Unruptured Paraclinoid Aneurysm Treatment Effects on Visual Function

Systematic Review and Meta-analysis

Mina Asaid, Anthea H. O'Neill, David Bervini, Ronil V. Chandra, Leon T. Lai

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective Postoperative visual outcomes following repair of unruptured paraclinoid aneurysms (UPAs) are not well defined. We aim to investigate the influence of treatment modality on visual function. Methods A systematic literature analysis using the Ovid Medline and EMBASE databases was performed, encompassing English language studies (published between 1996 and 2016) reporting treatment outcomes for UPAs. Rates of visual morbidity (new, permanent postoperative deficit, worsening preoperative deficit); angiographic (occlusion, recurrence, retreatment) and clinical outcomes (death, disability, post-treatment subarachnoid hemorrhage) were recorded. Random effects meta-analysis was performed. Results Twenty-eight studies reported visual outcomes, with data for 1013 endovascular and 691 microsurgical patients. In patients with normal vision undergoing elective repair of UPAs, rates of postoperative visual morbidity were higher following microsurgical (10.8%; 95% confidence interval [CI] 8.5–13.7) than endovascular (2.0%; 95% CI 1.2–3.2) interventions, P < 0.001. In those presenting with preoperative visual impairment, surgery was associated with a modest advantage in visual recovery compared with endovascular therapies (65.2% vs. 48.9%, P < 0.03). There were no differences in visual morbidity following treatment with any of the endovascular modalities. Meta-analysis of comparative studies suggested a trend toward poor visual (ES = 0.42; 95% CI 0.08–2.09) and clinical outcomes (ES = 0.57; 95% CI 0.07–4.44) following microsurgery and a trend toward angiographic recurrence (ES = 2.52; 95% CI 0.80–7.90) and retreatment (ES = 1.62; 95% CI 0.46–5.67) after endovascular interventions. Conclusion In patients with normal vision undergoing repairs for UPAs, there is a positive correlation between visual outcomes and endovascular treatments. When visual compromise is present, surgery provided modest advantage in visual recovery. However, definitive conclusions were not possible due to data heterogeneity.

Original languageEnglish
Pages (from-to)322-330
Number of pages9
JournalWorld Neurosurgery
Volume106
DOIs
Publication statusPublished - 1 Oct 2017

Keywords

  • Endovascular
  • Intracranial aneurysms
  • Meta-analysis
  • Microsurgery
  • Paraclinoid aneurysms
  • Visual complications

Cite this

@article{4f3dc09308704d5f9e84dd21f7d4e4e7,
title = "Unruptured Paraclinoid Aneurysm Treatment Effects on Visual Function: Systematic Review and Meta-analysis",
abstract = "Objective Postoperative visual outcomes following repair of unruptured paraclinoid aneurysms (UPAs) are not well defined. We aim to investigate the influence of treatment modality on visual function. Methods A systematic literature analysis using the Ovid Medline and EMBASE databases was performed, encompassing English language studies (published between 1996 and 2016) reporting treatment outcomes for UPAs. Rates of visual morbidity (new, permanent postoperative deficit, worsening preoperative deficit); angiographic (occlusion, recurrence, retreatment) and clinical outcomes (death, disability, post-treatment subarachnoid hemorrhage) were recorded. Random effects meta-analysis was performed. Results Twenty-eight studies reported visual outcomes, with data for 1013 endovascular and 691 microsurgical patients. In patients with normal vision undergoing elective repair of UPAs, rates of postoperative visual morbidity were higher following microsurgical (10.8{\%}; 95{\%} confidence interval [CI] 8.5–13.7) than endovascular (2.0{\%}; 95{\%} CI 1.2–3.2) interventions, P < 0.001. In those presenting with preoperative visual impairment, surgery was associated with a modest advantage in visual recovery compared with endovascular therapies (65.2{\%} vs. 48.9{\%}, P < 0.03). There were no differences in visual morbidity following treatment with any of the endovascular modalities. Meta-analysis of comparative studies suggested a trend toward poor visual (ES = 0.42; 95{\%} CI 0.08–2.09) and clinical outcomes (ES = 0.57; 95{\%} CI 0.07–4.44) following microsurgery and a trend toward angiographic recurrence (ES = 2.52; 95{\%} CI 0.80–7.90) and retreatment (ES = 1.62; 95{\%} CI 0.46–5.67) after endovascular interventions. Conclusion In patients with normal vision undergoing repairs for UPAs, there is a positive correlation between visual outcomes and endovascular treatments. When visual compromise is present, surgery provided modest advantage in visual recovery. However, definitive conclusions were not possible due to data heterogeneity.",
keywords = "Endovascular, Intracranial aneurysms, Meta-analysis, Microsurgery, Paraclinoid aneurysms, Visual complications",
author = "Mina Asaid and O'Neill, {Anthea H.} and David Bervini and Chandra, {Ronil V.} and Lai, {Leon T.}",
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Unruptured Paraclinoid Aneurysm Treatment Effects on Visual Function : Systematic Review and Meta-analysis. / Asaid, Mina; O'Neill, Anthea H.; Bervini, David; Chandra, Ronil V.; Lai, Leon T.

