Systematic Review For Efficacy And Safety Of Neurosurgical Clipping And Endovascular Coiling In Middle Cerebral Artery Aneurysms

Objective:To evaluate the effectiveness and safety of neurosurgical clipping and endovascular coiling in middle cerebral artery aneurysms. Thereby, it should be more objective and accurate to reflect the treatment effect.Methods:MEDLINE, EMBase, The Cochrane Library, CNKI were searched from Jan.1997to Sep.2011. We identified randomized controlled trials of middle cerebral artery aneurysms. The quality of included trials was evaluated by two estimators. And meta-analysis was conducted on homogeneous studies. The Selected literatures should to calculate OR (odds ratio)95%confidence interval (95%CI).Results:Eight studies (3574patients) were included. All included studies were graded in term of randomization, blinding, and allocation concealment. In these studies, three studies were graded B and five studies were graded C. Meta-analysis based on these studies show neurosurgical clipping and endovascular coiling in middle cerebral artery aneurysms that risk of poor outcome (death or dependence) OR (95%CI) values werel.55(1.06,2.28) 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.07(0.45,2.53)、0.72(0.31,1.67)for Hunt-Hess1-2grade,3-5grade patients, the difference had no significance statistically, p value>0.05. Aneurismal obliteration rate OR(95%CI) values was12.52(1.23,5.13), the difference had significance statistically, p value<0.05. Hydrocephalus OR(95%CI) values was0.37(0.21,0.63), the difference had significance statistically, p value<0.05. The cerebral vasospasm OR(95%CI) values was1.15(0.96,1.38), the difference had no significance statistically, p value>0.05.Conclusions:Our study shows that neurosurgical clipping and endovascular coiling had statistical difference to poor outcome in patients middle cerebral artery aneurysms, the endovascular coiling method may have a better tendency. The endovascular coiling have a better outcome at1year after onset. Two treatments make no statistical difference to poor outcome for the patients with different Hunt-Hess grades of middle cerebral artery aneurysms. Neurosurgical clipping treatment was more effective than endovascular treatment for aneurismal obliteration, the difference had significance statistically.The neurosurgical clipping has a low incidence of hydrocephalus after onset compared with endovascular treatment, the difference had significance statistically...