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Safety and efficacy of microsurgical treatment of previously coiled aneurysms: a systematic review and meta-analysis

  • Review Article - Vascular
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Abstract

Background

We conducted a systematic review of the literature to evaluate the safety and efficacy of surgical treatment of previously coiled aneurysms.

Methods

A comprehensive review of the literature for studies on surgical treatment of previously coiled aneurysms was conducted. For each study, the following data were extracted: patient demographics, initial clinical status, location and size of aneurysms, time interval between initial/last endovascular procedure and surgery, surgical indications, and microsurgical technique. We performed subgroup analyses to compare direct clipping versus coil removal and clipping versus parent vessel occlusion, early (<4 weeks post-coiling) versus late surgery and anterior versus posterior circulation.

Results

Twenty-six studies with 466 patients and 471 intracranial aneurysms were included. All of the studies were retrospective and non-comparative case-series. Patients undergoing direct clipping had lower perioperative morbidity (5.0 %, 95 % CI = 2.6–7.4 %) when compared to those undergoing coil removal and clipping (11.1 %, 95 % CI = 5.3–17.0 %) or parent vessel occlusion (13.1 %, 95 % CI = 4.6–21.6 %) (p = 0.05). Patients receiving early surgery (<4 weeks post-coiling) had significantly lower rates of good neurological outcome (77.1 %, 95 % CI = 69.3–84.8 %) when compared to those undergoing late surgery (92.1 %, 95 % CI = 89.0–95.2 %) (p < 0.01). There were higher rates of long-term neurological morbidity in the posterior circulation group (23.1 vs. 4.7 %, p < 0.01) as well as long-term neurological mortality (4.4 vs. 2.8 %, p < 0.01).

Conclusions

Our meta-analysis suggests that surgical treatment is safe and effective. Our data indicate that aneurysms that are amenable to direct clipping have superior outcomes. Late surgery was also associated with better clinical outcomes. Surgery of recurrent posterior circulation aneurysms was associated with high rates of morbidity and mortality. Given the characteristics of the included studies, the quality of evidence of this meta-analysis is limited.

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Disclosures

O. P., W. B., and C. T. report no disclosures or conflicts of interest. G. L. is a consultant for eV3/Covidien.

Conflict of interest

The author(s) declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Neurologic Surgery, Mayo Clinic, Rochester, 200 1st Street SW, Rochester, MN, 55905, USA

    Ondra Petr & Giuseppe Lanzino

  2. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Waleed Brinjikji

  3. Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria

    Ondra Petr & Claudius Thomé

Authors
  1. Ondra Petr
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  2. Waleed Brinjikji
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  3. Claudius Thomé
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  4. Giuseppe Lanzino
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Correspondence to Ondra Petr.

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Petr, O., Brinjikji, W., Thomé, C. et al. Safety and efficacy of microsurgical treatment of previously coiled aneurysms: a systematic review and meta-analysis. Acta Neurochir 157, 1623–1632 (2015). https://doi.org/10.1007/s00701-015-2500-y

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  • DOI: https://doi.org/10.1007/s00701-015-2500-y

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