title: Safety and Efficacy of Surgical and Endovascular Treatment for Distal Anterior Cerebral Artery Aneurysms: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  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 continues to be debated.
  
  
  OBJECTIVE
  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 performed for studies published from January 2000 to August 2015. We included studies describing treatment of DACA aneurysms with ≥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 neurologic morbidity/mortality.
  
  
  RESULTS
  Thirty studies with 1329 DACA aneurysms were included. Complete occlusion was 95% (95% confidence interval [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 neurologic 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 neurologic outcome was 80% and it 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).
  
  
  CONCLUSIONS
  Our meta-analysis showed 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. There were no substantial differences in procedure-related morbidity and mortality. These findings are important because they suggest that therapy of DACA aneurysms should be performed on a selective, case-by-case basis to maximize patient benefits.
authors.affiliation: Department of Neurosurgery, Medical University Innsbruck, Austria; Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA. Electronic address: ondra.petr@yahoo.com.
authors.forename: Ondra
authors.initials: O
authors.lastname: Petr
authors.affiliation: Department of Neurosurgery, Resuscitation and Intensive Care, 1(st) Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Střešovice, Czech Republic; Department of Anesthesiology, Resuscitation and Intensive Care, 1(st) Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Střešovice, Czech Republic.
authors.forename: Lucie
authors.initials: L
authors.lastname: Coufalová
authors.affiliation: Department of Neurosurgery, Resuscitation and Intensive Care, 1(st) Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Střešovice, Czech Republic.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Bradáč
authors.affiliation: Department of Radiology, Medical University Innsbruck, Austria.
authors.forename: Rafael
authors.initials: R
authors.lastname: Rehwald
authors.affiliation: Department of Radiology, Medical University Innsbruck, Austria.
authors.forename: Berharnd
authors.initials: B
authors.lastname: Glodny
authors.affiliation: Department of Neurosurgery, Resuscitation and Intensive Care, 1(st) Faculty of Medicine, Charles University in Prague, Military University Hospital Střešovice, Střešovice, Czech Republic.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Beneš
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002543:Cerebral Hemorrhage / Q000401:mortality*; D002548:Cerebral Revascularization / Q000401:mortality* / Q000706:statistics & numerical data; D003131:Combined Modality Therapy / Q000401:mortality / Q000706:statistics & numerical data; D015897:Comorbidity; D057510:Endovascular Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality*; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Aneurysm; DACA; Endovascular treatment; Meta-analysis; Microsurgery