Mortality and morbidity of surgery for unruptured intracranial aneurysms - A meta-analysis

被引:364
作者
Raaymakers, TWM
Rinkel, GJE
Limburg, M
Algra, A
机构
[1] Acad Hosp Utrecht, Dept Neurol, Utrecht, Netherlands
[2] Univ Utrecht, Julius Ctr Patient Oriented Res, NL-3508 TC Utrecht, Netherlands
[3] Univ Amsterdam, Acad Med Ctr, Dept Neurol, NL-1105 AZ Amsterdam, Netherlands
关键词
aneurysm; unruptured; cerebral aneurysm; meta-analysis; surgery;
D O I
10.1161/01.STR.29.8.1531
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-Greater availability and improvement of neuroradiological techniques have resulted in more frequent detection of unruptured aneurysms. Because prognosis of subarachnoid hemorrhage is still poor, preventive surgery is increasingly considered as a therapeutic option. Elective surgery requires reliable data on its risks, Therefore, we performed a meta-analysis on the mortality and morbidity of surgery for unruptured intracranial aneurysms. Methods-Through Medline and additional searches by hand, we retrieved studies on clipping of unruptured (additional, symptomatic, or incidental) aneurysms published from 1966 through June 1996. Two authors independently extracted data, We used weighted linear regression for data analysis. Results-We included 61 studies that involved 2460 patients (57% female; mean age, 50 years) and at least 2568 unruptured aneurysms (27% >25 mm, 30% located in the posterior circulation). Mortality was 2.6% (95% confidence interval [CI], 2.0% to 3.3%). Permanent morbidity occurred in 10.9% (95% CI, 9.6% to 12.2%) of patients. Postoperative mortality was significantly lower in more recent years for nongiant aneurysms and aneurysms with an anterior location; the last 2 characteristics were also associated with a significantly lower morbidity. Conclusions-In studies published between 1966 and 1996 on clipping of unruptured aneurysms, mortality was 2.6% and morbidity was 10.9%. In calculating the pros and cons of preventive surgery, these proportions should be taken into account.
引用
收藏
页码:1531 / 1538
页数:8
相关论文
共 76 条
[1]  
ABE K, 1992, EUR J ANAESTH, V9, P485
[2]   LONG-TERM OUTCOME OF SURGICALLY TREATED UNRUPTURED CEREBRAL ANEURYSMS [J].
ASARI, S ;
OHMOTO, T .
CLINICAL NEUROLOGY AND NEUROSURGERY, 1994, 96 (03) :230-235
[3]  
Auger R G, 1991, J Stroke Cerebrovasc Dis, V1, P174, DOI 10.1016/S1052-3057(10)80014-X
[4]   PERIOPERATIVE MANAGEMENT AND OUTCOME AFTER SURGICAL-TREATMENT OF ANTERIOR CEREBRAL-ARTERY ANEURYSMS [J].
AWAD, IA ;
LITTLE, JR .
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES, 1991, 18 (02) :120-125
[5]   MINIMAL OCULOMOTOR NERVE PARESIS SECONDARY TO UNRUPTURED INTRACRANIAL ANEURYSM [J].
BARTLESON, JD ;
TRAUTMANN, JC ;
SUNDT, TM .
ARCHIVES OF NEUROLOGY, 1986, 43 (10) :1015-1020
[6]   USE OF ETOMIDATE, TEMPORARY ARTERIAL-OCCLUSION, AND INTRAOPERATIVE ANGIOGRAPHY IN SURGICAL-TREATMENT OF LARGE AND GIANT CEREBRAL ANEURYSMS [J].
BATJER, HH ;
FRANKFURT, AI ;
PURDY, PD ;
SMITH, SS ;
SAMSON, DS .
JOURNAL OF NEUROSURGERY, 1988, 68 (02) :234-240
[7]   MULTIPLE INTRACRANIAL ANEURYSMS - SURGICAL-TREATMENT AND OUTCOME [J].
CERVONI, L ;
DELFINI, R ;
SANTORO, A ;
CANTORE, G .
ACTA NEUROCHIRURGICA, 1993, 124 (2-4) :66-70
[8]   QUANTIFICATION OF OPERATIVE BENEFIT FOR UNRUPTURED CEREBRAL ANEURYSMS - A THEORETICAL APPROACH [J].
CHANG, HS ;
KIRINO, T .
JOURNAL OF NEUROSURGERY, 1995, 83 (03) :413-420
[9]   TEMPORARY CLIPPING IN ANEURYSM SURGERY - TECHNIQUE AND RESULTS [J].
CHARBEL, FT ;
AUSMAN, JI ;
DIAZ, FG ;
MALIK, GM ;
DUJOVNY, M ;
SANDERS, J .
SURGICAL NEUROLOGY, 1991, 36 (02) :83-90
[10]   A TEMPORAL TRANSSYLVIAN APPROACH TO ANTERIOR CIRCULATION ANEURYSMS [J].
CHEHRAZI, BB .
NEUROSURGERY, 1992, 30 (06) :957-961