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BackgroundEndovascular coiling and surgical clipping are routinely used to treat unruptured middle cerebral artery aneurysms (MCAAs). However, the optimal treatment for unruptured MCAAs is controversial. We aimed to systematically and comprehensively compare the clinical outcomes between endovascular coiling and surgical clipping for the treatment of MCAAs.MethodThis meta-analysis retrieved academic articles comparing the clinical outcomes between endovascular coiling and surgical clipping for unruptured MCAAs from the Cochrane Library, Medline, PubMed, and EMBASE databases. The reference articles of the identified studies were carefully reviewed to ensure that all available articles were represented in the study. The meta-analysis was conducted in accordance with the acknowledged the prioritized reported items for systematic review and meta-analysis (PRISMA) guidelines.ResultsA total of 6 studies, which enrolled a total of 789 participants, were included in our analysis. Of these 789 patients with MCAAs, 144 were assigned to an endovascular coiling group, and 645 were assigned to a surgical clipping group. Our results demonstrated that endovascular coiling was associated with a higher rate of retreatment (OR = 104.926; 95% CI: 12.931 to 851.379; P<0.001) and postoperative complications (OR = 3.157; 95% CI: 1.239 to 8.048; P= 0.016) than surgical clipping, especially for postoperative thrombus without infarction (OR = 4.905, 95% CI: 1.097 to 21.933; P = 0.037). Furthermore, surgical clipping was related to a higher rate of complete occlusion (OR = 0.349, 95% CI: 0.140 to 0.872; P = 0.024) and Glasgow Outcome Scale (GOS) ≥4 (OR = 0.250; 95% CI: 0.072 to 0.867; P= 0.029) than endovascular coiling after the operation. However, there was no significant difference in the rate of death, the proportion of patients with modified Rankin Scale (mRS)>2, infarction, or bleeding.ConclusionAlthough this study has inherent limitations, surgical clipping of unruptured MCAAs resulted in significantly higher complete aneurysm occlusion and GOS≥4 rates and was associated with a lower incidence of retreatment and complication, especially for postoperative thrombus without infarction. Therefore, the effect induced by surgical clipping of unruptured MCAAs remains superior to that induced by endovascular coiling; surgical clipping should be regarded as the first choice of treatment for unruptured MCAAs.

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KEYWORDSlumber degenerative spondylolisthesis, decompression combined with fusion, decompression alone 2 Abstract Background To assess the necessity or not of the addition of fusion to decompression for lumber degenerative spondylolisthesis patients.Method Potential publications were selected from PubMed, Web of Science and Cochrane Library.Gray relevant studies were manually searched. We set the searching time spanning from the creating date of electronic engines to August 2019. STATA version 11.0 was exerted to process the pooled data.Results Six RCTs were selected in our analysis. A total of 650 participants were divided into 275 in the decompression group and 375 in the fusion group. Our meta-analysis showed negative results generally. No statistic differences were found in VAS score for low back pain (WMD, -0.045; 95%CI, -1.259 to 1.169; P=0.942) and leg pain (WMD, 0.075; 95% CI, -1.201 to 1.35; P=0.908), ODI score (WMD, 1.489; 95% CI, -7.232 to 10.211; P=0.738), EQ-5D score (WMD, 0.03; 95% CI, -0.05 to 0.12; P=0.43), Odom's classification (OR, 0.353; 95%CI 0.113, 1.099; P=0.072), postoperative complications (OR, 0.437; 95% CI, 0.065 to 2.949; P=0.395), secondary operation (OR, 2.541; 95% CI 0.897, 7.198; P=0.079) and postoperative degenerative spondylolisthesis (OR=8.59,P=0.27). Subgroup analysis in VAS score on low back pain (OR=0.77, 95% CI, 0.36 to 1.65; P=0.50) was demonstrated as no meaning as well.Conclusion The overall efficacy of the combination of decompression and fusion is not found to be superior to decompression alone. At the same time, more evidence-based performance is needed to supplement this opinion. BackgroundLumber degenerative spondylolisthesis (LDS) belongs to a common disease in spinal surgery.Anatomically, it presented as one vertebral body displace the latter from the anterior sagittal orientation while remaining intact arch, and accompanied by spinal stenosis in most conditions [1,2].Meanwhile, L4-5 was impaired frequently among all centrums [2,3], which seems to be explained by where the main force places when people stand upright. Clinically, it manifested by radiating pain from buttock to leg and mechanical backache in the lower part [3,4]. It is reported that LDS accounts All authors planned and designed the study. WXQ and QQX conducted the articles search, selection of studies, extraction of data and risk of bias assessment supervised by XYY. All authors have participated sufficiently in the writing work.