title: Endovascular and Surgical Treatment of Unruptured MCA Aneurysms: Meta-Analysis and Review of the Literature.
abstract: Introduction. The best treatment for unruptured middle cerebral artery (MCA) aneurysms is unclear. We perform a meta-analysis of recent publications to evaluate the results of unruptured MCA aneurysms treated with surgical clipping and endovascular coiling. Methods. A PubMed search for articles published between January 2004 and November 2013 was performed. The R statistical software package was used to create a random effects model for each desired incidence rate. Cochran's Q test was used to evaluate possible heterogeneity among the rates observed in each study. Results. A total of 1891 unruptured MCA aneurysms, 1052 clipped and 839 coiled, were included for analysis. The complete occlusion rate at 6-9 months mean follow-up was 95.5% in the clipped group and 67.8% in the coiled group (P < 0.05). The periprocedural thromboembolism rate in the clipping group was 1.8% compared with 10.7% in the aneurysms treated by coiling (P < 0.05). The recanalization rate was 0% for clipping and 14.3% for coiling (P = 0.05). Modified Rankin scores of 0-2 were obtained in 98.9% of clipped patients compared to 95.5% of coiled (NS). Conclusions. This review weakly supports clipping as the preferred treatment of unruptured MCA aneurysms. Clinical outcomes did not differ significantly between the two groups.
authors.affiliation: University of Florida, Department of Neurosurgery, P.O. Box 100265, Gainesville, FL 32610-0265, USA.
authors.forename: Spiros L
authors.initials: SL
authors.lastname: Blackburn
authors.affiliation: University of Florida, Department of Neurosurgery, P.O. Box 100265, Gainesville, FL 32610-0265, USA ; Assiut University, Department of Radiology, Assiut 71515, Egypt.
authors.forename: Abdelrahman M
authors.initials: AM
authors.lastname: Abdelazim
authors.affiliation: University of Florida, College of Medicine, Gainesville, FL 32603, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Cutler
authors.affiliation: University of Florida, College of Medicine, Gainesville, FL 32603, USA.
authors.forename: Kevin T
authors.initials: KT
authors.lastname: Brookins
authors.affiliation: University of Florida, Department of Neurosurgery, P.O. Box 100265, Gainesville, FL 32610-0265, USA.
authors.forename: Kyle M
authors.initials: KM
authors.lastname: Fargen
authors.affiliation: University of Florida, Department of Neurosurgery, P.O. Box 100265, Gainesville, FL 32610-0265, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Hoh
authors.affiliation: Division of Interventional Neuroradiology, Abbott Northwestern Hospital, Minneapolis, MN 55407, USA.
authors.forename: Yasha
authors.initials: Y
authors.lastname: Kadkhodayan