In: World Neurosurgery, Vol. 106, 01.10.2017, p. 322-330.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Unruptured Paraclinoid Aneurysm Treatment Effects on Visual Function

T2 - Systematic Review and Meta-analysis

AU - Asaid, Mina

AU - O'Neill, Anthea H.

AU - Bervini, David

AU - Chandra, Ronil V.

AU - Lai, Leon T.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Objective Postoperative visual outcomes following repair of unruptured paraclinoid aneurysms (UPAs) are not well defined. We aim to investigate the influence of treatment modality on visual function. Methods A systematic literature analysis using the Ovid Medline and EMBASE databases was performed, encompassing English language studies (published between 1996 and 2016) reporting treatment outcomes for UPAs. Rates of visual morbidity (new, permanent postoperative deficit, worsening preoperative deficit); angiographic (occlusion, recurrence, retreatment) and clinical outcomes (death, disability, post-treatment subarachnoid hemorrhage) were recorded. Random effects meta-analysis was performed. Results Twenty-eight studies reported visual outcomes, with data for 1013 endovascular and 691 microsurgical patients. In patients with normal vision undergoing elective repair of UPAs, rates of postoperative visual morbidity were higher following microsurgical (10.8%; 95% confidence interval [CI] 8.5–13.7) than endovascular (2.0%; 95% CI 1.2–3.2) interventions, P < 0.001. In those presenting with preoperative visual impairment, surgery was associated with a modest advantage in visual recovery compared with endovascular therapies (65.2% vs. 48.9%, P < 0.03). There were no differences in visual morbidity following treatment with any of the endovascular modalities. Meta-analysis of comparative studies suggested a trend toward poor visual (ES = 0.42; 95% CI 0.08–2.09) and clinical outcomes (ES = 0.57; 95% CI 0.07–4.44) following microsurgery and a trend toward angiographic recurrence (ES = 2.52; 95% CI 0.80–7.90) and retreatment (ES = 1.62; 95% CI 0.46–5.67) after endovascular interventions. Conclusion In patients with normal vision undergoing repairs for UPAs, there is a positive correlation between visual outcomes and endovascular treatments. When visual compromise is present, surgery provided modest advantage in visual recovery. However, definitive conclusions were not possible due to data heterogeneity.

AB - Objective Postoperative visual outcomes following repair of unruptured paraclinoid aneurysms (UPAs) are not well defined. We aim to investigate the influence of treatment modality on visual function. Methods A systematic literature analysis using the Ovid Medline and EMBASE databases was performed, encompassing English language studies (published between 1996 and 2016) reporting treatment outcomes for UPAs. Rates of visual morbidity (new, permanent postoperative deficit, worsening preoperative deficit); angiographic (occlusion, recurrence, retreatment) and clinical outcomes (death, disability, post-treatment subarachnoid hemorrhage) were recorded. Random effects meta-analysis was performed. Results Twenty-eight studies reported visual outcomes, with data for 1013 endovascular and 691 microsurgical patients. In patients with normal vision undergoing elective repair of UPAs, rates of postoperative visual morbidity were higher following microsurgical (10.8%; 95% confidence interval [CI] 8.5–13.7) than endovascular (2.0%; 95% CI 1.2–3.2) interventions, P < 0.001. In those presenting with preoperative visual impairment, surgery was associated with a modest advantage in visual recovery compared with endovascular therapies (65.2% vs. 48.9%, P < 0.03). There were no differences in visual morbidity following treatment with any of the endovascular modalities. Meta-analysis of comparative studies suggested a trend toward poor visual (ES = 0.42; 95% CI 0.08–2.09) and clinical outcomes (ES = 0.57; 95% CI 0.07–4.44) following microsurgery and a trend toward angiographic recurrence (ES = 2.52; 95% CI 0.80–7.90) and retreatment (ES = 1.62; 95% CI 0.46–5.67) after endovascular interventions. Conclusion In patients with normal vision undergoing repairs for UPAs, there is a positive correlation between visual outcomes and endovascular treatments. When visual compromise is present, surgery provided modest advantage in visual recovery. However, definitive conclusions were not possible due to data heterogeneity.

KW - Endovascular

KW - Intracranial aneurysms

KW - Meta-analysis

KW - Microsurgery

KW - Paraclinoid aneurysms

KW - Visual complications

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