Endovascular and surgical treatment of unruptured cerebral aneurysms: Comparison of risks

Unruptured cerebral aneurysms are commonly treated by surgical clipping, bu t endovascular coil embolization is increasingly employed as an alternative . In a blinded review of unruptured aneurysms treated at our institution si nce 1990, we identified patients whose aneurysms were judged to be treatabl e by both neurosurgeons and neurointerventional radiologists. A change in R ankin Scale score of 2 or more from hospital admission to discharge, indica ting a new moderate disability or worse, was predefined as the primary outc ome measure. Long-term follow-up was obtained by mailed questionnaire and t elephone interview. Length of stay and hospital charges were totaled for al l hospitalizations, including follow-up. Sixty-eight patients treated surgi cally and 62 patients treated with endovascular coil embolization were cons idered candidates for either procedure on blinded review, and overall antic ipated procedure risk was rated as identical. A larger proportion of patien ts in the surgical group developed a change in Rankin Scale score of 2 or m ore (25% of surgical patients vs 8% of endovascular patients). Total length of stay was longer (mean days: 7.7 for surgical patients vs 5.0 for endova scular patients) and hospital charges were greater (mean, $38,000 for surgi cal patients vs $33,400 for endovascular patients) for the surgical patient s. At follow-up, an average of 3.9 years after the procedure, surgical pati ents were more likely to report persistent new symptoms or disability since treatment (34% of surgical patients vs 8% of endovascular patients) and a longer period for recovery to normal (50% returning to normal in 1 year for surgery and in 27 days for coil embolization). Coil embolization of unrupt ured cerebral aneurysms seems to be associated with significantly fewer com plications than surgical clipping. More long-term data on aneurysm rupture rates are required to confirm efficacy.