349-6.

20. Mahaney K.B., Todd M.M., Bayman E.O., Torner J.C. Acute postoperative neurological deterioration associated with surgery for ruptured intracranial aneurysm: incidence, predictors, and outcomes. J Neurosurg. 2012; 116 (6): 1267–78. https://doi.org/10.3171/2012.1.JNS111277.

21. Stabel H.H., Pedersen A.R., Johnsen S.P., Nielsen J.F. Functional independence: a comparison of the changes during neurorehabilitation between patients with nontraumatic subarachnoid hemorrhage and patients with intracerebral hemorrhage or acute ischemic stroke. Arch Phys Med Rehabil. 2017; 98 (4): 759–65. https://doi.org/10.1016/j.apmr.2016.11.010.

22. Lindner A., Brunelli L., Rass V., et al. Long-term clinical trajectory of patients with subarachnoid hemorrhage: linking acute care and neurorehabilitation. Neurocrit Care. 2023; 38 (1): 138–48. https://doi.org/10.1007/s12028-022-01572-6.

23. Abdelgadir J., Gelman J., Dutko L., et al. Cognitive outcomes following aneurysmal subarachnoid hemorrhage: rehabilitation strategies. World Neurosurg X. 2024; 22: 100341. https://doi.org/10.1016/j.wnsx.2024.100341.

24. Wong G.K.C., Nung R.C.H., Sitt J.C.M., et al. Location, infarct load, and 3-month outcomes of delayed cerebral infarction after aneurysmal subarachnoid hemorrhage. Stroke. 2015; 46 (11): 3099–104. https://doi.org/10.1161/STROKEAHA.115.010844.

25. Rost N.S., Brodtmann A., Pase M.P., et al. Post-stroke cognitive impairment and dementia. Circ Res. 2022; 130 (8): 1252–71. https://doi.org/10.1161/CIRCRESAHA.122.319951.

26. Corraini P., Henderson V.W., Ording A.G., et al. Long-term risk of dementia among survivors of ischemic or hemorrhagic stroke. Stroke. 2017; 48 (1): 180–6. https://doi.org/10.1161/STROKEAHA.116.015242.

27. Nwafor D.C., Kirby B.D., Ralston J.D., et al. Neurocognitive sequelae and rehabilitation after subarachnoid hemorrhage: optimizing outcomes. J Vasc Dis. 2023; 2 (2): 197–211. https://doi.org/10.3390/jvd2020014.

28. Kreiter K.T., Copeland D., Bernardini G.L., et al. Predictors of cognitive dysfunction after subarachnoid hemorrhage. Stroke. 2002; 33 (1): 200–8. https://doi.org/10.1161/hs0102.101080.

29. Orbo M., Waterloo K., Egge A., et al. Predictors for cognitive impairment one year after surgery for aneurysmal subarachnoid hemorrhage. J Neurol. 2008; 255 (11): 1770–6. https://doi.org/10.1007/s00415-008-0047-z.

30. Bellebaum C., Schäfers L., Schoch B., et al. Clipping versus coiling: neuropsychological follow up after aneurysmal subarachnoid haemorrhage (SAH). J Clin Exp Neuropsychol. 2004; 26 (8): 1081–92. https://doi.org/10.1080/13803390490515342.

31. Wu X., Zhang L., Chen Y., et al. Effectiveness and influencing factors of comprehensive rehabilitation therapy in patients with aneurysmal subarachnoid hemorrhage. J Behav Brain Sci. 2020; 10 (10): 387–99. https://doi.org/10.4236/jbbs.2020.1010024.

32. Shukla D.P. Outcome and rehabilitation of patients following aneurysmal subarachnoid haemorrhage. J Neuroanaesth Crit Care. 2017; 4 (4): S65–75. https://doi.org/10.4103/2348-0548.199952.

33. Al-Khindi T., Macdonald R.L., Schweizer T.A. Cognitive and functional outcome after aneurysmal subarachnoid hemorrhage. Stroke. 2010; 41 (8): e519-36. https://doi.org/10.1161/STROKEAHA.110.581975.

34. Powell J., Kitchen N., Heslin J., Greenwood R. Psychosocial outcomes at three and nine months after good neurological recovery from aneurysmal subarachnoid haemorrhage: predictors and prognosis. J Neurol Neurosurg Psychiatry. 2002; 72 (6): 772–81. https://doi.org/10.1136/jnnp.72.6.772.

35. Powell J., Kitchen N., Heslin J., Greenwood R. Psychosocial outcomes at 18 months after good neurological recovery from aneurysmal subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2004; 75 (8): 1119–24. https://doi.org/10.1136/jnnp.2002.000414.

36. Wang Y., Gao Y., Lu M., Liu Y. Long-term functional prognosis of patients with aneurysmal subarachnoid hemorrhage treated with rehabilitation combined with hyperbaric oxygen: case-series study. Medicine. 2020; 99 (3): e18748. https://doi.org/10.1097/MD.0000000000018748.

37. Malinova V., Bleuel K., Stadelmann C., et al. The impact of transcranial direct current stimulation on cerebral vasospasm in a rat model of subarachnoid hemorrhage. J Cereb Blood Flow Metab. 2021; 41 (8): 2000–9. https://doi.org/10.1177/0271678X21990130.

38. Doumas I., Lejeune T., Edwards M., et al. Clinical validation of an individualized auto-adaptative serious game for combined cognitive and upper limb motor robotic rehabilitation after stroke. J Neuroeng Rehabil. 2025; 22 (1): 10. https://doi.org/10.1186/s12984-025-01551-w.

39. Kim M.S., Park H., Kwon I., et al. Efficacy of brain-computer interface training with motor imagery-contingent feedback in improving upper limb function and neuroplasticity among persons with chronic stroke: a double-blinded, parallel-group, randomized controlled trial. J Neuroeng Rehabil. 2025; 22 (1): 1. https://doi.org/10.1186/s12984-024-01535-2.

40. Livolsi C., Conti R., Ciapetti T., et al. Bilateral hip exoskeleton assistance enables faster walking in individuals with chronic strokerelated gait impairments. Sci Rep. 2025; 15 (1): 2017. https://doi.org/10.1038/s41598-025-86343-x.

41. Costantini S., Falivene A., Chiappini M., et al. Artificial intelligence tools for engagement prediction in neuromotor disorder patients during rehabilitation. J Neuroeng Rehabil. 2024; 21 (1): 215. https://doi.org/10.1186/s12984-024-01519-2.

42. Sánchez-Gil J.J., Sáez-Manzano A., López-Luque R., et al. Gamified devices for stroke rehabilitation: a systematic review. Comput Methods Programs Biomed. 2025; 258: 108476. https://doi.org/10.1016/j.cmpb.2024.108476.