From the Department of Neurology, Academic Hospital Utrecht (T.W.M.R.,
G.J.E.R., A.A.), and the Julius Center for Patient Oriented Research (A.A.),
University of Utrecht; and the Department of Neurology, Academic Medical
Center (M.L.), Amsterdam, the Netherlands.
Correspondence to Dianne Raaymakers, MD, University Department of Neurology, Heidelberglaan 100, 3584 CX Utrecht, Netherlands. E-mail t.w.m.raaymakers{at}neuro.azu.nl
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.
© 1998 American Heart Association, Inc.
Original Contributions
Mortality and Morbidity of Surgery for Unruptured Intracranial Aneurysms
A Meta-Analysis
Key Words: aneurysm, unruptured • cerebral aneurysm • meta-analysis • surgery
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