Introduction. The best treatment for unruptured middle cerebral artery (MCA) aneurysms is unclear. We perform a meta-analysis of recent publications to evaluate the results of unruptured MCA aneurysms treated with surgical clipping and endovascular coiling. Methods. A PubMed search for articles published between January 2004 and November 2013 was performed. The R statistical software package was used to create a random effects model for each desired incidence rate. Cochran’s Q test was used to evaluate possible heterogeneity among the rates observed in each study. Results. A total of 1891 unruptured MCA aneurysms, 1052 clipped and 839 coiled, were included for analysis. The complete occlusion rate at 6–9 months mean follow-up was 95.5% in the clipped group and 67.8% in the coiled group ( ). The periprocedural thromboembolism rate in the clipping group was 1.8% compared with 10.7% in the aneurysms treated by coiling ( ). The recanalization rate was 0% for clipping and 14.3% for coiling ( ). Modified Rankin scores of 0–2 were obtained in 98.9% of clipped patients compared to 95.5% of coiled (NS). Conclusions. This review weakly supports clipping as the preferred treatment of unruptured MCA aneurysms. Clinical outcomes did not differ significantly between the two groups. 1. Introduction Endovascular coiling has emerged as an option in the management of intracranial aneurysms that traditionally have been treated through open surgical clipping [1]. In the United States, the endovascular management of intracranial aneurysms continues to increase [2, 3]. To support this trend, growing literature is demonstrating low complication rates, durable treatment, and outcomes competitive with surgical results [1, 2, 4–7]. Unlike aneurysms in other locations, the unruptured middle cerebral artery (MCA) aneurysm has several characteristics favoring surgical treatment. This includes superficial location, a familiar surgical approach, easy proximal control at the supraclinoid carotid, and minimal perforator vessels. In contrast, endovascular therapy can be somewhat more difficult in this location due to the small parent vessels, difficulty with obtaining adequate working projection views, and incorporation of branch vessels in the aneurysm. However, the endovascular management of aneurysms has evolved, and coiling of unruptured MCA aneurysms is considered an appropriate alternative to clipping for some aneurysms [8]. As the trend for endovascular management of aneurysms has grown to incorporate MCA aneurysms, recent literature has emerged to promote the surgical option as
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