The Choice of the Treatment Method for Cerebral Aneurysms of Different Locations in the Era of Advanced Endovascular Technologies: A Meta-Analysis

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Abstract

Relevance: Until recently, microsurgical clipping was the main method to eliminate cerebral aneurysms (CA) from the circulation. The rate of endovascular versus microsurgical treatment for CA of different locations in the era of rapidly emerging endovascular medicine is unknown. Aim: To study the frequency of microsurgical or endovascular techniques for the treatment of CA of different locations. Methods: Methods of treatment and localization of CA were studied in meta-analysis of clinical series published from 2003 to 2014. Case-control studies, studies with externally balanced number of patients in the groups, and the series in which a large number of patients were treated out the study were excluded. Results: 1 international, 2 American, 2 Japanese and 3 Russian clinical series (n=5254 CA) were included in the meta-analysis. The pooled rate of microsurgical treatment used for the CA of the internal carotid artery was 65% (95% CI 55−75), the anterior cerebral artery ― 65% (95% CI 46−84), the middle cerebral artery ― 90% (95% CI 82−98), and vertebrobasilar basin ― 39% (95% CI 41−64). Conclusions: In clinical series both methods of CA treatment were available but endovascular closure was used for the majority of vertebrobasilar basin aneurysms, and for more than a third of anterior cerebral artery or internal carotid artery aneurysms. Middle cerebral artery aneurysms, as opposed to CA of other locations, were subjected to microsurgical treatment in the most cases (90%). In some cases CA are not suitable for endovascular closure, or require microvascular reconstructive operations. In competition with less invasive but more expensive option of endovascular treatment, and under the conditions of decreasing volume and experience of open CA surgery, microsurgical techniques should be mastered to a high level which requires centralization of the patients in the specialized centers and microneurosurgical training. 

About the authors

V. A. Byval’tsev

Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk;
Railway Clinical Hospital on the station Irkutsk-Passazhirskiy of Russian Railways Ltd., Irkutsk;
Irkutsk State Medical University, Irkutsk;
Irkutsk State Medical Academy of Postgraduate Education, Irkutsk

Author for correspondence.
Email: byval75vadim@yandex.ru

доктор медицинских наук, главный нейрохирург Департамента здравоохранения ОАО «РЖД», заведующий курсом нейрохирургии Иркутского государственного медицинского университета, ведущий научный сотрудник лаборатории БНЗТ ИЯФ СО РАН, заведующий научно-клиническим отделом нейрохирургии Иркутского научного центра хирургии и травматологии, , профессор кафедры травматологии, ортопедии и нейрохирургии Иркутской государственной медицинской академии последипломного образования 

Russian Federation

E. G. Belykh

Irkutsk Scientific Center of Surgery and Traumatology, Irkutsk

Email: e.belykh@yandex.ru

аспирант

Russian Federation

I. A. Stepanov

Irkutsk State Medical University, Irkutsk

Email: edmoilers@mail.ru

аспирант курса нейрохирургии

Russian Federation

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