scholarly journals 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

2016 ◽  
Vol 41 (3-4) ◽  
pp. 187-198 ◽  
Author(s):  
Julius Dengler ◽  
Nicolai Maldaner ◽  
Sven Gläsker ◽  
Matthias Endres ◽  
Martin Wagner ◽  
...  
Keyword(s):  
Treatment Outcome ◽  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Meta Analysis ◽  
Separate Analysis ◽  
Patient Age ◽  
Good Outcome ◽  
Giant Intracranial Aneurysms ◽  
Patient Âgé

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.

Cost Comparison of Surgical and Endovascular Treatment of Unruptured Giant Intracranial Aneurysms

Neurosurgery ◽  
2015 ◽  
Vol 77 (5) ◽  
pp. 733-743 ◽  
Author(s):  
◽  
Pietro Familiari ◽  
Nicolai Maldaner ◽  
Adisa Kursumovic ◽  
Stefan A. Rath ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Treatment Group ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Direct Costs ◽  
Treatment Costs ◽  
Cost Comparison ◽  
Treatment Groups ◽  
Giant Intracranial Aneurysms ◽  
Hospital Stays

Abstract BACKGROUND: Giant intracranial aneurysms (GIAs), which are defined as intracranial aneurysms (IAs) with a diameter of ≥25 mm, are most likely associated with the highest treatment costs of all IAs. However, the treatment costs of unruptured GIAs have so far not been reported. OBJECTIVE: To examine direct costs of endovascular and surgical treatment of unruptured GIAs. METHODS: We retrospectively examined 55 patients with unruptured GIAs treated surgically (37 patients) or endovascularly (18 patients) between April 2004 and March 2014. We analyzed the costs of all hospital stays, interventions, and imaging with a median follow-up of 46 months. RESULTS: There was no difference in the costs of hospital stay between surgical and endovascular treatment groups ($10 565 vs $14 992; P = .37). Imaging costs were significantly higher in the surgical group than in the endovascular treatment group ($2890 vs $1612; P &lt; .01), as were the costs of the intervention room and personnel involved in the intervention ($5566 vs $1520; P &lt; .01). Implants used per patient were more expensive in the endovascular group than in the surgical treatment group ($20 885 vs $167). The total direct treatment costs were higher in the endovascular group ($52 325) than in the surgical treatment group ($20 619; P &lt; .01). Treatment costs were associated with the type of treatment and GIA location but not with patient age, sex, or GIA size. CONCLUSION: Endovascular GIA treatment produced higher direct costs than surgical GIA treatment mainly due to higher implant costs. Reducing endovascular implant costs may be the most effective tool to decrease direct costs of GIA treatment.

Comparison of posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation Type I in pediatric patients: a meta-analysis

2008 ◽  
Vol 2 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Susan R. Durham ◽  
Kristina Fjeld-Olenec
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Treatment ◽  
Clinical Improvement ◽  
Posterior Fossa ◽  
Chiari Malformation ◽  
Meta Analysis ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Patient Age

Object Surgery for Chiari malformation Type I (CM-I) is one of the most common neurosurgical procedures performed in children, although there is clearly no consensus among practitioners about which surgical method is preferred. The objective of this meta-analysis was to compare the outcome of posterior fossa decompression with duraplasty (PFDD) and posterior fossa decompression without duraplasty (PFD) for the treatment of CM-I in children. Methods The authors searched Medline–Ovid, The Cochrane Library, and the conference proceedings of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons (2000–2007) for studies meeting the following inclusion criteria: 1) surgical treatment of CM-I; 2) surgical techniques of PFD and PFDD being reported in a single cohort; and 3) patient age < 18 years. Results Five retrospective and 2 prospective cohort studies involving a total of 582 patients met the criteria for inclusion in the meta-analysis. Of the 582 patients, 316 were treated with PFDD and 266 were treated with PFD alone. Patient age ranged from 6 months to 18 years. Patients undergoing PFDD had a significantly lower reoperation rate (2.1 vs 12.6%, risk ratio [RR] 0.23, 95% confidence interval [CI] 0.08–0.69) and a higher rate of cerebrospinal fluid–related complications (18.5 vs 1.8%, RR 7.64, 95% CI 2.53–23.09) than those undergoing PFD. No significant differences in either clinical improvement (78.6 vs 64.6%, RR 1.23, 95% CI 0.95–1.59) or syringomyelia decrease (87.0 vs 56.3%, RR 1.43, 95% CI 0.91–2.25) were noted between PFDD and PFD. Conclusions Posterior fossa decompression with duraplasty is associated with a lower risk of reoperation than PFD but a greater risk for cerebrospinal fluid–related complications. There was no significant difference between the 2 operative techniques with respect to clinical improvement or decrease in syringomyelia.

