Al-Salihi Mohammed Maan, Saha Ram, Abd Elazim Ahmed, Gillani Syed A, Al-Jebur Maryam Sabah, Siddiq Farhan, Saleh Ahmed, Ayyad Ali, Qureshi Adnan I
Zeenat Qureshi Stroke Institute, University of Missouri, Columbia, Missouri, USA.
Department of Neurology, Schoold of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
World Neurosurg. 2025 Feb;194:123529. doi: 10.1016/j.wneu.2024.11.112. Epub 2024 Dec 22.
Ophthalmic artery (OphA) aneurysms, occurring at the junction of the internal carotid artery and the OphA orifice, present significant treatment challenges due to their location and complex anatomy. This systematic review and meta-analysis aimed to evaluate endovascular therapy and microsurgery in managing OphA aneurysms.
Adhering to Cochrane Handbook guidelines, a comprehensive search was conducted in ClinicalTrials.gov and 4 databases (PubMed, Scopus, Web of Science, and Embase). Study quality was assessed using the National Institutes of Health tool. Statistical analyses were performed with Review Manager and open MetaAnalyst software.
The meta-analysis included 9 articles, covering 902 OphA aneurysms. Cohort studies showed fair quality, while case series demonstrated good quality. No significant difference in clinical outcomes was found between endovascular therapy and surgery. Post-treatment visual outcomes had an odds ratio (OR) of 2.48 (95% confidence interval [CI] [0.35, 17.45], P = 0.36), modified Rankin Scale (mRS) >2 outcomes had an OR of 0.53 (95% CI [0.16, 1.7], P = 0.28), and severe complications had an OR of 0.52 (95% CI [0.20, 1.35], P = 0.18). In the single-arm analysis, direct surgery outcomes for visual, mRS >2, severe complications, intraoperative aneurysm rupture, and postoperative infarction were 0.139, 0.008, 0.05, 0.036, and 0.037, respectively. In the endovascular group, these outcomes were 0.078, 0.028, 0.03, and 0.691, respectively.
Our comparison of endovascular therapy and surgery for OphA aneurysms showed no significant difference in clinical outcomes. However, visual complications were more common with surgery, while mRS >2 was higher with endovascular therapy. Flow diversion reduced visual deficits compared to clipping and coiling, but further studies are needed.
眼动脉（OphA）动脉瘤发生于颈内动脉与眼动脉开口的交界处，因其位置和复杂的解剖结构，在治疗上面临重大挑战。本系统评价和荟萃分析旨在评估血管内治疗和显微手术治疗眼动脉动脉瘤的效果。
按照Cochrane手册指南，在ClinicalTrials.gov及4个数据库（PubMed、Scopus、Web of Science和Embase）中进行全面检索。使用美国国立卫生研究院工具评估研究质量。采用Review Manager和开放式MetaAnalyst软件进行统计分析。
荟萃分析纳入9篇文章，涵盖902例眼动脉动脉瘤。队列研究质量一般，病例系列质量良好。血管内治疗与手术治疗的临床结局无显著差异。治疗后视力结局的比值比（OR）为2.48（95%置信区间[CI][0.35, 17.45]，P = 0.36），改良Rankin量表（mRS）>2的结局OR为0.53（95% CI[0.16, 1.7]，P = 0.28），严重并发症的OR为0.52（95% CI[0.20, 1.35]，P = 0.18）。在单臂分析中，直接手术在视力、mRS>2、严重并发症、术中动脉瘤破裂及术后梗死方面的结局分别为0.139、0.008、0.05、0.036和0.037。在血管内治疗组，这些结局分别为0.078、0.028、0.03和0.691。
我们对眼动脉动脉瘤血管内治疗和手术治疗的比较显示，临床结局无显著差异。然而，手术治疗的视力并发症更常见，而血管内治疗的mRS>2更高。与夹闭和弹簧圈栓塞相比，血流导向减少了视力缺陷，但仍需进一步研究。
