Clinical evaluation of therapeutic measures for intracranial aneurysms

Abstract

Objective To evaluate the therapeutic efficacy and side effect of various treatment for intracranial aneurysms in order to formulate the best therapeutic regimen for the evidence⁃based treatment of intracranial aneurysms. Methods Intracranial aneurysms, treatment, endovascular coiling treatment or neurosurgical clipping treatment were used as retrieval words. MEDLINE, PubMed, Cochrane library were used for retrieval, and manual searching was also used. Related clinical guidelines, systematic reviews, randomised controlled clinical trials, controlled clinical trials, retrospective case analysis and case-observation studies were collected and evaluated by Jadad Scale. Results Twenty⁃six related articles were selected as follow: 4 clinical guidelines, 4 randomised controlled clinical trials, 7 systematic reviews, 9 retrospective case analysis, 1 controlled clinical trials, and 1 case ⁃ observation study. Among the above articles 20 were of high quality (2 articles with 7 points, 2 articles 6 points, 4 articles 5 points, 12 articles 4 points), while 6 were of low quality by score. According to therapeutic principle and the evaluation of therapeutic efficacy and side effects of various therapies, it is suggested that: 1) Endovascular coiling treatment and surgical clipping treatment are the two main methods of intracranial aneurysms, but it is still controversial which method is more advantage. 2) For unruptured intracranial aneurysms, there is still having controversy in whether they should be treated or not. Symptomatic unruptured intracranial aneurysms are suggested to be treated actively, but for asymptomatic small unruptured aneurysms, there is still having controversy, various factors should be comprehensively accounted, such as age, previous history, family history, the size of the aneurysm, location, morphology and life expectancy, etc. 3) For rupture intracranial aneurysms, it should be treated as soon as possible, only when the patients with poor condition, untolerating the surgical treatment in the acute period, treatment should be appropriately delayed. Before determining the treatment protocols, we should consider comprehensively the specific conditions of patients. 4) About the pharmacotherapy after aneurysmal subarachnoid hemorrhage, besides nimodipine is proved effectively by a large randomized controlled trial, other pharmacotherapies still remain controversial. Conclusion Evidence ⁃ based medicine can provide the best clinical evidence on the treatment for intracranial aneurysms.

DOI：10.3969/j.issn.1672⁃6731.2012.01.003