Available online 11 August 2022
AbstractBackgroundBoth microsurgical and endovascular techniques continued to be treatment options for basilar apex aneurysms (BAA). We conducted a systematic review to compare both treatment options in terms of both clinical and radiological outcomes.
MethodsThe PRISMA method was used to identify related articles. Data collected from each article and the two treatment approaches were compared in terms of favorable clinical outcome and complete/near complete occlusion rate. Subgroup analysis was done based on the size and the rupture status of BAA.
ResultsFifty-nine (59) and 32 articles reported a measurable clinical and radiological outcome respectively. The weighted average favorable clinical outcome was significantly higher in the endovascular group (86.4% vs 79.6%, P < 0.0001), while the weighted average complete/near complete occlusion rate was significantly higher in the surgical group (92.6% vs 83.8%, P < 0.0001). In the subgroup analysis, the favorable clinical outcome remained significantly higher in the endovascular group for the ruptured, unruptured and giant/large BAA (P < 0.001), but not in the small BAA subgroup (P = 0.26). The occlusion rate remained significantly higher in the surgical group for all subgroups (P < 0.001).
ConclusionTreatment of BAA remains in a trade-off between favorable clinical outcome and complete or near-complete occlusion depending on the treatment modality selected. Careful selection of cases and judicial discussion between open surgical and endovascular team is warranted for treatment optimization.
Section snippetsAbbreviationsBAABasilar Apex Aneurysm
PRISMAPreferred Reporting Items for Systematic Reviews and Meta-Analyses
HHHunt and Hess
ADLsActivity of Daily Livings
GOSGlasgow Outcome Scale
GOSEGlasgow Outcome Scale-Extended
mRSmodified Rankin Scale
Guglielmi Detachable CoilsGDC
MethodsMedical literature was reviewed to compare microsurgical to endovascular treatment of the BAA. Databases consulted in the project included: PubMed, EBSCO, and Scopus. Four queries were used for the search: “basilar apex aneurysm”, “basilar top aneurysm”, “basilar tip aneurysm” and “basilar bifurcation aneurysm”. Filters applied to the search engines included: “Human studies”, “English and Spanish publications”, “critical trials”, “clinical studies at any level”, “comparative studies”,
ResultsSix-hundred and seventy-three (673) articles were pulled from the three combined databases. Eighteen (18) additional articles were added for screening after reviewing the references of the database-selected articles. Three-hundred and nineteen articles (319) were selected for the secondary review which entitled the Full-text review. Out of the 319 articles, 60 were selected for the study because either one or both clinical or radiological outcomes were reported in a measurable fashion and after
DiscussionMicrosurgical treatment of basilar tip aneurysm, beyond other cerebral aneurysm location remains a challenge due to its proximity to the vital brain structures, associated perforating arteries in the interpeduncular space and narrow surgical corridor which makes clipping or wrapping of such aneurysms a daunting task [2], [12], [13], requiring a careful preoperative analysis to select the appropriate skull base approach (i.e. pterional versus cranio-orbito-zygomatic, middle fossa, subtemporal,
ConclusionWith the advent of endovascular coiling there has been a paradigm shift in the treatment of basilar tip aneurysms with the majority of the patients being treated with endovascular coiling. Our study has demonstrated a better clinical outcome in the endovascularly-treated BAA patients, yet the surgical treatment demonstrated a better occlusion rate. Further studies are needed to evaluate this radiological outcome in the era of using the new endovascular technologies such as stenting and flow
Disclosure of interestThe authors declare that they have no competing interest.
FundingNone.
AcknowledgementNone.
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