Department of Preventive Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA.
Department of Family Medicine, Memorial Medical Center, Las Cruces, NM, USA.
Neurochirurgie. 2022 Dec;68(6):661-673. doi: 10.1016/j.neuchi.2022.07.007. Epub 2022 Aug 11.
Both microsurgical and endovascular techniques continued to be treatment options for basilar apex aneurysms (BAA). We conducted a systematic review to compare both treatment options in terms of both clinical and radiological outcomes.
The PRISMA method was used to identify related articles. Data collected from each article and the two treatment approaches were compared in terms of favorable clinical outcome and complete/near complete occlusion rate. Subgroup analysis was done based on the size and the rupture status of BAA.
Fifty-nine (59) and 32 articles reported a measurable clinical and radiological outcome respectively. The weighted average favorable clinical outcome was significantly higher in the endovascular group (86.4% vs 79.6%, P<0.0001), while the weighted average complete/near complete occlusion rate was significantly higher in the surgical group (92.6% vs 83.8%, P<0.0001). In the subgroup analysis, the favorable clinical outcome remained significantly higher in the endovascular group for the ruptured, unruptured and giant/large BAA (P<0.001), but not in the small BAA subgroup (P=0.26). The occlusion rate remained significantly higher in the surgical group for all subgroups (P<0.001).
Treatment of BAA remains in a trade-off between favorable clinical outcome and complete or near-complete occlusion depending on the treatment modality selected. Careful selection of cases and judicial discussion between open surgical and endovascular team is warranted for treatment optimization.
对于基底动脉顶端动脉瘤（BAA），显微手术和血管内治疗技术一直是治疗选择。我们进行了一项系统评价，比较了这两种治疗方法在临床和影像学结果方面的差异。
采用 PRISMA 方法来确定相关文章。从每篇文章中收集数据，并比较两种治疗方法的良好临床结局和完全/近完全闭塞率。根据 BAA 的大小和破裂状态进行亚组分析。
59 篇和 32 篇文章分别报告了可测量的临床和影像学结果。血管内治疗组的加权平均良好临床结局显著更高（86.4%比 79.6%，P<0.0001），而手术组的加权平均完全/近完全闭塞率显著更高（92.6%比 83.8%，P<0.0001）。在亚组分析中，对于破裂和未破裂以及巨大/大型 BAA，血管内治疗组的良好临床结局仍然显著更高（P<0.001），但在小型 BAA 亚组中则没有（P=0.26）。对于所有亚组，手术组的闭塞率仍然显著更高（P<0.001）。
对于 BAA 的治疗，根据所选的治疗方式，在良好的临床结局和完全或接近完全闭塞之间仍然存在权衡。需要仔细选择病例，并在开放手术和血管内团队之间进行公正的讨论，以实现治疗的优化。
