Li Gang
Department of Neurosurgery, Sanya Central Hospital (Hainan Third People's Hospital）, No. 1154, Jiefang Road, Sanya City, Hainan Province, 572000, China.
Neurosurg Rev. 2025 Jan 24;48(1):80. doi: 10.1007/s10143-025-03183-z.
Patients with intracranial aneurysm (IA) are at high risk of cerebral hemorrhage, which is associated with high mortality. Craniotomy or interventional endovascular coiling are common treatment methods in clinical practice, depending on the patient's condition. However, the recurrence rate of IA after either method remains unclear. This meta-analysis was conducted to study the relationship between different treatment regimens and IA recurrence. PubMed, CNKI, Web of Science, Wan Fang, and VIP databases were used to identify studies on "intracranial aneurysm," "craniotomy," "endovascular coiling," and "recurrence rate." Included studies adhered to rigorous screening and diagnostic criteria, and statistical models were applied based on homogeneity testing. This study encompassed 28 articles, including five on craniotomy and 23 on endovascular coiling, published between 2007 and 2022; among 1,448 cases treated with craniotomy, 20 experienced recurrences (recurrence rate: 1.4%, 95% CI: 0.2%), while among 5,975 cases treated with endovascular coiling, 872 cases experienced recurrence (recurrence rate: 14.6%, 95% CI: 14%, 20%). High heterogeneity (87%) was observed in the endovascular coiling, likely due to differences in patient demographics and aneurysm characteristics. For IAs, although endovascular coiling has advantages in terms of lower trauma and faster recovery, its high recurrence rate warrants closer post-treatment monitoring. Despite being more invasive, Craniotomy may be preferable in specific cases, such as when treating aneurysms with complex shapes or challenging locations. Treatment choice should be individualized, and future advancements in endovascular coiling technologies may help reduce recurrence rates.
颅内动脉瘤（IA）患者发生脑出血的风险很高，这与高死亡率相关。开颅手术或介入性血管内栓塞是临床实践中常见的治疗方法，具体取决于患者的病情。然而，两种方法治疗后IA的复发率仍不清楚。本荟萃分析旨在研究不同治疗方案与IA复发之间的关系。使用PubMed、中国知网、Web of Science、万方和维普数据库来识别关于“颅内动脉瘤”“开颅手术”“血管内栓塞”和“复发率”的研究。纳入的研究遵循严格的筛选和诊断标准，并根据同质性检验应用统计模型。本研究涵盖了2007年至2022年发表的28篇文章，其中5篇关于开颅手术，23篇关于血管内栓塞；在1448例接受开颅手术的病例中，20例复发（复发率：1.4%，95%CI：0.2%），而在5975例接受血管内栓塞的病例中，872例复发（复发率：14.6%，95%CI：14%，20%）。血管内栓塞组观察到高度异质性（87%），可能是由于患者人口统计学和动脉瘤特征的差异。对于IA，尽管血管内栓塞在创伤较小和恢复较快方面具有优势，但其高复发率需要更密切的治疗后监测。尽管开颅手术的侵入性更大，但在特定情况下可能更可取，例如治疗形状复杂或位置具有挑战性的动脉瘤时。治疗选择应个体化，血管内栓塞技术的未来进展可能有助于降低复发率。
