YU Zhengyong, QI Wentao, DUAN Xiaochun, HUANG Ying. A Meta-analysis of surgical treatment for paraclinoid aneurysms[J]. Journal of Clinical Medicine in Practice, 2023, 27(13): 6-15. DOI: 10.7619/jcmp.20230618
Citation: YU Zhengyong, QI Wentao, DUAN Xiaochun, HUANG Ying. A Meta-analysis of surgical treatment for paraclinoid aneurysms[J]. Journal of Clinical Medicine in Practice, 2023, 27(13): 6-15. DOI: 10.7619/jcmp.20230618

A Meta-analysis of surgical treatment for paraclinoid aneurysms

More Information
  • Received Date: February 28, 2023
  • Revised Date: May 10, 2023
  • Available Online: July 18, 2023
  • 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.

  • [1]
    BROWN B, HANEL R A. Endovascular management of cavernous and paraclinoid aneurysms[J]. Neurosurg Clin N Am, 2014, 25(3): 415-424. doi: 10.1016/j.nec.2014.04.017
    [2]
    FLORES B C, WHITE J A, BATJER H H, et al. The 25th anniversary of the retrograde suction decompression technique (Dallas technique) for the surgical management of paraclinoid aneurysms: historical background, systematic review, and pooled analysis of the literature[J]. J Neurosurg, 2018, 130(3): 902-916.
    [3]
    SERRANO L E, AYYAD A, ARCHAVLIS E, et al. A literature review concerning contralateral approaches to paraclinoid internal carotid artery aneurysms[J]. Neurosurg Rev, 2019, 42(4): 877-884. doi: 10.1007/s10143-018-01063-3
    [4]
    WU D G, LAI N S, ZHAO X T, et al. Enterprise 2 stent-assisted embolization of paraclinoid aneurysms: a single center preliminary study[J]. Clin Interv Aging, 2022, 17: 1833-1840. doi: 10.2147/CIA.S390882
    [5]
    DI R Y, GE L, LU G, et al. Clinical and angiographic outcomes of stent-assisted coiling of paraclinoid aneurysms: comparison of LVIS and neuroform stents[J]. J Clin Neurosci, 2021, 83: 1-7. doi: 10.1016/j.jocn.2020.11.047
    [6]
    LIANG C H, GUANG Y Z, HOU K. Balloon-assisted coils embolization for ophthalmic segment aneurysms of the internal carotid Artery[J]. Front Neurol, 2021, 12: 658661. doi: 10.3389/fneur.2021.658661
    [7]
    LU D L, XIONG J, LIU H J, et al. Surgical clipping of ophthalmic artery aneurysms: a single center series[J]. Br J Neurosurg, 2021, 35(2): 157-160. doi: 10.1080/02688697.2020.1775787
    [8]
    KAMIDE T, BURKHARDT J K, TABANI H, et al. Microsurgical clipping techniques and outcomes for paraclinoid internal carotid artery aneurysms[J]. Oper Neurosurg, 2019, 18(2): 183-192.
    [9]
    OTA N, PETRAKAKIS I, NODA K, et al. Predictor of visual impairment following paraclinoid aneurysm surgery: special consideration of surgical microanatomy related to paraclinoid structures[J]. Oper Neurosurg, 2020, 20(1): 45-54.
    [10]
    OTANI N, MORI K, WADA K, et al. Limited indications for clipping surgery of paraclinoid aneurysm based on long-term visual morbidity[J]. World Neurosurg, 2020, 134: e153-e161. doi: 10.1016/j.wneu.2019.09.147
    [11]
    HIRATA K, ITO Y, TSURUTA W, et al. Treatment outcomes of cerebral aneurysms presenting with optic neuropathy: a retrospective case series[J]. Asian J Neurosurg, 2019, 14(2): 499-505. doi: 10.4103/ajns.AJNS_294_18
    [12]
    SILVA M A, SEE A P, DASENBROCK H H, et al. Vision outcomes in patients with paraclinoid aneurysms treated with clipping, coiling, or flow diversion: a systematic review and meta-analysis[J]. Neurosurg Focus, 2017, 42(6): E15. doi: 10.3171/2017.3.FOCUS1718
    [13]
