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Although randomized controlled trials have compared surgery versus endovascular treatment for intracranial aneurysms, the literature is sparse in terms of subgroup analysis for anterior communicating artery (ACoA) aneurysm management. This systematic review and meta-analysis sought to compare surgical versus endovascular treatment for ACoA aneurysms. Medline, PubMed, and Embase were searched from inception to December 12, 2022. Primary outcomes were post-treatment modified Rankin Scale (mRS) >2 and mortality. Secondary outcomes were aneurysm obliteration, retreatment and recurrence, rebleeding, technical failure, vessel rupture, aneurysmal subarachnoid hemorrhage-related hydrocephalus, symptomatic vasospasm, and stroke. Eighteen studies yielded 2368 patients, from which 1196 (50.5%) and 1172 (49.4%) patients underwent surgery and endovascular treatment, respectively. The odds ratio (OR) of mortality was similar in total (OR = 0.92 [0.63–1.37], P = 0.69), ruptured (OR = 0.92 [0.62–1.36], P = 0.66), and unruptured cohorts (OR = 1.58 [0.06–39.60], P = 0.78). The OR of mRS > 2 was similar in total (OR = 0.75 [0.50–1.13], P = 0.17), ruptured (OR = 0.77 [0.49–1.20], P = 0.25), and unruptured cohorts (OR = 0.64 [0.21–1.96], P = 0.44). The OR of obliteration was higher with surgery in the total (OR = 2.52 [1.49–4.27], P = 0.0008) and ruptured cohorts (OR = 2.61 [1.33–5.10], P = 0.005) and unruptured group (OR = 3.46 [1.30–9.20], P = 0.01). The OR of retreatment was lower with surgery in the total (OR = 0.37 [0.17–0.76], P = 0.007) and ruptured cohorts (OR = 0.31 [0.11–0.89], P = 0.03), thought it was similar in the unruptured group (OR = 0.51 [0.08–3.03], P = 0.46). The OR of recurrence was lower with surgery in the total (OR = 0.22 [0.10, 0.47], P = 0.0001), ruptured (OR = 0.16 [0.03, 0.90], P = 0.04), and mixed (un) ruptured cohorts (OR = 0.22 [0.09–0.53], P = 0.0009). The OR of rebleeding in ruptured group was similar (OR = 0.66 [0.29–1.52], P = 0.33). The ORs of other outcomes were similar. ACoA aneurysms may be safely treated with either surgery or endovascular treatment, although microsurgical clipping demonstrates higher obliteration rates and lower rates of retreatment and recurrence. [ABSTRACT FROM AUTHOR]

Objective Aneurysms of the anterior pontine segment of the anterior-inferior cerebellar artery (AICA) are uncommon. Their treatment is challenging because critical neurovascular structures are adjacent to it and the available surgical corridors are narrow and deep. Although endoscopic endonasal approaches are accepted for treating midline skull base lesions, their role in the treatment vascular lesions remains undefined. The present study is aimed to assess the anatomic feasibility of the endoscopic endonasal transclival (EET) approach for treating anterior pontine AICA aneurysms and compare it with the subtemporal anterior transpetrosal (SAT) approach. Methods Twelve cadaveric specimens were prepared for surgical simulation. The AICAs were exposed using both EET and SAT approaches. Surgical window area and the length of the exposed artery were measured. The distance from the origin of the artery to the clip applied for proximal control was measured. The number of AICA perforators exposed and the anatomic features of each AICA were recorded. Results The EET approach provided a wider surgical window area compared with the SAT ( P < 0.001). More AICA perforators were visualized using the EET approach ( P < 0.05). To obtain proximal control of the AICA, an aneurysm clip could be applied closer to the origin of AICA using EET (0.2 ± 0.42 mm) compared with SAT (6.26 ± 3.4 mm) ( P < 0.001). Conclusion Clipping anterior pontine AICA aneurysms using the EET approach is feasible. Compared with SAT, the EET approach provides advantages in surgical window area, ensuring proximal control before aneurysm dissection, visualization of perforating branches, and better proximal control. [ABSTRACT FROM AUTHOR]