Comparison of surgical and endovascular treatments for fusiform intracranial aneurysms: systematic review and individual
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REVIEW
Comparison of surgical and endovascular treatments for fusiform intracranial aneurysms: systematic review and individual patient data meta-analysis João Paulo Mota Telles 1 & Davi Jorge Fontoura Solla 1,2 & Vitor Nagai Yamaki 1 & Nicollas Nunes Rabelo 1 & Saul Almeida da Silva 1,2 & José Guilherme Pereira Caldas 2 & Manoel Jacobsen Teixeira 1 & Jefferson Rosi Junior 1 & Eberval Gadelha Figueiredo 1 Received: 14 July 2020 / Revised: 14 October 2020 / Accepted: 12 November 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Fusiform intracranial aneurysms (FIA) are associated with significant morbidity and mortality. We carried out a systematic review and meta-analysis of individual participant data with propensity score adjustment to compare the functional and angiographic outcomes between surgical and endovascular approaches to FIA. We conducted a systematic review for articles on the treatment of FIA with individual patient-level detailing. Data from patients treated for FIA in our institution from 2010 to 2018 were also collected. The primary studied outcome was morbidity, and secondary outcomes were angiographic results and retreatment. Propensity score–adjusted mixed-effects logistic regression models evaluated treatment options, stratified by anatomical location. Compiling original and published data, there were 312 cases, of which 79 (25.3%) had open surgery, and 233 (74.5%) were treated with endovascular procedures. There were no differences between treatment groups, for neither cavernous ICA (OR 1.04, 95% CI 0.05–23.6) nor supraclinoid aneurysms (OR 7.82, 95% CI 0.65–94.4). Both size (OR 1.11, 95% CI 1.03– 1.19) and initial mRS (OR 2.0, 95% CI 1.2–3.3) were risk factors for morbidity, independent of location. Neither age nor rupture status influenced the odds of posterior morbidity. Unfavorable angiographic outcomes were more common in the endovascular group for supraclinoid and vertebrobasilar aneurysms (χ2, P < 0.01). There were no differences between morbidity of surgical and endovascular treatments for FIA, regardless of aneurysm location. Size and initial mRS were correlated with functional outcomes, whereas age and rupture status were not. Microsurgery seems to yield better long-term angiographic results compared to endovascular procedures. Keywords Fusiform aneurysm . Microsurgery . Endovascular . Meta-analysis
Introduction Fusiform intracranial aneurysms (FIA) are circumferential arterial dilatations 1.5 times the normal diameter of an arterial segment with any degree of tortuosity, without a definable neck. [9, 36] Significant morbidity and mortality are * João Paulo Mota Telles [email protected] 1
Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
2
Department of Interventional Neuroradiology, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
attributable to those spindle-shaped aneurysms, which have exhibited annual gr
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