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

Objective:To evaluate the effectiveness and safety of neurosurgical clipping and endovascular coiling in anterior circulating aneurysms. Thereby, it is more objective, actual and accurate to reflet the treatment effect.Methods:MEDLINE (Ovid),Science direct, The Cochrane Library, CNKI were searched from 1996 to Aug.2010. 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, random effect model should be selected to calculate OR (odds ratio) 95% confidence interval (95%Cl)。Results:Twenty-one studies (4978 patients) were included. All included studies were graded in term of randomization, blinding, and allocation concealment. In these studies, Ten studies were graded B and eleven studies were graded C.Meta-analysis based on these studies show endovascular coiling and neurosurgical clipping in anterior circulating aneurysms that risk of poor outcome (death or dependence) OR (95%CI) values were 2.01(1.49,2.70) at the end of one year, the difference of two groups had significance statistically, p value<0.05;The risk of poor outcome OR(95%CI) value werel.26 (0.56,2.80),1.35 (0.75,2.43) 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) for the patients with intracranial aneurysms located ACA, MCA, ICA respectively, the difference had no significance statistically, p value>0.05. Aneurysmal obliteration rate OR(95%CI) values was 1.72 (1.04,2.83), 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. cerebral vasospasm OR(95%CI) values was 1.32(0.98,1.76), the difference had no significance statistically, p>0.05.Conclusions:Our studies show that neurosurgical clipping and endovascular coiling make no statistical difference to poor outcome in patients intracranial anterior circulating aneurysms, but neurosurgical clipping may have a worse tendency. neurosurgical clipping have a worse outcome in one year after onset. Two treatments make no statistical difference to poor outcome for Our studies with different Hunt-Hess grades,cerebral vasospasm and locations of anterior circulating intracranial aneurysms. Endovascular treatment has a low rate of aneurysmal obliteration compared with neurosurgical clipping, the difference had significance statistically. Endovascular coiling has a high risk of hydrocephalus after onset compared with neurosurgical coiling, the difference had significance statistically. Because of high possibility of selection bias in our studies, There may be a negative impact on evidence intensity of our studies results.