1. Outcome of Surgical or Endovascular Treatment of Giant Intracranial Aneurysms, with Emphasis on Age, Aneurysm Location, and Unruptured Aneuryms - A Systematic Review and Meta-Analysis
- Author
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Dengler, Julius, Maldaner, Nicolai, Maldaner, N., van der Zwan, A., van Doormaal, T., Cognard, C., Gawlitza, M., Walter, J., Kalff, R., Fiedler, J., Uebelacker, A., Dengler, J., Bohner, G., Wiener, E., Bauknecht, H. C., Heuschmann, P. U., Malzahn, U., Gläsker, S., Zentner, J., Gläsker, Sven, Van Velthoven, V., Guhl, S., Schroeder, H. W. S., Strowitzki, M., Etminan, N., Haengghi, D., Eicker, S., Turowski, B., Schebesch, K. M., Brawanski, A., Endres, Matthias, Wrede, K., Sure, U., Schmidt, N. O., Regelsberger, J., Westphal, M., Mielke, D., Rohde, V., Hosch, H., Moskopp, D., Joedicke, A., Wagner, Martin, Hohaus, C., Meisel, H. J., Wostrack, M., Meyer, B., Lehmberg, J., Musahl, C., Hopf, N., Winkler, G., Spetzger, U., Graewe, A., Malzahn, Uwe, Meier, U., Hong, B., Nakamura, M., Krauss, J., Grote, A., Simon, M., Schramm, J., Kursumovic, A., Rath, S. A., Marbacher, S., Heuschmann, Peter U, Fathi, A., Fandino, J., Familiari, P., Raco, A., Bijlenga, P., Schaller, K., Gruber, A., Wang, W. T., Knosp, E., Hoffmann, K. T., Vajkoczy, Peter, Boxhammer, E., Rüfenacht, D. A., Wanke, I., Boccardi, E., Piano, M., Niemelä, M., Nurminen, V., Lehecka, M., Hernesniemi, J., Burkhardt, J. K., Group, Giant Intracranial Aneurysm Study, Bozinov, O., Regli, L., Shekhtman, O. D., Eliava, S. S., Kato, N., Irie, K., Nishimura, K., Kaku, S., Arakawa, H., Yuki, I., Vajkoczy, P., Ishibashi, T., Murayama, Y., Fiss, I., Kombos, T., Pedro, M. T., König, R., Wirtz, R., Brand, C., Hagel, V., Helthuis, J., Surgical clinical sciences, University of Zurich, and Dengler, Julius
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methods [Embolization, Therapeutic] ,medicine.medical_treatment ,Review ,030218 nuclear medicine & medical imaging ,0302 clinical medicine ,Medicine ,Giant intracranial aneurysm ,Embolization ,Research Support, Non-U.S. Gov't ,surgery [Intracranial Aneurysm] ,Embolization, Therapeutic ,2728 Neurology (clinical) ,Treatment Outcome ,Neurology ,Endovascular procedures ,Meta-analysis ,Internal carotid artery ,Therapeutic ,Cardiology and Cardiovascular Medicine ,Carotid Artery, Internal ,medicine.medical_specialty ,pathology [Intracranial Aneurysm] ,Surgical aneurysm treatment ,MEDLINE ,610 Medicine & health ,surgery [Carotid Artery, Internal] ,2705 Cardiology and Cardiovascular Medicine ,03 medical and health sciences ,10180 Clinic for Neurosurgery ,Aneurysm ,medicine.artery ,Humans ,Endovascular treatment ,ddc:610 ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Intracranial Aneurysm ,medicine.disease ,Internal ,Surgery ,ddc:616.8 ,Clinical trial ,meta-analysis ,pathology [Carotid Artery, Internal] ,2808 Neurology ,Endovascular Procedures ,Neurology (clinical) ,Carotid Artery ,business ,030217 neurology & neurosurgery ,methods [Endovascular Procedures] - Abstract
Background: Designing treatment strategies for unruptured giant intracranial aneurysms (GIA) is difficult as evidence of large clinical trials is lacking. We examined the outcome following surgical or endovascular GIA treatment focusing on patient age, GIA location and unruptured GIA. Methods: Medline and Embase were searched for studies reporting on GIA treatment outcome published after January 2000. We calculated the proportion of good outcome (PGO) for all included GIA and for unruptured GIA by meta-analysis using a random effects model. Results: We included 54 studies containing 64 study populations with 1,269 GIA at a median follow-up time (FU-T) of 26.4 months (95% CI 10.8-42.0). PGO was 80.9% (77.4-84.4) in the analysis of all GIA compared to 81.2% (75.3-86.1) in the separate analysis of unruptured GIA. For each year added to patient age, PGO decreased by 0.8%, both for all GIA and unruptured GIA. For all GIA, surgical treatment resulted in a PGO of 80.3% (95% CI 76.0-84.6) compared to 84.2% (78.5-89.8, p = 0.27) after endovascular treatment. In unruptured GIA, PGO was 79.7% (95% CI 71.5-87.8) after surgical treatment and 84.9% (79.1-90.7, p = 0.54) after endovascular treatment. PGO was lower in high quality studies and in studies presenting aggregate instead of individual patient data. In unruptured GIA, the OR for good treatment outcome was 5.2 (95% CI 2.0-13.0) at the internal carotid artery compared to 0.1 (0.1-0.3, p < 0.1) in the posterior circulation. Patient sex, FU-T and prevalence of ruptured GIA were not associated with PGO. Conclusions: We found that the chances of good outcome after surgical or endovascular GIA treatment mainly depend on patient age and aneurysm location rather than on the type of treatment conducted. Our analysis may inform future research on GIA.
- Published
- 2016