Management strategies and outcomes of basilar trunk aneurysms: a systematic review and meta-analysis

TL;DR

This study compares surgical and endovascular treatments for basilar trunk aneurysms and finds no significant difference in outcomes between the two approaches.

Contribution

The study provides a meta-analysis comparing open surgery and endovascular treatments for BTAs, highlighting the role of institutional expertise.

Findings

Endovascular treatments showed a higher favorable outcome proportion (0.75) compared to open surgery (0.46).

No statistically significant difference was found in mortality, complications, or complete occlusion between the two treatment methods.

Institutional expertise was identified as a critical factor influencing treatment outcomes.

Abstract

Due to the complex anatomical structure surrounding the basilar artery trunk, basilar trunk aneurysms (BTAs) can result in severe complications and poor prognosis for patients. The treatments for BTAs still remain challenging and uncertain.

We conducted a comprehensive search of Embase, MEDLINE, Cochrane Library databases using medical subject headings and free-text terms, with the last search completed on July 1st, 2024. Both single-arm and two-arm meta-analysis were performed to compare the safety and effectiveness of different treatments for BTAs. Both fixed-effects models and random-effects models were calculated. When the heterogeneity was over 50%, we chose the random-effects model.

We identified 21 studies enrolling 593 participants and 599 aneurysms. The summary favorable outcome proportion was 0.46 (95% CI: 0.303 to 0.625) for open surgery and 0.75 (95% CI: 0.671 to 0.819) for endovascular treatments in the random-effects model, as the I2 for heterogeneity was 66% (P < 0.01) for open surgery and 53% for endovascular treatments (P < 0.01). Significant differences were observed between the two subgroups in the single-arm meta-analysis (P < 0.01). In the direct comparisons of good outcomes between open surgery and endovascular treatments in BTAs, no statistically significant difference was observed. The relative risk (RR) was 0.82 (95% CI: 0.549 to 1.224) and the P value was 0.5226. The comparison revealed no statistically significant changes in mortality, complications and complete occlusion (P > 0.05).

No statistically significant difference was observed between the open surgery and endovascular treatments. The mortality and complication outcomes revealed no distinctions between the two subgroups, regardless of whether direct or indirect comparisons was conducted. The influence of institutional expertise emerged as a critical factor in treatment outcomes. Furthermore, more effective controls and larger sample size are required to achieve more credible and conclusive results.

The online version contains supplementary material available at 10.1007/s00423-025-03959-3.

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