TY - JOUR
T1 - Mortality and morbidity of surgery for unruptured intracranial aneurysms
T2 - A meta-analysis
AU - Raaymakers, Theodora W.M.
AU - Rinkel, Gabriel J.E.
AU - Limburg, Martien
AU - Algra, Ale
PY - 1998/1/1
Y1 - 1998/1/1
N2 - 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 mete-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 1.966 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.
AB - 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 mete-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 1.966 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.
KW - Aneurysm
KW - Mete-analysis surgery
KW - Unruptured cerebral
UR - http://www.scopus.com/inward/record.url?scp=0031949035&partnerID=8YFLogxK
U2 - 10.1161/01.STR.29.8.1531
DO - 10.1161/01.STR.29.8.1531
M3 - Article
C2 - 9707188
AN - SCOPUS:0031949035
SN - 0039-2499
VL - 29
SP - 1531
EP - 1538
JO - Stroke
JF - Stroke
IS - 8
ER -