<p>Meta-Analysis of Clipping versus Coiling for the Treatment of Unruptured Middle Cerebral Artery Aneurysms: Direct Comparison of Procedure-Related Complications</p>

Abstract

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.

A Meta-Analysis of Endoscopic vs. Microscopic Transsphenoidal Surgery for Non-functioning and Functioning Pituitary Adenomas: Comparisons of Efficacy and Safety

“…The systematic review and meta-analysis of the literature was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) ( 12 ).…”

Early Exposure of the Dorsal Surface of M1 Segment via the Distal Transsylvian Approach for Clipping of Anteroinferior-Projecting Middle Cerebral Artery Bifurcation Aneurysms

“…For MCA aneurysms, several studies showed that the efficacy of the surgical clipping is better than the coiling with regard to the occlusion rate. 4 5 6 7 16 However, with regard to the functional outcome and procedural complications, the endovascular approach was comparable to the surgical clipping. 5 7 MCAB aneurysms typically have a wide neck that usually incorporates the origin of one or both M2 branches.…”

Surgical Treatment of Middle Cerebral Artery Aneurysms: Hints and Precautions for Young Cerebrovascular Surgeons

“…Surgical clipping still represents the gold standard for treatment of MCA aneurysms in all experienced tertiary referral cerebrovascular centers, since several studies have supported the superiority of open surgery in obtaining complete aneurysm occlusion with distal flow preservation and lower risk of thromboembolism of the perforators and hemorrhagic infarction. 12 Moreover, a lower risk of long-term recurrence and a reduced probability of retreatment have also been associated with surgical clipping compared with coiling. 13…”