Objective To analyze a series of published literatures on surgical clipping and endovascular embolization treatment for paraclinoid aneurysms by systematic review and the Meta-analysis.

Methods The computer was used to search electronic databases such as PubMed and Web of Science to obtain literatures on surgical clipping and endovascular treatment for paraclinoid aneurysms from January 1980 to December 2022. The differences in the rate of complete occlusion, the improvement rate of symptoms, and the incidence rate of related complications in literatures were analyzed.

Results This study systematically reviewed the clinical materials of 2 698 patients from 37 studies, of which 1, 164 patients(endovascular embolization group)received endovascular embolization treatment, and 1, 534 patients(surgical clipping group) underwent surgical clipping. The complete occlusion rate of endovascular embolization group was significantly lower than that of surgical clipping group (OR=0.53; 95%CI, 0.37 to 0.77; P=0.001; I²=0%). The improvement rate of symptoms in the surgical clipping group was significantly better than that in the endovascular embolization group (OR=0.26; 95%CI, 0.14 to 0.50; P < 0.001; I²=5.9%). There was no significant difference in the incidence of complications between the two groups (OR=0.25; 95%CI, 0.03 to 2.20; P=0.21; I²=7.43%).

Conclusion Compared with endovascular embolization, surgical clipping treatment can increase the complete occlusion rate, which seems more beneficial for improving symptoms, but the incidence of intraoperative and postoperative complications increases.