Neurosurgical Clipping versus Endovascular Coiling for Patients with Intracranial Aneurysms: A Systematic Review and Meta-Analysis

Jiang, Zhiqun; Chen, Yanchun; Zeng, Chunhui; Feng, Jingyuan; Wan, Yilv; Zhang, Xuezhi

doi:10.1016/j.wneu.2020.02.091

Cited by 23 publications

(14 citation statements)

References 75 publications

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“…Comparison of the keyhole approach and endovascular treatment For interventional therapy, no open injury or blood transfusion is required, and the incidence of postoperative infection and epilepsy is low [9,10,12]. This advantage of endovascular treatment was also con rmed by this study.…”

Section: Comparison Of the Keyhole Approach And Conventional Craniotomysupporting

confidence: 65%

A randomized controlled study comparing microsurgical clipping via the keyhole approach, conventional craniotomy, and endovascular coiling for ruptured anterior circulation aneurysms

Zhu

Lan

Chen

2021

Preprint

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Objective: Few prospective randomized controlled studies have investigated the efficacy of endovascular treatment and microsurgical clipping of intracranial aneurysms, especially via microsurgical keyhole approach. We compared the efficacy of three techniques in treating patients with ruptured anterior circulation aneurysms to provide surgeons with a more objective basis for treatment selection. Methods: 150 patients with ruptured anterior circulation aneurysms were randomly assigned to endovascular treatment, conventional craniotomy, and keyhole approach groups. Aneurysm occlusion, surgical time, hospitalization time, hospitalization expenses, and surgical complications were compared between groups. Results: The complete occlusion rates of aneurysms at discharge were 90% in the endovascular group, 94% in the conventional group, and 96% in the keyhole group. No significant differences in complete occlusion rates or Glasgow Outcome Scale scores were found between groups. In the keyhole approach, conventional craniotomy, and endovascular groups, the overall surgical times were 161.78±34.51 min, 201.55±38.79 min, and 85.86±58.57 min, respectively; the hospitalization times were 11.42±6.64 d, 18.03±7.14 d, and 10.57±8.67 d; hospitalization expenses were 10574.25±4154.25 USD, 13214.54±5487.65 USD, and 20134.58±6587.61 USD; and the incidence rates of postoperative complications such as intracranial infection, cerebral vasospasm, hydrocephalus, intracranial hematoma, and epilepsy were 8%, 28%, and 20%. Conclusions: Endovascular coiling and the microsurgical keyhole approach have the advantages of simple execution, time savings, and short hospitalization. Microsurgical clipping of intracranial aneurysms needs to be updated to a minimally invasive procedure to maintain its complementary value with endovascular treatment.Clinical trial registration: The study has been retrospectively registered in clinicaltrial.org (NCT05049564) in Sep. 8th, 2021.

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Section: Comparison Of the Keyhole Approach And Conventional Craniotomysupporting

confidence: 65%

A randomized controlled study comparing microsurgical clipping via the keyhole approach, conventional craniotomy, and endovascular coiling for ruptured anterior circulation aneurysms

Zhu

Lan

Chen

2021

Preprint

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“…Microsurgical occlusion was not only a viable option for some patients, but sometimes a better one. In addition to the previously mentioned higher degree of aneurysm obliteration and lower risk of recurrence or rebleeding [ 24 ], it also has the benefit of the decreased risk of hydrocephalus [ 25 ] and a lower cost [ 26 ]. Although the clinical outcome of patients with posterior circulation aneurysms was better in the endovascular treatment group at one year, this difference no longer existed after one year [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Microsurgical Management of Posterior Circulation Aneurysms: A Retrospective Study on Epidemiology, Outcomes, and Surgical Approaches

