title: Outcome of Surgical or Endovascular Treatment of Giant Intracranial Aneurysms, with Emphasis on Age, Aneurysm Location, and Unruptured Aneuryms--A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Designing treatment strategies for unruptured giant intracranial aneurysms (GIA) is difficult as evidence of large clinical trials is lacking. We examined the outcome following surgical or endovascular GIA treatment focusing on patient age, GIA location and unruptured GIA.
  
  
  METHODS
  Medline and Embase were searched for studies reporting on GIA treatment outcome published after January 2000. We calculated the proportion of good outcome (PGO) for all included GIA and for unruptured GIA by meta-analysis using a random effects model.
  
  
  RESULTS
  We included 54 studies containing 64 study populations with 1,269 GIA at a median follow-up time (FU-T) of 26.4 months (95% CI 10.8-42.0). PGO was 80.9% (77.4-84.4) in the analysis of all GIA compared to 81.2% (75.3-86.1) in the separate analysis of unruptured GIA. For each year added to patient age, PGO decreased by 0.8%, both for all GIA and unruptured GIA. For all GIA, surgical treatment resulted in a PGO of 80.3% (95% CI 76.0-84.6) compared to 84.2% (78.5-89.8, p = 0.27) after endovascular treatment. In unruptured GIA, PGO was 79.7% (95% CI 71.5-87.8) after surgical treatment and 84.9% (79.1-90.7, p = 0.54) after endovascular treatment. PGO was lower in high quality studies and in studies presenting aggregate instead of individual patient data. In unruptured GIA, the OR for good treatment outcome was 5.2 (95% CI 2.0-13.0) at the internal carotid artery compared to 0.1 (0.1-0.3, p < 0.1) in the posterior circulation. Patient sex, FU-T and prevalence of ruptured GIA were not associated with PGO.
  
  
  CONCLUSIONS
  We found that the chances of good outcome after surgical or endovascular GIA treatment mainly depend on patient age and aneurysm location rather than on the type of treatment conducted. Our analysis may inform future research on GIA.
authors.affiliation: Department of Neurosurgery, Charitx00E9; - Universitaetsmedizin Berlin, Berlin, Germany.
authors.forename: Julius
authors.initials: J
authors.lastname: Dengler
authors.forename: Nicolai
authors.initials: N
authors.lastname: Maldaner
authors.forename: Sven
authors.initials: S
authors.lastname: Gläsker
authors.forename: Matthias
authors.initials: M
authors.lastname: Endres
authors.forename: Martin
authors.initials: M
authors.lastname: Wagner
authors.forename: Uwe
authors.initials: U
authors.lastname: Malzahn
authors.forename: Peter U
authors.initials: PU
authors.lastname: Heuschmann
authors.forename: Peter
authors.initials: P
authors.lastname: Vajkoczy
mesh_terms: D002343:Carotid Artery, Internal / Q000473:pathology / Q000601:surgery*; D004621:Embolization, Therapeutic / Q000379:methods; D057510:Endovascular Procedures / Q000379:methods; D006801:Humans; D002532:Intracranial Aneurysm / Q000473:pathology* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome