published a very interesting prospective double-blind study, in which they compared the influence of two anesthetics, frequently used, on the development of postoperative cognitive deficit (POCD) in patients undergoing surgical clipping of aneurysm due to aneurysmal subarachnoid hemorrhage (aSAH).e authors reported an incidence of POCD of 82% in the group treated with desflurane and 65% in those treated with propofol using the MOCA system.e authors conclude that although there was no significant difference between groups, there was a significant difference in the average scores of certain domains of cognitive function. [9] We agree with the authors when they conclude that POCD is very common in survivors of aSAH, a condition that seriously compromises their long-term quality of life.POCD is considered to be the most common long-term neurological complication in patients with aSAH. [7]wever, in the study, the researchers only took into account the type of anesthesia to explain the presence of POCD within the first 2 weeks of bleeding, a period in which other complications of the same aSAH, namely cerebral vasospasm, delayed cerebral ischemia (DCI), and hydrocephalus can significantly compromise the neurological status of the patient and can significantly influence the development of POCD.Previous studies confirm that in the context of aSAH, both hydrocephalus and vasospasm (or a consequent late ischemic déficit) are some of the factors that affect the development of cognitive deficit (CD) after aSAH in the short and long term. [3,6,7,10] Vasospasm can occur acutely in the intraoperative and immediate postoperative periods due to manipulation of the vessels by the surgeon and from day 3 to day 21 postbleeding with a peak around day 7 and is described as the main cause of morbidity and mortality in patients who survive more than 2 weeks after aSAH generating a high risk of DCI. [5]Hydrocephalus, on the www.surgicalneurologyint.com