AUTHOR=Arrese Ignacio , García-García Sergio , Cepeda Santiago , Sarabia Rosario 

TITLE=Treatment of unruptured middle cerebral artery aneurysms: Systematic review in an attempt to perform a network meta-analysis

JOURNAL=Frontiers in Surgery

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2022.1005602

DOI=10.3389/fsurg.2022.1005602

ISSN=2296-875X

ABSTRACT=OBJECTIVE 
Open surgical clipping has been generally considered the best treatment option for unruptured middle cerebral artery aneurysms (uMCAAs). However, this type of aneurysm is being treated endovascularly with the appearance of new devices. We have carried out a systematic review of randomized and quasi-experimental studies to conduct a network meta-analysis (NMA) to assess the safety and efficacy of the different treatment methods currently used in uMCAAs.
METHODS 
The literature was searched by using PubMed, and Google Scholar databases. Eligibility criteria were: randomized or quasi-experimental studies including at least 5 cases per arm and reporting duration of follow-up and number of lost cases. The end points were: angiographic success, final neurological outcome and need of retreatments.
RESULTS
We could only analyze 4 quasi-experimental studies with 398 uMMAAs. All of them compared clipping vs coiling. Clipping showed better results than Coiling in all analyzed end points. We could not conduct the proposed NMA because of the absence of randomized or quasi-experimental studies. Instead, a systematic review is further discussed.
CONCLUSIONS 
There is an urgent need for comparative studies on the treatment of uMCAAs