Systematic Review For Efficacy And Safety Of Neurosurgical Clipping And Endovascular Coiling In Intracranial Aneurysms

Objective:To evaluate the effectiveness and safety of neurosurgical clipping and endovascular coiling in intracranial aneurysms.Methods:MEDLINE, EMBASE, The Cochrane Library, CNKI were searched from 1995 to Dec.2009. We identified randomized controlled trials of intracranial aneurysms. The quality of included trials was evaluated by two estimators. And meta-analysis was conducted on homogeneous studies.Results:Twenty studies (6037 patients) were included. All included studies were graded in term of randomization, allocation concealment, and blinding. Eight studies were graded B and the other twelve were graded C.Meta-analysis based on included studies shows neurosurgical clipping and endovascular coiling in intracranial aneurysms that risk of poor outcome (death or dependence) OR (95%CI) values were 1.01(0.68,1.50),1.27(0.87,1.86),1.26(0.64,2.50),2.23(1.23,4.05) at the end of 1,3,6, 12 months respectively, the difference of the two groups had no significance statistically, p value >0.05 at the end of 1,3,6 months, only at 12 month the difference of two groups had significance statistically, p value<0.05;The risk of poor outcome OR(95%CI) value werel.14 (0.54,2.44),0.88 (0.50,1.56) for Hunt-Hess 1～2 grade,3～5grade patients, the difference had no significance statistically, p value>0.05. The risk of poor outcome OR(95%CI) value were 0.85(0.39,1.85),1.72(0.35,8.42),1.08(0.35,3.28),1.13(0.18,7.17) for the patients with intracranial aneurysms located ACA, MCA, ICA, VBA respectively, the difference had no significance statistically, p value>0.05. Aneurysmal obliteration rate OR(95%CI) values was 3.51 (2.22,5.55), the difference had significance statistically, p value<0.05. Hydrocephalus OR(95%CI) values was 0.73 (0.56,0.97), the difference had significance statistically, p value <0.05.Conclusions:Our study shows that neurosurgical clipping and endovascular coiling make no statistical difference to poor outcome in patients intracranial aneurysms, but endovascular coiling may have a better tendency.Two treatments make no statistical difference to poor outcome of intracranial aneurysms patients at 1,3,6 months, but endovascular coiling have a better outcome at 12 month after onset. Two treatments make no statistical difference to poor outcome for the patients with different Hunt-Hess grades or locations of intracranial aneurysms. Neurosurgical clipping makes a high rate of aneurysmal obliteration compared with endovascular treatment, the difference had significance statistically. Neurosurgical coiling make a low risk of hydrocephalus after onset compared with endovascular coiling, the difference also had significance statistically. Owing to high possibility of selection bias in included studies, there must be a negative impact on evidence intensity of our results. We expect high quality evidences provided by high quality double blind randomized controlled trials.