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Systematic reviews of the literature on clipping and coiling of unruptured intracranial aneurysms.
MedLine Citation:
PMID:  22483172     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: The best management of unruptured aneurysms remains controversial. Accurate estimates of treatment-related morbidity and efficacy are needed for clinical decision making. METHODS: We review recent systematic reviews, case series and population-based studies on clipping and coiling of unruptured aneurysms. A critical analysis of the quality of available studies and of the reliability of results is followed by reappraisal of the logic of clinical research on unruptured aneurysms. RESULTS: Unfavourable outcome, including death, up to 1year after surgical clipping, was found in 692 of 9845 patients (REW average: 6.7%; (99%)CI: 4.9-9.0). Unfavourable outcome after coiling occurred in 189 of 5044 patients (REW average 4.8%, ((99%)CI: 3.9-6.0). Location and size of aneurysms were risk factors for clipping, while no risk factor reached statistical significance for coiling studies. The quality of reports was in general poor. Estimates from epidemiological studies showed higher morbidity rates than reviews of case series. Treatment efficacy could not be assessed. All studies are attempts to provide answers to questions that were never properly raised. CONCLUSION: Results of reviews and observational studies should serve as hypotheses for clinical trials.
Authors:
M Kotowski; O Naggara; T E Darsaut; J Raymond
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-4-4
Journal Detail:
Title:  Neuro-Chirurgie     Volume:  -     ISSN:  0028-3770     ISO Abbreviation:  -     Publication Date:  2012 Apr 
Date Detail:
Created Date:  2012-4-9     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0401057     Medline TA:  Neurochirurgie     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012. Published by Elsevier Masson SAS.
Affiliation:
Département de neurochirurgie, VHU Vaudois, Lausanne, Switzerland.
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