Abstract 3956: Outcomes of Patients Undergoing Endovascular Treatment for Mycotic Intracranial Aneurysms

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Ameer E Hassan ◽  
Saqib A Chaudhry ◽  
M Fareed K Suri ◽  
Adnan I Qureshi
Keyword(s):  
Surgical Treatment ◽  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Multivariate Logistic Regression Analysis ◽  
Primary Treatment ◽  
Endovascular Embolization ◽  
Parent Artery ◽  
Hospital Outcomes ◽  
Aneurysm Wall ◽  
Mycotic Aneurysms

Background: Mycotic intracranial aneurysms are rare with primary treatment focusing on underlying infection to reduce the high mortality rates. Treating these aneurysms remains challenging and obliteration procedures without sacrificing the parent artery often fail due to the fusiform and fragile aneurysm wall. Objective: To determine the outcomes associated with endovascular embolization in patients with mycotic intracranial aneurysms using a large nationally representative sample. Methods: We determined the frequency of endovascular and surgical procedures performed in patients with mycotic intracranial aneurysms and associated in-hospital outcomes using data from the Nationwide Inpatient Survey (NIS) data files from 2002 to 2009. All the in-hospital outcomes were analyzed after adjusting for potential confounders using multivariate logistic regression analysis. Results: Of the 1,915 patients admitted with the diagnosis of infected “mycotic” aneurysms, 83 (4.3%) underwent endovascular embolization, and 59 (3.1%) underwent surgical treatment. In mycotic aneurysms treated with endovascular treatment compared to surgical treatment, discharge outcomes were better with higher rates of minimal disability self-care (40% vs. 23.7% p=0.2436), and lower rates of moderate-severe disability (36% vs. 40% p=0.7874), and in-hospital deaths death (22.9 vs. 35.2 p= 0.3608). After adjusting for age, gender, and hospital teaching status, discharge mortality after endovascular treatment was not inferior to surgical treatment (odds ratio [OR] 1.58, 95% confidence interval [CI] 0.14 - 17.9) or those treated medically (OR 0.56, 95% CI 0.132 - 2.36). Conclusion: Endovascular embolization for mycotic intracranial aneurysms provides comparable outcomes to surgical treatment and should be considered whenever feasible when aneurysm obliteration is indicated.

CHALLENGES IN THE ENDOVASCULAR TREATMENT OF GIANT INTRACRANIAL ANEURYSMS

Neurosurgery ◽  
2008 ◽  
Vol 62 (suppl_3) ◽  
pp. S3-113-S3-124 ◽  
Author(s):  
Nestor R. Gonzalez ◽  
Gary Duckwiler ◽  
Reza Jahan ◽  
Yuichi Murayama ◽  
Fernando Viñuela
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Giant Intracranial Aneurysms

ENDOVASCULAR TREATMENT OF GIANT INTRACRANIAL ANEURYSMS WITH WILLIS COVERED STENTS

Neurosurgery ◽  
2008 ◽  
Vol 62 (5) ◽  
pp. E1176-E1177 ◽  
Author(s):  
Jian B. Wang ◽  
Ming H. Li ◽  
Chun Fang ◽  
Wu Wang ◽  
Ying S. Cheng ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Intracranial Aneurysms ◽  
Covered Stents ◽  
Giant Intracranial Aneurysms
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