    JIA Z Y, SONG Y S, SHEEN J J, et al. Loop microcatheter technique for coil embolization of paraclinoid aneurysms[J]. Acta Neurochir, 2018, 160(9): 1755-1760. doi: 10.1007/s00701-018-3642-5
    [14]
    KAMIDE T, TABANI H, SAFAEE M M, et al. Microsurgical clipping of ophthalmic artery aneurysms: surgical results and visual outcomes with 208 aneurysms[J]. J Neurosurg, 2018, 129(6): 1511-1521. doi: 10.3171/2017.7.JNS17673
    [15]
    KIM S Y, PARK D S, PARK H Y, et al. Simple coiling versus stent-assisted coiling of paraclinoid aneurysms: radiological outcome in a single center study[J]. J Korean Neurosurg Soc, 2017, 60(6): 644-653. doi: 10.3340/jkns.2017.0193
    [16]
    LYU N, ZHAO R, YANG P F, et al. Predictors of recurrence after stent-assisted coil embolization of paraclinoid aneurysms[J]. J Clin Neurosci, 2016, 33: 173-176. doi: 10.1016/j.jocn.2016.03.039
    [17]
    PAHL F H, DE OLIVEIRA M F, BROCK R S, et al. Surgical clipping is still a good choice for the treatment of paraclinoid aneurysms[J]. Arq Neuro-Psiquiatr, 2016, 74(4): 314-319. doi: 10.1590/0004-282X20150215
    [18]
    PARK W, PARK J C, HAN K, et al. Anterior optic pathway compression due to internal carotid artery aneurysms: neurosurgical management and outcomes[J]. J Stroke, 2015, 17(3): 344-353. doi: 10.5853/jos.2015.17.3.344
    [19]
    DURST C R, STARKE R M, GAUGHEN J, et al. Vision outcomes and major complications after endovascular coil embolization of ophthalmic segment aneurysms[J]. AJNR Am J Neuroradiol, 2014, 35(11): 2140-2145. doi: 10.3174/ajnr.A4032
    [20]
    LAI L T, MORGAN M K. Outcomes for unruptured ophthalmic segment aneurysm surgery[J]. J Clin Neurosci, 2013, 20(8): 1127-1133. doi: 10.1016/j.jocn.2012.12.004
    [21]
    MATTINGLY T, KOLE M K, NICOLLE D, et al. Visual outcomes for surgical treatment of large and giant carotid ophthalmic segment aneurysms: a case series utilizing retrograde suction decompression (the "Dallas technique")[J]. J Neurosurg, 2013, 118(5): 937-946. doi: 10.3171/2013.2.JNS12735
    [22]
    WANG Y, LI Y X, JIANG C H, et al. Endovascular treatment of paraclinoid aneurysms: 142 aneurysms in one centre[J]. J Neurointerv Surg, 2013, 5(6): 552-556. doi: 10.1136/neurintsurg-2012-010494
    [23]
    WANG Y, LI Y X, JIANG C H, et al. Could the types of paraclinoid aneurysm be used as a criterion in choosing endovascular treatment Neuro-radiologists' view[J]. Acta Neurochir, 2013, 155(11): 2019-2027. doi: 10.1007/s00701-013-1830-x
    [24]
    DEHDASHTI A R, LE ROUX A, BACIGALUPPI S, et al. Long-term visual outcome and aneurysm obliteration rate for very large and giant ophthalmic segment aneurysms: assessment of surgical treatment[J]. Acta Neurochir, 2012, 154(1): 43-52. doi: 10.1007/s00701-011-1167-2
    [25]
    NANDA A, JAVALKAR V. Microneurosurgical management of ophthalmic segment of the internal carotid artery aneurysms: single-surgeon operative experience from Louisiana state university, Shreveport[J]. Neurosurgery, 2011, 68(2): 355-371. doi: 10.1227/NEU.0b013e3182039819
    [26]
    SUN Y, LI Y, LI A M. Endovascular treatment of paraclinoid aneurysms[J]. Interv Neuroradiol, 2011, 17(4): 425-430. doi: 10.1177/159101991101700405
    [27]
    YADLA S, CAMPBELL PG, GROBELNY B, et al. Open and endovascular treatment of unruptured carotid-ophthalmic aneurysms: clinical and radiographic outcomes[J]. Neurosurgery, 2011, 68(5): 1434-1443. doi: 10.1227/NEU.0b013e31820b4f85
