Safety and occlusion rates of surgical treatment of unruptured intracranial aneurysms: a systematic review and meta-analysis of the literature from 1990 to 2011

摘要: Background and purpose Surgical clipping of unruptured intracranial aneurysms (UIAs) has recently been challenged by the emergence endovascular treatment. We performed an updated systematic review meta-analysis on surgical treatment UIAs, in attempt to determine aneurysm occlusion rates safety surgery modern era. Methods A detailed protocol was developed prior conducting according Cochrane Collaboration guidelines. Electronic databases spanning January 1990–April 2011 were searched, complemented hand searching. Heterogeneity assessed using I2, publication bias with funnel plots. mortality morbidity analysed weighted random effect models. Results 60 studies 9845 patients harbouring 10 845 included. Mortality occurred 157 (1.7%; 99% CI 0.9% 3.0%; I2=82%). Unfavourable outcomes, including death, 692 (6.7%; 4.9% 9.0%; I2=85%). Morbidity significantly greater higher quality studies, large or posterior circulation aneurysms. Reported decreased over time. Studies generally poor quality; plots showed heterogeneous results bias, data scant. Conclusions In published between 1990 2011, UIAs associated 1.7% 6.7% overall morbidity. The reputed durability not rigorously documented. Due included available literature cannot properly guide clinical decisions.