Unruptured Paraclinoid Aneurysm Treatment Effects on Visual Function: Systematic Review and Meta-analysis

Area of Science:

• Neurosurgery
• Vascular Neurology
• Ophthalmology

Background:

• Unruptured paraclinoid aneurysms (UPAs) pose risks to visual function.
• Postoperative visual outcomes after UPA repair are not well-established.
• Treatment modality may significantly impact visual outcomes.

Purpose of the Study:

• To investigate the influence of treatment modality on visual function after unruptured paraclinoid aneurysm repair.
• To compare visual outcomes between endovascular and microsurgical interventions for UPAs.
• To analyze rates of visual morbidity, angiographic results, and clinical outcomes.

Main Methods:

• Systematic literature review of Ovid Medline and EMBASE databases (1996-2016).
• Inclusion of English language studies reporting treatment outcomes for UPAs.
• Random effects meta-analysis of recorded visual, angiographic, and clinical outcomes.

Main Results:

• Microsurgery had higher visual morbidity (10.8%) than endovascular treatment (2.0%) in patients with normal vision (P < 0.001).
• Surgery showed a modest advantage in visual recovery (65.2%) for patients with preoperative visual impairment compared to endovascular therapies (48.9%, P < 0.03).
• Trends suggested poorer visual and clinical outcomes with microsurgery, and higher recurrence/retreatment rates with endovascular interventions.

Conclusions:

• Endovascular treatment correlates with better visual outcomes for UPAs in patients with normal vision.
• Microsurgery offers a modest advantage in visual recovery when preoperative visual compromise is present.
• Data heterogeneity limits definitive conclusions regarding optimal treatment strategy.