    [28]
    SHARMA B S, KASLIWAL M K, SURI A, et al. Outcome following surgery for ophthalmic segment aneurysms[J]. J Clin Neurosci, 2010, 17(1): 38-42. doi: 10.1016/j.jocn.2009.04.022
    [29]
    XU B N, SUN Z H, ROMANI R, et al. Microsurgical management of large and giant paraclinoid aneurysms[J]. World Neurosurg, 2010, 73(3): 137-146. doi: 10.1016/j.surneu.2009.07.042
    [30]
    DE OLIVEIRA J G, BORBA L A, RASSI-NETO A, et al. Intracranial aneurysms presenting with mass effect over the anterior optic pathways: neurosurgical management and outcomes[J]. Neurosurg Focus, 2009, 26(5): E3. doi: 10.3171/2009.3.FOCUS0924
    [31]
    RACO A, FRATI A, SANTORO A, et al. Long-term surgical results with aneurysms involving the ophthalmic segment of the carotid artery[J]. J Neurosurg, 2008, 108(6): 1200-1210. doi: 10.3171/JNS/2008/108/6/1200
    [32]
    HERAN N, SONG J K, KUPERSMITH M, et al. Large ophthalmic segment aneurysms with anterior optic pathway compression: assessment of anatomical and visual outcomes after endosaccular coil therapy[J]. J Neurosurg, 2007, 106(6): 968-975. doi: 10.3171/jns.2007.106.6.968
    [33]
    NONAKA T, HARAGUCHI K, BABA T, et al. Clinical manifestations and surgical results for paraclinoid cerebral aneurysms presenting with visual symptoms[J]. Surg Neurol, 2007, 67(6): 612-619. doi: 10.1016/j.surneu.2006.08.074
    [34]
    ZHAO J Z, WANG S, ZHAO Y L, et al. Microneurosurgical management of carotid-ophthalmic aneurysms[J]. J Clin Neurosci, 2006, 13(3): 330-333. doi: 10.1016/j.jocn.2005.04.029
    [35]
    BARAMI K, HERNANDEZ V S, DIAZ F G, et al. Paraclinoid carotid aneurysms: surgical management, complications, and outcome based on a new classification scheme[J]. Skull Base, 2003, 13(1): 31-41.
    [36]
    PARK H K, HOROWITZ M, JUNGREIS C, et al. Endovascular treatment of paraclinoid aneurysms: experience with 73 patients[J]. Neurosurgery, 2003, 53(1): 14-24. doi: 10.1227/01.NEU.0000068789.08955.1C
    [37]
    HOH B L, CARTER B S, BUDZIK R F, et al. Results after surgical and endovascular treatment of paraclinoid aneurysms by a combined neurovascular team[J]. Neurosurgery, 2001, 48(1): 78-90.
    [38]
    ARNAUTOVIC K I, AL-MEFTY O, ANGTUACO E. A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms[J]. Surg Neurol, 1998, 50(6): 504-520. doi: 10.1016/S0090-3019(97)80415-6
    [39]
    FRIES G, PERNECZKY A, VAN LINDERT E, et al. Contralateral and ipsilateral microsurgical approaches to carotid-ophthalmic aneurysms[J]. Neurosurgery, 1997, 41(2): 333-343. doi: 10.1097/00006123-199708000-00001
    [40]
    DIAZ F G, OHAEGBULAM S, DUJOVNY M, et al. Surgical alternatives in the treatment of cavernous sinus aneurysms[J]. J Neurosurg, 1989, 71(6): 846-853. doi: 10.3171/jns.1989.71.6.0846
    [41]
    JEON J S, AHN J H, HUH W, et al. A retrospective analysis on the natural history of incidental small paraclinoid unruptured aneurysm[J]. J Neurol Neurosurg Psychiatry, 2014, 85(3): 289-294. doi: 10.1136/jnnp-2013-305019
    [42]
    KALLURI A G, SUKUMARAN M, NAZARI P, et al. Retrospective review of 290 small carotid cave aneurysms over 17 years[J]. J Neurosurg, 2019, 18: 1-5.
    [43]
    MOLYNEUX A, KERR R, STRATTON I, et al. International Subarachnoid Aneurysm Trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised trial[J]. Lancet, 2002, 360(9342): 1267-1274. doi: 10.1016/S0140-6736(02)11314-6
    [44]
