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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]

Introduction: Colloid cysts are histologically benign but can present with a broad spectrum of symptoms. A systematic review of the literature did not reveal any patient-centered data on the headache disability and quality of life (QoL) of these patients. Methods: This is a retrospective cohort study of 187 colloid cyst patients from the Colloid Cyst Survival Group who completed a survey that included demographic data, clinical data, a modified QoL survey (SF36v2), and a headache disability inventory or index (HDI). Results: Using multivariable linear regressions, we confirmed that the physical (PCS) and mental (MCS) components of SF-36 were significantly increased in the surgery group after adjustment for various baseline characteristics (p=0.025; p=0.006). Self-reported headache disability was significantly decreased with surgery when adjusted for the same baseline characteristics (p=0.02). Finally, patients with an incidental diagnosis of colloid cyst reported similar benefits from surgery in PCS, MCS and HDI. Conclusion: Our results suggest that colloid cyst patients who underwent a surgical resection self-report a better QoL and less headache disability compared with patients who did not undergo surgery. Future prospective studies with baseline measures of QoL are indicated to confirm our findings. [ABSTRACT FROM AUTHOR]