Treatment strategies and outcomes for intracranial fusiform aneurysms: A systematic review and meta-analysis

Background: Fusiform aneurysms are a distinct subgroup of intracranial aneurysms with unique characteristics and pose a treatment challenge compared to common saccular aneurysms. Traditionally, surgery was the main treatment; however, endovascular techniques are gaining favor. Methods: We searched major databases for studies on treatment, clinical outcomes, and radiological outcomes of intracranial fusiform aneurysms published before May 31st, 2023 in order to compare surgical Vs endovascular treatment strategies. Pooled data analysis was performed using a random-effects model. Results: This systematic review and meta-analysis analyzed 1704 patients with 1737 fusiform aneurysms from 63 studies. Endovascular treatment, particularly stent-assisted coiling and stenting, emerged as the preferred approach with lower mortality and complication rates compared to surgery. Aneurysm location played a role in outcomes, with anterior circulation aneurysms generally faring better. Deconstructive strategies, designed to occlude the parent artery, carried a doubled risk of complications compared to reconstructive approaches, which aim to preserve blood flow (OR: 2.188; 95% CI: 1.474-3.248; p < 0.001). Conclusion: Endovascular techniques are becoming the mainstay of treatment for fusiform aneurysms, offering improved safety and efficacy compared to surgery. Anterior circulation location and reconstructive strategies are associated with better outcomes. However, no significant differences in OR for early complete occlusion were found between surgery and endovascular techniques at discharge and follow-up with very low heterogeneity among studies.