Endovascular and Surgical Treatment of Superior Cerebellar Artery Aneurysms: A Systematic Review and Meta-analysis of Outcomes and Complications

Introduction: Superior cerebellar artery (SCA) aneurysms, located in the posterior circulation, present significant treatment challenges. Although studies have shown that both endovascular and microsurgical treatments can be safe and effective, there is no consensus on the optimal approach. This systematic review and meta-analysis compare the safety and efficacy of endovascular versus microsurgical treatment for SCA aneurysms.

Methods: A systematic search of EMBase, PubMed, and the Web of Science databases identified studies on SCA aneurysms treated with endovascular coiling or surgical clipping. Outcome measures included postoperative morbidity, mortality, aneurysm occlusion, and neurologic outcomes as measured by the Glasgow Outcome Scale (GOS) or modified Rankin Scale (mRS). Good functional recovery was defined as GOS > 3 or mRS < 3. Single- and double-arm meta-analyses were performed in STATA, using a random effects model to calculate pooled proportions.

Results: Fourteen studies with 433 patients (89 males, 233 females, and 114 unspecified) and 436 SCA aneurysms met the inclusion criteria. Of the aneurysms, 50.2% were ruptured, with 79.8% located proximally (BA–SCA and S1 segment). The overall complication rate was 15.1%, with a mortality rate of 4.7%, and 86.3% of patients had favorable recovery. Among the 227 patients treated with endovascular coiling, complication and mortality rates were 9.0% and 3.2%, respectively, with 92.2% achieving good recovery and 75.1% complete obliteration. For the 206 patients undergoing microsurgical clipping, complication and mortality rates were 26.2% and 7.4%, respectively, with 72.9% achieving good recovery and 90.5% obliteration. A dual-arm meta-analysis from three studies found no significant difference in complication rates, occlusion rates, and good neurologic recovery between coiling and clipping.

Conclusion : This systematic review and meta-analysis demonstrate that both endovascular coiling and microsurgical clipping are viable treatment options for SCA aneurysms. Endovascular coiling showed a lower complication and mortality rate but a slightly lower complete obliteration rate than microsurgical clipping. Treatment choice may be guided by patient-specific and aneurysm-specific factors. Further prospective studies, including the use of flow diversion, are needed to refine treatment guidelines for SCA aneurysms.