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

Zhichao Tian¹, Feng Gu¹, Bohan Li¹

¹Department of Neurosurgery & Brain and Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu Province, China.

Langenbeck'S Archives of Surgery

|January 20, 2026

Insights

This meta-analysis found no significant difference in outcomes between open surgery and endovascular treatments for basilar trunk aneurysms (BTAs). Institutional expertise, rather than treatment type, appears to be a critical factor influencing patient prognosis.

Area of Science:

Neurosurgery
Vascular Surgery
Interventional Radiology

Background:

Basilar trunk aneurysms (BTAs) pose significant treatment challenges due to complex anatomy.
High complication rates and poor prognosis are associated with BTAs, necessitating effective therapeutic strategies.

Purpose of the Study:

To compare the safety and effectiveness of open surgery versus endovascular treatments for basilar trunk aneurysms (BTAs).
To evaluate outcomes including mortality, complications, and complete aneurysm occlusion.

Main Methods:

A comprehensive literature search was conducted across Embase, MEDLINE, and Cochrane Library databases.
Both single-arm and two-arm meta-analyses were performed, utilizing fixed-effects and random-effects models.
Heterogeneity was assessed, with random-effects models employed when I² exceeded 50%.

Main Results:

Twenty-one studies with 593 participants and 599 aneurysms were analyzed.
Favorable outcome proportions were 0.46 for open surgery and 0.75 for endovascular treatments (random-effects model).
No statistically significant differences were found in outcomes, mortality, complications, or complete occlusion between open surgery and endovascular approaches.

Conclusions:

Open surgery and endovascular treatments for BTAs show comparable safety and effectiveness.
Institutional expertise significantly influences treatment outcomes.
Larger studies with robust controls are needed for more definitive conclusions on BTA management.

Read full analysis

Abstract

Background:

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.

Methods:

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.

Results:

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).

Conclusion:

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.

Keywords:

Basilar trunk aneurysms Endovascular treatments Meta-analysis Open surgery Outcomes

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