    MOLYNEUX A J, BIRKS J, CLARKE A, et al. The durability of endovascular coiling versus neurosurgical clipping of ruptured cerebral aneurysms: 18 year follow-up of the UK cohort of the International Subarachnoid Aneurysm Trial (ISAT)[J]. Lancet, 2015, 385(9969): 691-697. doi: 10.1016/S0140-6736(14)60975-2
    [45]
    MOLYNEUX A J, KERR R S C, YU L M, et al. International subarachnoid aneurysm trial (ISAT) of neurosurgical clipping versus endovascular coiling in 2143 patients with ruptured intracranial aneurysms: a randomised comparison of effects on survival, dependency, seizures, rebleeding, subgroups, and aneurysm occlusion[J]. Lancet, 2005, 366(9488): 809-817. doi: 10.1016/S0140-6736(05)67214-5
    [46]
    BRINJIKJI W, RABINSTEIN A A, NASR D M, et al. Better outcomes with treatment by coiling relative to clipping of unruptured intracranial aneurysms in the United States, 2001-2008[J]. AJNR Am J Neuroradiol, 2011, 32(6): 1071-1075. doi: 10.3174/ajnr.A2453
    [47]
    FALK DELGADO A, ANDERSSON T, FALK DELGADO A. Ruptured carotid-ophthalmic aneurysm treatment: a non-inferiority meta-analysis comparing endovascular coiling and surgical clipping[J]. Br J Neurosurg, 2017, 31(3): 345-349. doi: 10.1080/02688697.2017.1297371
    [48]
    SUN Y, WAN B L, LI Q, et al. Endovascular treatment for cavernous carotid aneurysms: a systematic review and meta-analysis[J]. J Stroke Cerebrovasc Dis, 2020, 29(6): 104808. doi: 10.1016/j.jstrokecerebrovasdis.2020.104808
    [49]
    CHOULAKIAN A, DRAZIN D, ALEXANDER M J. Endosaccular treatment of 113 cavernous carotid artery aneurysms[J]. J Neurointerv Surg, 2010, 2(4): 359-362. doi: 10.1136/jnis.2010.003137
    [50]
    ASAID M, O'NEILL A H, BERVINI D, et al. Unruptured paraclinoid aneurysm treatment effects on visual function: systematic review and meta-analysis[J]. World Neurosurg, 2017, 106: 322-330. doi: 10.1016/j.wneu.2017.06.135
    [51]
    MARIO Z, NOHRA C, STARKE ROBERT M, et al. Flow diversion versus conventional treatment for carotid cavernous aneurysms[J]. Stroke, 2014, 45(9): 2656-2661. doi: 10.1161/STROKEAHA.114.006247
    [52]
    HOU K, LI G C, GUO Y B, et al. Endovascular treatment for aneurysms at the A1 segment of the anterior cerebral artery: current difficulties and solutions[J]. Acta Neurol Belg, 2020, 121: 55-69.
    [53]
    STARKE R M, CHALOUHI N, ALI M S, et al. Endovascular treatment of carotid cavernous aneurysms: complications, outcomes and comparison of interventional strategies[J]. J Clin Neurosci, 2014, 21(1): 40-46. doi: 10.1016/j.jocn.2013.03.003
    [54]
    MIYACHI S, OHNISHI H, HIRAMATSU R, et al. Innovations in endovascular treatment strategies for large carotid cavernous aneurysms—the safety and efficacy of a flow diverter[J]. J Stroke Cerebrovasc Dis, 2017, 26(5): 1071-1080. doi: 10.1016/j.jstrokecerebrovasdis.2016.12.023
    [55]
    BECSKE T, BRINJIKJI W, POTTS M B, et al. Long-term clinical and angiographic outcomes following pipeline embolization device treatment of complex internal carotid artery aneurysms: five-year results of the pipeline for uncoilable or failed aneurysms trial[J]. Neurosurgery, 2017, 80(1): 40-48. doi: 10.1093/neuros/nyw014
  • Cited by

    Periodical cited type(1)

    1. 诸建华. 富血小板纤维蛋白治疗慢性创面的应用价值探讨. 中国实用乡村医生杂志. 2024(08): 72-74+78 .

    Other cited types(0)

Catalog

    Article views (136) PDF downloads (11) Cited by(1)

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return