Schartz Derrek, Mattingly Thomas K, Rahmani Redi, Ellens Nathaniel, Akkipeddi Sajal Medha K, Bhalla Tarun, Bender Matthew T
1Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York; and.
2Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York.
J Neurosurg. 2021 Nov 19;137(1):129-139. doi: 10.3171/2021.9.JNS211698. Print 2022 Jul 1.
Microsurgery for cerebral aneurysms is called definitive, yet some patients undergo a craniotomy that results in noncurative treatment. Furthermore, the overall rate of noncurative microsurgery for cerebral aneurysms is unclear. The objective of this study was to complete a systematic review and meta-analysis to quantify three scenarios of noncurative treatment: aneurysm wrapping, postclipping remnants, and late regrowth of completely obliterated aneurysms.
A PRISMA-guided systematic literature review of the MEDLINE and Cochrane Library databases and meta-analysis was completed. Studies were included that detailed rates of aneurysm wrapping, residua confirmed with imaging, and regrowth after confirmed total occlusion. Pooled rates were subsequently calculated using a random-effects model. An assessment of statistical heterogeneity and publication bias among the included studies was also completed for each analysis, with resultant I2 values and p values determined with Egger's test.
Sixty-four studies met the inclusion criteria for final analysis. In 41 studies, 573/15,715 aneurysms were wrapped, for a rate of 3.5% (95% CI 2.7%-4.2%, I2 = 88%). In 43 studies, 906/13,902 aneurysms had residual neck or dome filling, for a rate of 6.4% (95% CI 5.2%-7.6%, I2 = 93%). In 15 studies, 71/2568 originally fully occluded aneurysms showed regrowth, for a rate of 2.1% (95% CI 1.2%-3.1%, I2 = 58%). Together, there was a total rate of noncurative surgery of 12.0% (95% CI 11.5%-12.5%). Egger's test suggested no significant publication bias among the studies. Meta-regression analysis revealed that the reported rate of aneurysm wrapping has significantly declined over time, whereas the rates of aneurysm residua and recurrence have not significantly changed.
Open microsurgery for cerebral aneurysm results in noncurative treatment approximately 12% of the time. This metric may be used to counsel patients and as a benchmark for other treatment modalities. This investigation is limited by the high degree of heterogeneity among the included studies.
脑动脉瘤显微手术被称为根治性手术，但仍有一些患者接受了开颅手术，却未得到根治性治疗。此外，脑动脉瘤非根治性显微手术的总体发生率尚不清楚。本研究的目的是进行一项系统评价和荟萃分析，以量化三种非根治性治疗情况：动脉瘤包裹术、夹闭术后残余以及完全闭塞的动脉瘤晚期再生长。
完成了一项基于PRISMA指南的对MEDLINE和Cochrane图书馆数据库的系统文献综述及荟萃分析。纳入的研究详细报道了动脉瘤包裹术的发生率、经影像学证实的残余情况以及确认完全闭塞后的再生长情况。随后使用随机效应模型计算合并发生率。还对纳入研究中的统计异质性和发表偏倚进行了评估，每项分析均通过Egger检验确定I²值和p值。
64项研究符合最终分析的纳入标准。在41项研究中，15715例动脉瘤中有573例接受了包裹术，发生率为3.5%（95%可信区间2.7% - 4.2%，I² = 88%）。在43项研究中，13902例动脉瘤中有906例存在残余颈部或瘤顶充盈，发生率为6.4%（95%可信区间5.2% - 7.6%，I² = 93%）。在15项研究中，2568例最初完全闭塞的动脉瘤中有71例出现再生长，发生率为2.1%（95%可信区间1.2% - 3.1%，I² = 58%）。总体而言，非根治性手术的总发生率为12.0%（95%可信区间11.5% - 12.5%）。Egger检验表明研究之间无显著的发表偏倚。荟萃回归分析显示，报道的动脉瘤包裹术发生率随时间显著下降，而动脉瘤残余和复发的发生率没有显著变化。
脑动脉瘤的开放性显微手术约有12%的时间会导致非根治性治疗。这一指标可用于向患者提供咨询，并作为其他治疗方式的基准。本研究受到纳入研究高度异质性的限制。
