{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T16:41:31Z","timestamp":1789663291668,"version":"4.0.1"},"reference-count":29,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,8,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Unruptured middle cerebral artery aneurysm (uMCAA) has traditionally been treated with open surgical clipping (SC). Endovascular treatments (EVTs) were designed to reduce surgical risks in these cases. Nevertheless, despite its potential benefits, many surgeons favor SC for uMCAA. This updated meta-analysis aimed to compare the safety, efficacy, and clinical outcomes of SC and EVT for uMCAA.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors searched the Medline, Embase, and Cochrane Library databases according to the Cochrane and PRISMA guidelines. Eligible studies included those with \u2265 4 patients with uMCAA reporting comparative data of SC and EVT. The endpoints were the complete occlusion rate (Raymond class I and II), good clinical outcomes (modified Rankin Scale score \u2264 2 or Glasgow Outcome Scale score \u2265 4), procedure-related complications (further divided into major and minor), and mortality. The authors pooled OR with 95% CI values with a random-effects model. I<jats:sup>2<\/jats:sup> statistics were used to assess heterogeneity, and sensitivity analysis was conducted to address high heterogeneity. Publication bias was assessed with funnel plot analysis and the Egger\u2019s test.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>The analysis included data from 10 studies. Regarding the complete occlusion assessment, the comparative analysis revealed OR 0.17 (95% CI 0.08\u20130.40, p &lt; 0.01), favoring SC. In terms of achieving good clinical outcomes, OR 0.44 (95% CI 0.20\u20130.97, p &lt; 0.05) was determined, favoring SC. No differences regarding total procedure-related complications, major complications, or mortality were identified. However, a higher likelihood of minor complications was identified for EVT, with OR 4.68 (95% CI 2.01\u201310.92, p &lt; 0.01).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This systematic review and meta-analysis identified a lower likelihood of complete occlusion at last follow-up and lower likelihood of good clinical outcomes in patients treated with EVT when compared with SC. Furthermore, a higher likelihood of minor complications was identified in patients who underwent EVT when compared with SC. The findings reinforce that, based on the currently available data, SC should be considered the primary approach for treating uMCAA. However, EVT is an evolving approach, and this study\u2019s findings represent a synthesis of observational studies. Randomized trials are warranted to elucidate which approach should be the mainstay for uMCAA and to identify the nuances that determine whether SC or EVT is more or less indicated for addressing uMCAA with consideration of the individuality of each patient and aneurysm.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.4.jns24343","type":"journal-article","created":{"date-parts":[[2024,8,3]],"date-time":"2024-08-03T01:28:24Z","timestamp":1722648504000},"page":"1-11","source":"Crossref","is-referenced-by-count":13,"title":["Comparing surgical clipping with endovascular treatment for unruptured middle cerebral artery aneurysms: a systematic review and updated meta-analysis"],"prefix":"10.3171","author":[{"given":"Marcio Yuri","family":"Ferreira","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Ninth July University, S\u00e3o Paulo, Brazil;"},{"name":"Department of Neurosurgery, Lenox Hill Hospital\/Northwell Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savio","family":"Batista","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Federal University of Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo B.","family":"Oliveira","sequence":"additional","affiliation":[{"name":"School of Medicine, State University of Ponta Grossa, Paran\u00e1, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Nunes","family":"Marques","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Federal University of Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henrique Garcia","family":"Maia","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Estacio de S\u00e1 Citt\u00e1 University (IDOMED), Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucca B.","family":"Palavani","sequence":"additional","affiliation":[{"name":"Max Planck University Center, Indaiatuba, S\u00e3o Paulo, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filipi Fim","family":"Andre\u00e3o","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Federal University of Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pedro G. L. B.","family":"Borges","sequence":"additional","affiliation":[{"name":"School of Medicine, Technical Educational Foundation Souza Marques, Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Semione","sequence":"additional","affiliation":[{"name":"University of West of Santa Catarina, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcelo Porto","family":"Sousa","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Federal University of Rio de Janeiro, Brazil;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael Muszkat","family":"Besborodco","sequence":"additional","affiliation":[{"name":"Rusk Rehabilitation, NYU Langone Health, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raphael","family":"Bertani","sequence":"additional","affiliation":[{"name":"University of S\u00e3o Paulo, Department of Neurosurgery, S\u00e3o Paulo, Brazil; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yafell","family":"Serulle","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lenox Hill Hospital\/Northwell Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Ferreira","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lenox Hill Hospital\/Northwell Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Langer","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Lenox Hill Hospital\/Northwell Health, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"2","key":"b1","series-title":"World Neurosurg","first-page":"322","article-title":"Middle cerebral artery aneurysms: a single-center series comparing endovascular and surgical treatment","volume":"81","author":"Diaz OM","year":"2014","unstructured":"Diaz OM, Rangel-Castilla L, Barber S, Mayo RC, Klucznik R, Zhang YJ. 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