Safety and efficacy of microsurgical treatment of previously coiled aneurysms: a systematic review and meta-analysis

Ondra Petr, Waleed Brinjikji, Claudius Thomé, Giuseppe Lanzino

Research output: Contribution to journalReview article

11 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1623-1632
Number of pages10
JournalActa Neurochirurgica
Volume157
Issue number10
DOIs
StatePublished - Oct 22 2015

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Aneurysm
Meta-Analysis
Safety
Morbidity
Endovascular Procedures
Mortality
Intracranial Aneurysm
Retrospective Studies
Demography
Therapeutics

Keywords

  • Meta-analysis
  • Microsurgery
  • Previously coiled aneurysm

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Medicine(all)

Cite this

Safety and efficacy of microsurgical treatment of previously coiled aneurysms : a systematic review and meta-analysis. / Petr, Ondra; Brinjikji, Waleed; Thomé, Claudius; Lanzino, Giuseppe.

In: Acta Neurochirurgica, Vol. 157, No. 10, 22.10.2015, p. 1623-1632.

Research output: Contribution to journalReview article

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abstract = "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.",
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T2 - a systematic review and meta-analysis

AU - Petr, Ondra

AU - Brinjikji, Waleed

AU - Thomé, Claudius

AU - Lanzino, Giuseppe

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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.

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