Comparative study on the clinical outcomes and prognosis of endovascular embolization and craniotomy clipping for the treatment of cerebral aneurysms

Abstract

Objective: To investigate the safety and outcomes of endovascular embolization and craniotomy clipping in the treatment of cerebral aneurysms.
 Methods: We collected the clinical data of 106 patients with cerebral aneurysm who underwent surgical treatment (endovascular embolization, Group-A, n=55; craniotomy clipping, Group-B, n=51) in the First People’s Hospital of Yichang from January 2020 to May 2021. We compared surgical treatment indexes, treatment costs, neurological function before and after the treatment, incidence of postoperative complications and the prognosis after one-year follow-up between the two groups.
 Results: Endovascular embolization (Group-A) was associated with a shorter mean operation time and hospital stay, a lower mean intraoperative bleeding amount, and a higher mean treatment cost than craniotomy clipping (Group-B) (P<0.05). Compared with the pre-operative neurological function scores, the scores of both groups decreased after the surgery, and the mean post-operative score of Group-A was significantly lower than that of Group-B (P<0.05). Compared with Group-B , patients in Group-A had a lower overall complication rate (P < 0.05. Higher proportion of patients in Group-A had a good prognosis (P < 0.05).
 Conclusion: Endovascular embolization for the treatment of cerebral aneurysms is safe as it can shorten the operation time and hospital stay, reduce the incidence of neurological injury and complications, and have a favorable prognosis. However, the treatment is more expensive. Endovascular embolization can be selected for the treatment of cerebral aneurysms when economic conditions allow it.
 doi: https://doi.org/10.12669/pjms.39.5.7401
 How to cite this: Li G, Chen S, Han J, Pan W, Ji P. Comparative study on the clinical outcomes and prognosis of endovascular embolization and craniotomy clipping for the treatment of cerebral aneurysms. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/ 10.12669/pjms.39.5.7401
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Efficacy of endovascular embolization versus microsurgical clamping in the treatment of intracranial aneurysms: a meta-analysis

“…After further reading the abstract and full text, we then excluded 213 reviews, guidelines, conferences, case reports, and 25 studies that did not meet the criteria for inclusion of patients or with incomplete data. Ultimately, 10 eligible studies were incorporated into the analysis [7,[9][10][11][12][13][14][15][16][17]. The procedure for sifting through the literature is depicted in Figure 1.…”

“…(1) Complete occlusion rate: 3 studies [12,14,17] with a total of 228 patients reported the complete occlusion rate, and the study data were not statistically heterogeneous (I 2 =0%, Am J Transl Res 2024;16(5):1845-1858 al. [7] was the source of the heterogeneity. After exclusion of their study, endovascular coiling for cerebral aneurysms demonstrated a better clinical near-term prognosis compared with cranial clamping [OR=1.55, 95% CI (1.05, 2.27), P=0.03] (Figure 5).…”

“…(5) Incidence of postoperative ischemic stroke: 7 studies [7,9,[11][12][13][14]17], which included a total of 1,705 patients, reported incidence of P=0.62), so a fixed-effects model was used. No significant difference was found in the complete occlusion rate when comparing the clip and coil groups [OR=1.76, 95% CI (0.78, 3.96), P=0.17] (Figure 2).…”

“…(2) Short-term clinical prognosis: 9 studies [7,9,[11][12][13][14][15][16][17] with a total of 2,251 patients reported short-term clinical prognosis, and the study data were statistically heterogeneous (I 2 =67%, P=0.002), so we used random-effects model. No significant difference was found in the shortterm clinical prognosis when comparing the clip and coil groups [OR=1.09, 95% CI (0.67, 1.80), P=0.72] (Figure 4).…”

“…The novelty of this study lies in its ability to synthesize a large body of evidence to provide clearer guidance for clinical practice. Unlike previous studies that may have been limited by smaller sample sizes (106) or less rigorous methodology [7], this meta-analysis leverages a large dataset and high-quality studies to draw more definitive conclusions about the relative benefits and risks associated with endovascular coiling versus craniotomy clipping.…”