et al. 2022

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Posterior circulation aneurysms have been regarded as the most challenging for endovascular coiling and microsurgical occlusion. The role of microsurgical treatment is gradually being overlooked and diminishing in the trend of endovascular treatment. As microsurgical occlusion of posterior circulation aneurysms is decreasing, we present our relevant experience to evaluate treatment options and surgical approaches. A retrospective study was conducted in the Department of Neurosurgery of the First Affiliated Hospital of Soochow University between 2016 and 2021. Patients with posterior circulation aneurysms treated by clipping, bypass, and trapping were enrolled and followed up for at least six months. We included 50 patients carrying 53 posterior circulation aneurysms, 43 of whom had aneurysm ruptures. The posterior cerebral artery and posterior inferior cerebellar artery were the most common aneurysm locations. Direct clipping was performed in 43 patients, while bypass and trapping was performed in six patients. The retrosigmoid, far-lateral, and midline or paramedian suboccipital approaches were performed for those aneurysms in the middle and lower thirds. Aneurysms in the upper third required the lateral supraorbital approach, pterional approach, subtemporal approach, and occipital craniotomy. The lateral supraorbital approach was utilized in seven patients for aneurysms above the posterior clinoid process. Thirty-four patients recovered well with modified Rankin score 0–3 at discharge. No patient experienced aneurysm recurrence during the mean follow-up period of 3.57 years. Microsurgery clipping and bypass should be considered in conjunction with endovascular treatment as a treatment option in posterior circulation aneurysms. The lateral supraorbital approach is a feasible, safe, and simple surgical approach for aneurysms above the posterior clinoid process.

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“…The endovascular intervention is a less invasive method wherein a micro-catheter is inserted, typically through the femoral artery, and reaches the IA where it detaches a coil in the lumen of the aneurysm to stabilise the region. Both intervention types come with their own complications however, and an up-to-date Cochrane review has identified the endovascular method as the safer intervention for IAs [5], especially for unruptured IAs [6].…”

Section: Treatmentmentioning

confidence: 99%

Impact of COVID-19 on incidence and treatment of intracranial aneurysms in Poland: a national study

Miękisiak

Fercho

Janusz

et al. 2022

Neurol Neurochir Pol.

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Introduction.The COVID-19 pandemic greatly disrupted the national healthcare system in Poland, resulting in the implementation of new protocols allowing only patients with severe diagnoses to receive immediate treatment. Given that an intracranial aneurysm (IA) is regarded as one of the most severe diagnoses, we planned to assess whether the current protocol has successfully provided the standard treatment for IAs. Material and methods.Data on all IA cases treated from 2015 to 2020 was extracted from the JGP (a homogeneous group of patients) catalogue provided by the National Health Index of Poland (NFZ, Narodowy Fundusz Zdrowia). Poisson regression was used to determine the significance of the change in hospital admissions, and differences between proportions were analysed using the "N-1" Chi-squared test.Results. A total of 21,801 IA patients treated during 2015-2020 were included in this study. The overall number of hospitalisations due to IAs fell in the open surgery group, but not in the endovascular cohort. Mortality rates following IA treatment increased significantly by 21% in 2020 compared to preceding years. The demographics changed as well; the patients were significantly younger during the pandemic. Conclusions.Our findings show that the current strategy for optimal care for patients diagnosed with IAs in Poland during the pandemic is failing to maintain high quality treatment. New methods to improve the current plan should be implemented to address future crises.

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Neurosurgical Clipping versus Endovascular Coiling for Patients with Intracranial Aneurysms: A Systematic Review and Meta-Analysis

Cited by 23 publications

References 75 publications

A randomized controlled study comparing microsurgical clipping via the keyhole approach, conventional craniotomy, and endovascular coiling for ruptured anterior circulation aneurysms

A randomized controlled study comparing microsurgical clipping via the keyhole approach, conventional craniotomy, and endovascular coiling for ruptured anterior circulation aneurysms

Microsurgical Management of Posterior Circulation Aneurysms: A Retrospective Study on Epidemiology, Outcomes, and Surgical Approaches

Impact of COVID-19 on incidence and treatment of intracranial aneurysms in Poland: a national study

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