TY - JOUR
T1 - Safety and efficacy of microsurgical treatment of previously coiled aneurysms
T2 - a systematic review and meta-analysis
AU - Petr, Ondra
AU - Brinjikji, Waleed
AU - Thomé, Claudius
AU - Lanzino, Giuseppe
N1 - Publisher Copyright:
© 2015, Springer-Verlag Wien.
PY - 2015/10/22
Y1 - 2015/10/22
N2 - Background: We conducted a systematic review of the literature to evaluate the safety and efficacy of surgical treatment of previously coiled aneurysms. Methods: A comprehensive review of the literature for studies on surgical treatment of previously coiled aneurysms was conducted. For each study, the following data were extracted: patient demographics, initial clinical status, location and size of aneurysms, time interval between initial/last endovascular procedure and surgery, surgical indications, and microsurgical technique. We performed subgroup analyses to compare direct clipping versus coil removal and clipping versus parent vessel occlusion, early (<4 weeks post-coiling) versus late surgery and anterior versus posterior circulation. Results: Twenty-six studies with 466 patients and 471 intracranial aneurysms were included. All of the studies were retrospective and non-comparative case-series. Patients undergoing direct clipping had lower perioperative morbidity (5.0 %, 95 % CI = 2.6–7.4 %) when compared to those undergoing coil removal and clipping (11.1 %, 95 % CI = 5.3–17.0 %) or parent vessel occlusion (13.1 %, 95 % CI = 4.6–21.6 %) (p = 0.05). Patients receiving early surgery (<4 weeks post-coiling) had significantly lower rates of good neurological outcome (77.1 %, 95 % CI = 69.3–84.8 %) when compared to those undergoing late surgery (92.1 %, 95 % CI = 89.0–95.2 %) (p < 0.01). There were higher rates of long-term neurological morbidity in the posterior circulation group (23.1 vs. 4.7 %, p < 0.01) as well as long-term neurological mortality (4.4 vs. 2.8 %, p < 0.01). Conclusions: Our meta-analysis suggests that surgical treatment is safe and effective. Our data indicate that aneurysms that are amenable to direct clipping have superior outcomes. Late surgery was also associated with better clinical outcomes. Surgery of recurrent posterior circulation aneurysms was associated with high rates of morbidity and mortality. Given the characteristics of the included studies, the quality of evidence of this meta-analysis is limited.
AB - Background: We conducted a systematic review of the literature to evaluate the safety and efficacy of surgical treatment of previously coiled aneurysms. Methods: A comprehensive review of the literature for studies on surgical treatment of previously coiled aneurysms was conducted. For each study, the following data were extracted: patient demographics, initial clinical status, location and size of aneurysms, time interval between initial/last endovascular procedure and surgery, surgical indications, and microsurgical technique. We performed subgroup analyses to compare direct clipping versus coil removal and clipping versus parent vessel occlusion, early (<4 weeks post-coiling) versus late surgery and anterior versus posterior circulation. Results: Twenty-six studies with 466 patients and 471 intracranial aneurysms were included. All of the studies were retrospective and non-comparative case-series. Patients undergoing direct clipping had lower perioperative morbidity (5.0 %, 95 % CI = 2.6–7.4 %) when compared to those undergoing coil removal and clipping (11.1 %, 95 % CI = 5.3–17.0 %) or parent vessel occlusion (13.1 %, 95 % CI = 4.6–21.6 %) (p = 0.05). Patients receiving early surgery (<4 weeks post-coiling) had significantly lower rates of good neurological outcome (77.1 %, 95 % CI = 69.3–84.8 %) when compared to those undergoing late surgery (92.1 %, 95 % CI = 89.0–95.2 %) (p < 0.01). There were higher rates of long-term neurological morbidity in the posterior circulation group (23.1 vs. 4.7 %, p < 0.01) as well as long-term neurological mortality (4.4 vs. 2.8 %, p < 0.01). Conclusions: Our meta-analysis suggests that surgical treatment is safe and effective. Our data indicate that aneurysms that are amenable to direct clipping have superior outcomes. Late surgery was also associated with better clinical outcomes. Surgery of recurrent posterior circulation aneurysms was associated with high rates of morbidity and mortality. Given the characteristics of the included studies, the quality of evidence of this meta-analysis is limited.
KW - Meta-analysis
KW - Microsurgery
KW - Previously coiled aneurysm
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U2 - 10.1007/s00701-015-2500-y
DO - 10.1007/s00701-015-2500-y
M3 - Review article
C2 - 26166207
AN - SCOPUS:84941875713
SN - 0001-6268
VL - 157
SP - 1623
EP - 1632
JO - Acta Neurochirurgica
JF - Acta Neurochirurgica
IS - 10
ER -