Article
Surgical versus endovascular treatment of paraclinoid aneurysms: single-center series and meta-analysis
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Authors
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Erdem Güresir
- Klinik für Neurochirurgie
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Patrick Schuss
- Klinik für Neurochirurgie
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Valeri Borger
- Klinik für Neurochirurgie
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Jennifer Nadal
- Insitut für Medizinische Biometrie, Informatik und Epidemiologie
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Elke Hattingen
- Klinik für Radiologie, Rheinische Friedrich-Wilhelms-Universität, Bonn
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Hartmut Vatter
- Klinik für Neurochirurgie
| Published: | June 2, 2015 |
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Outline
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Objective: Intracranial paraclinoid aneurysms are treated by surgical clipping or endovascular treatment. However, controversy exists regarding the best therapeutic strategy in patients with ruptured or unruptured paraclinoid aneurysms. We therefore analyzed surgical and endovascular results in patients with ruptured and unruptured paraclinoid aneurysms.
Method: Between 2004 and 2013, we treated 40 patients with paraclinoid aneurysms at our institution. We assessed complete aneurysm occlusion, aneurysm recurrence and retreatment. To gain a larger population, MEDLINE was searched for published studies of surgical and endovascular treatment of paraclinoid aneurysms. Two reviewers independently extracted data.
Results: Of 40 patients with paraclinoid aneurysms treated at our institution, 12 underwent surgical treatment and 28 underwent endovascular treatment. Literature data, including the current series revealed a total of 322 paraclinoid aneurysms in patients who underwent surgical or endovascular treatment. Overall, 36% of the paraclinoid aneurysms were treated surgically, and 64% were treated endovascularly. Complete occlusion was achieved in 90% of aneurysms treated surgically compared to 75% treated endovascularly (p=0.002). Retreatment was necessary in 3% of patients treated surgically and in 24% of patients treated endovascularly (p<0.0001). All patients who required further treatment after surgical clipping underwent additional endovascular treatment due to initial incomplete aneurysm occlusion.
Conclusions: The present data indicates that surgical clipping of paraclinoid aneurysms leads to significantly higher complete occlusion rates and fewer necessity of retreatment. Nevertheless, for optimal treatment an interdisciplinary decision-making process is necessary in each individual case.
