Surgical treatment of giant intracranial aneurysms: A systematic review and single arm Meta-Analysis.

While endovascular approaches for giant intracranial aneurysms (GIAs) gained significant attention, there is no consensus regarding the superior approach between endovascular treatment and surgery for GIAs, particularly in underdeveloped countries. Thus, the authors investigated the safety and efficacy of non-endovascular treatment for GIAs. A systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies lacking clear aneurysm size data were excluded. Analysis was performed in R (version 4.4.1) using a generalized linear mixed model with a random-effects approach, including subgroup analyses for ruptured and unruptured aneurysms. Heterogeneity was assessed using I² statistics. Fifty-seven studies encompassing 2,109 patients with 2,133 aneurysms were analyzed. Clipping was the most common technique, followed by bypass procedures. Intraoperative complications occurred in 57 cases (6% [95% CI: 4%-9%]), while postoperative complications were reported in 398 cases (20% [95% CI: 16%-24%]). Bypass occlusion was observed in 9% of patients (95% CI: 7%-13%). Good clinical outcomes were achieved in 82% of patients (95% CI: 77%-85%), with a significantly higher rate of 89% in patients with unruptured aneurysms compared to 65% in those with ruptured aneurysms. The overall mortality rate was 7% (95% CI: 5%-8%), while the recurrence rate was 1% (95% CI: 0.35%-3%). Open surgical management for GIAs is effective and safe, especially for unruptured aneurysms. The low mortality rate and high rate of good clinical outcomes highlight the viability of surgical options. Given these results, surgical intervention remains a strong alternative, especially in settings where endovascular options may be less accessible or more costly. Further research is needed to refine treatment strategies and improve outcomes for both ruptured and unruptured GIAs.