Neurosurgical clipping vs spiral management in ruptured brain aneurysm. A systematic review

Abstract

Introduction: The rupture of intracranial aneurysms can be treated by clipping or endovascular therapy with spiral, so it is necessary to conduct research on neurocritical and neurosurgical management, considering that subarachnoid hemorrhage is an important cause of death and disability worldwide. Objectives: To compare endovascular therapy versus surgical clipping treatment in patients with subarachnoid hemorrhage due to ruptured cerebral aneurysm. Materials and methods: Through the application of inclusion and exclusion criteria, the search for systematic review began. Databases such as Google Scholar, ScienceDirect, Mendeley, Pubmed, IntechOpen, websites of prestigious journals were reviewed, to consult the records and identify studies with the topic of endovascular therapy search versus surgical treatment with clipping in patients with subarachnoid hemorrhage by ruptured cerebral aneurysm. Results: Greater efficacy with surgical treatment of patients with medium brain aneurysms, modified Rankin >2 points: 18% for clipping versus 24% endovascular treatment. Complete occlusion of aneurysm75% for surgical treatment versus 35% for endovascular management. Complete occlusion of the aneurysm. Patients assigned to clipping (85%) patients assigned to the spiral (67%). In comparison, clipping was associated with a lower rate of resangrado at discharge and a higher rate of aneurysmal occlusion at 1 year follow-up. The spiral reduced the rate of vasospasm to high and the rate of results to 1 year was better for spiral. Conclusion: Endovascular therapy is a feasible option in patients with ruptured aneurysms of difficult surgical approach such as the posterior cerebral circuit, posterior communication, upper and lower cerebellum. Surgical clipping in the treatment of ruptured brain aneurysm is the best option when the approach is possible both by open surgery, as well as minimally invasive surgery, presenting high percentages of complete occlusion of the aneurysm. Both therapies represent a possibility in the management of the ruptured aneurysm, according to the location and assessed by the modified Rankin scale