Endovascular and surgical treatment of superior cerebellar artery aneurysms: a systematic review and meta-analysis of outcomes and complications.
Abstract
[BACKGROUND AND OBJECTIVES] Superior cerebellar artery (SCA) aneurysms are rare and technically challenging to treat. While both endovascular and microsurgical approaches can be effective, the optimal treatment strategy remains unclear. This systematic review and meta-analysis compare the safety and efficacy of endovascular versus microsurgical treatment of SCA aneurysms.
[METHODS] A systematic search of EMBase, PubMed, and the Web of Science identified studies reporting outcomes of SCA aneurysms treated endovascularly or surgically. Primary outcomes included complication and mortality rates, aneurysm occlusion, and functional outcomes measured by the Glasgow Outcome Scale (GOS) or modified Rankin Scale (mRS). Good functional recovery was defined as GOS > 3 or mRS < 3. Single- and double-arm meta-analyses were performed in R.
[RESULTS] Thirteen studies comprising 370 patients (89 males, 232 females), with a mean age of 54.1 years were included. 227 patients were treated endovascularly and 143 patients surgically, of which 52.3% of aneurysms were ruptured. Overall, complication, mortality, complete occlusion, and good recovery rates were 14.5%, 4.4%, 85.7%, and 87.2%, respectively. Surgical treatment had higher complications (36.2% vs. 8.1%, p = 0.053) and mortality (7.4% vs. 2.7%, p = 0.060), approaching statistical significance. Surgical treatment yielded significantly higher occlusion rates than endovascular treatment (92.8% vs. 79.8%, p = 0.028), while endovascular therapy was associated with better functional recovery (93.3% vs. 70.9%, p = 0.0196). Mean radiologic and clinical follow-up durations were 28.4 and 27.6 months, respectively.
[CONCLUSION] Both endovascular and surgical treatments are viable for SCA aneurysms. Endovascular therapy offers lower complication and mortality rates, while microsurgical treatment achieves higher complete occlusion. Treatment decisions should be tailored to patient and aneurysm characteristics. Further prospective studies, including the role of flow diversion, are needed to optimize treatment selection.
[METHODS] A systematic search of EMBase, PubMed, and the Web of Science identified studies reporting outcomes of SCA aneurysms treated endovascularly or surgically. Primary outcomes included complication and mortality rates, aneurysm occlusion, and functional outcomes measured by the Glasgow Outcome Scale (GOS) or modified Rankin Scale (mRS). Good functional recovery was defined as GOS > 3 or mRS < 3. Single- and double-arm meta-analyses were performed in R.
[RESULTS] Thirteen studies comprising 370 patients (89 males, 232 females), with a mean age of 54.1 years were included. 227 patients were treated endovascularly and 143 patients surgically, of which 52.3% of aneurysms were ruptured. Overall, complication, mortality, complete occlusion, and good recovery rates were 14.5%, 4.4%, 85.7%, and 87.2%, respectively. Surgical treatment had higher complications (36.2% vs. 8.1%, p = 0.053) and mortality (7.4% vs. 2.7%, p = 0.060), approaching statistical significance. Surgical treatment yielded significantly higher occlusion rates than endovascular treatment (92.8% vs. 79.8%, p = 0.028), while endovascular therapy was associated with better functional recovery (93.3% vs. 70.9%, p = 0.0196). Mean radiologic and clinical follow-up durations were 28.4 and 27.6 months, respectively.
[CONCLUSION] Both endovascular and surgical treatments are viable for SCA aneurysms. Endovascular therapy offers lower complication and mortality rates, while microsurgical treatment achieves higher complete occlusion. Treatment decisions should be tailored to patient and aneurysm characteristics. Further prospective studies, including the role of flow diversion, are needed to optimize treatment selection.
MeSH Terms
Humans; Cerebellum; Endovascular Procedures; Intracranial Aneurysm; Microsurgery; Neurosurgical Procedures; Postoperative Complications; Treatment Outcome