gms | German Medical Science

68th Annual Meeting of the German Society of Neurosurgery (DGNC)
7th Joint Meeting with the British Neurosurgical Society (SBNS)

German Society of Neurosurgery (DGNC)

14 - 17 May 2017, Magdeburg

Article

Send article

Safety and Efficacy of Surgical and Endovascular Treatment for Distal Anterior Cerebral Artery Aneurysms: a Systematic Review and Meta-analysis

Meeting Abstract

Search Medline for

  • Ondra Petr - Department of Neurosurgery, Medical University Innsbruck, Innsbruck, Austria
  • Lucie Coufalová - Department of Neurosurgery, 1. Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
  • Ondřej Bradáč - Department of Neurosurgery, 1. Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
  • Berndhard Glodny - Department of Radiology, Medical University Innsbruck, Innsbruck, Austria
  • Vladimír Beneš - Department of Neurosurgery, 1. Faculty of Medicine, Charles University in Prague, Praha, Czech Republic
  • Rafael Rehwald - Department of Radiology, Medical University Innsbruck, Innsbruck, Austria

Deutsche Gesellschaft für Neurochirurgie. Society of British Neurological Surgeons. 68. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), 7. Joint Meeting mit der Society of British Neurological Surgeons (SBNS). Magdeburg, 14.-17.05.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. DocMO.05.08

doi: 10.3205/17dgnc031, urn:nbn:de:0183-17dgnc0310

Published: June 9, 2017

© 2017 Petr et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

Objective: Aneurysms of the distal anterior cerebral artery (DACA) are rare, representing between 1% and 9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continue to be debated. We conducted a systematic review of the literature to evaluate the safety and efficacy of treatment strategies of DACA-aneurysms.

Methods: A systematic search of Medline, EMBASE, Scopus and Web of Science was done for studies published from 01/2000 to 08/2015. We included studies describing treatment of DACA-aneurysms with ³ 10 patients. Random-effects meta-analysis was used to pool the following outcomes: complete occlusion, technical success, periprocedural morbidity/mortality and stroke rates, aneurysm recurrence/rebleed, and long-term neurological morbidity/mortality.

Results: 30 studies with 1329 DACA-aneurysms were included. Complete occlusion was 95% (95%CI=91.0%-97.0%) in the surgical group and 68% 95%CI=56.0%-78.0%) in the endovascular group (P<0.0001). Aneurysm recurrence occurred in 3% (95%CI=2.0%-4.0%) after surgery and in 19.1% (95%CI=12.0%-27.0%) after endovascular treatment (P<0.0001). Overall neurological morbidity and mortality were 15% (95%CI=11.0%-21.0%) and 9% (95%CI=7.0%-11.0%) after surgery and 14% (95%CI=10.0%-19.0%) (P=0.725) and 7% (95%CI=5.0%-10.0%) (P=0.422) after endovascular treatment, respectively. Overall long-term favorable neurological outcome was 80% and was equal in both groups (80%; 95%CI=73.0%-85.0% in the surgical group and 80%; 95%CI=72.0%-87.0% in the endovascular group) (P=0.892).

Conclusion: Our meta-analysis demonstrated that both treatment modalities are technically feasible and effective with sufficient long-term aneurysm occlusion and acceptable recurrence/rebleed rates. Surgical treatment is associated with superior angiographic outcomes including significantly lower postoperative aneurysm rebleed rates. There were no substantial differences in procedure-related morbidity and mortality. These findings should be considered when deciding the best therapeutic strategy for treatment of DACA-aneurysms. However, the final decision-making should be performed on a selective, case-by-case basis in order to maximize patient benefits and limit the risk of periprocedural complications.