Comparative Efficacy of Endovascular Therapy and Microsurgery in Treating Ophthalmic Artery Aneurysms: A Systematic Review and Meta-Analysis

IF 1.9 4区 医学 Q3 CLINICAL NEUROLOGY
Mohammed Maan Al-Salihi , Ram Saha , Ahmed Abd Elazim , Syed A. Gillani , Maryam Sabah Al-Jebur , Farhan Siddiq , Ahmed Saleh , Ali Ayyad , Adnan I. Qureshi
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引用次数: 0

Abstract

Background

Ophthalmic artery (OphA) aneurysms, occurring at the junction of the internal carotid artery and the OphA orifice, present significant treatment challenges due to their location and complex anatomy. This systematic review and meta-analysis aimed to evaluate endovascular therapy and microsurgery in managing OphA aneurysms.

Methods

Adhering to Cochrane Handbook guidelines, a comprehensive search was conducted in ClinicalTrials.gov and 4 databases (PubMed, Scopus, Web of Science, and Embase). Study quality was assessed using the National Institutes of Health tool. Statistical analyses were performed with Review Manager and open MetaAnalyst software.

Results

The meta-analysis included 9 articles, covering 902 OphA aneurysms. Cohort studies showed fair quality, while case series demonstrated good quality. No significant difference in clinical outcomes was found between endovascular therapy and surgery. Post-treatment visual outcomes had an odds ratio (OR) of 2.48 (95% confidence interval [CI] [0.35, 17.45], P = 0.36), modified Rankin Scale (mRS) >2 outcomes had an OR of 0.53 (95% CI [0.16, 1.7], P = 0.28), and severe complications had an OR of 0.52 (95% CI [0.20, 1.35], P = 0.18). In the single-arm analysis, direct surgery outcomes for visual, mRS >2, severe complications, intraoperative aneurysm rupture, and postoperative infarction were 0.139, 0.008, 0.05, 0.036, and 0.037, respectively. In the endovascular group, these outcomes were 0.078, 0.028, 0.03, and 0.691, respectively.

Conclusions

Our comparison of endovascular therapy and surgery for OphA aneurysms showed no significant difference in clinical outcomes. However, visual complications were more common with surgery, while mRS >2 was higher with endovascular therapy. Flow diversion reduced visual deficits compared to clipping and coiling, but further studies are needed.
血管内治疗与显微手术治疗眼动脉瘤的疗效比较:系统综述和荟萃分析。
眼动脉(OphA)动脉瘤发生在颈内动脉(ICA)和眼动脉口交界处,由于其位置和复杂的解剖结构,给治疗带来了重大挑战。本系统综述和荟萃分析旨在评价血管内治疗和显微手术在治疗眼动脉瘤中的作用。方法:根据Cochrane Handbook指南,在ClinicalTrials.gov和PubMed、Scopus、Web of Science、Embase四个数据库中进行全面检索。使用NIH工具评估研究质量。使用Review Manager和open MetaAnalyst软件进行统计分析。结果:meta分析纳入9篇文章,涵盖902例眼动脉瘤。队列研究质量一般,而病例系列研究质量较好。血管内治疗与手术的临床结果无显著差异。治疗后视力结果的OR为2.48 (95% CI [0.35, 17.45], P=0.36), mRS bbb2结果的OR为0.53 (95% CI [0.16, 1.7], P=0.28),严重并发症的OR为0.52 (95% CI [0.20, 1.35], P=0.18)。在单臂分析中,视力、mRS bbb2、严重并发症、术中动脉瘤破裂和术后梗死的直接手术结果分别为0.139、0.008、0.05、0.036和0.037。在血管内组,这些结果分别为0.078、0.028、0.03和0.691。结论:血管内治疗与手术治疗对眼动脉瘤的临床疗效无显著性差异。然而,视觉并发症在手术中更为常见,而血管内治疗的mRS >2更高。与夹持和盘绕相比,分流术减少了视觉缺陷,但需要进一步的研究。
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来源期刊
World neurosurgery
World neurosurgery CLINICAL NEUROLOGY-SURGERY
CiteScore
3.90
自引率
15.00%
发文量
1765
审稿时长
47 days
期刊介绍: World Neurosurgery has an open access mirror journal World Neurosurgery: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. The journal''s mission is to: -To provide a first-class international forum and a 2-way conduit for dialogue that is relevant to neurosurgeons and providers who care for neurosurgery patients. The categories of the exchanged information include clinical and basic science, as well as global information that provide social, political, educational, economic, cultural or societal insights and knowledge that are of significance and relevance to worldwide neurosurgery patient care. -To act as a primary intellectual catalyst for the stimulation of creativity, the creation of new knowledge, and the enhancement of quality neurosurgical care worldwide. -To provide a forum for communication that enriches the lives of all neurosurgeons and their colleagues; and, in so doing, enriches the lives of their patients. Topics to be addressed in World Neurosurgery include: EDUCATION, ECONOMICS, RESEARCH, POLITICS, HISTORY, CULTURE, CLINICAL SCIENCE, LABORATORY SCIENCE, TECHNOLOGY, OPERATIVE TECHNIQUES, CLINICAL IMAGES, VIDEOS
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