Endovascular coiling vs. surgical clipping for unruptured intracranial aneurysm: A meta-analysis.

BACKGROUND: With increasing use of high-resolution imaging of brain, unruptured aneurysms are more and more frequently detected. With the advances in treatment techniques, an increasing number of aneurysms are now occluded using endovascular coiling instead of conventional surgical clipping. However, the better modality for unruptured intracranial aneurysm has been poorly understood. OBJECTIVE: The objective of this meta-analysis was to compare the outcomes between endovascular coiling and surgical clipping among patients with unruptured intracranial aneurysms. METHODS: PubMed, Embase, Web of Science, CENTRAL, and SIGLE were electronically searched from January 1, 1990 to March 13, 2012 with no language restriction for randomized or nonrandomized clinical controlled trials. Article screening and data extraction were conducted in duplicate. Results were statistically pooled through Review Manager 5 and StatsDirect 2.7.9. RESULTS: Seven studies met our inclusion criteria. The pooled risk ratios (coiling vs. clipping) were 0.59 (95% CI = 0.23-1.54) for death; 0.37 (95% CI = 0.10-1.41) for bleeding; 0.78 (95% CI = 0.38-1.58) for cerebral ischemia; 0.87 (95% CI = 0.70-1.08) for occlusion of aneurysm; 0.53 (95% CI = 0.18-1.52) for independence in daily activities. The pooled rates of death, bleeding, ischemia, occlusion of aneurysm, and mRS no less than 3 were 1% (95% CI = 0-2%), 2% (95% CI = 0-5%), 8% (95% CI = 4-13%), 82% (95% CI = 64-95%), and 5% (95% CI = 1-10%) for endovascular coiling, respectively, and 1% (95% CI = 0-2%), 6% (95% CI = 3-10%), 9% (95% CI = 5-15%), 95% (95% CI = 90-98%), and 8% (95% CI = 3-14%) for surgical clipping, respectively. We failed to evaluate quality of life and cognitive outcome due to insufficient data. Both meta-regression and sensitivity analysis showed consistent results. Furthermore, Begg's test and Egger's test failed to detect publication bias. CONCLUSION: We suggest that endovascular coiling and surgical clipping bear similar risk ratios of death, bleeding, cerebral ischemia, occlusion of aneurysm, and independence in daily activities and encourage further studies on quality of life and cognitive outcome. However, albeit the results in this meta-analysis are robust, due to great clinical heterogeneity and low quality of studies, the results in this meta-analysis should be interpreted with caution.

A comparative study on the measurements of palatal shelf area and gradient for adult patients with unoperated cleft palate.

OBJECTIVE: To determine the maxillary growth potential of cleft palate patients compared with the normal population. METHODS: By using a three-dimensional computed tomography scanning and imaging system, the gradient and surface area of the palatal shelves were measured and analyzed statistically among 30 adults with normal occlusion, 30 adult patients with operated unilateral complete cleft lip and palate, and 30 adults with unoperated unilateral complete cleft lip and palate. RESULTS: In comparison with the control group, for the unoperated unilateral complete cleft lip and palate subjects, the gradient of the palatal shelves at both the cleft and noncleft sides was larger, meaning that the palatal shelves were rotated cranially and were more vertically positioned. The palatal surface area was significantly smaller in the unoperated and operated unilateral complete cleft lip and palate groups than in the noncleft control group; although, there was no significant difference between the unoperated and operated unilateral complete cleft lip and palate groups. CONCLUSIONS: There is an intrinsic tissue deficiency in the palate/maxilla of unilateral complete cleft lip and palate patients.

A comparative study on dental-arch morphology in adult unoperated and operated cleft palate patients.

PURPOSE: To investigate the effects of cleft itself and palatoplasty on the development of dental-arch morphology. METHODS: Computed tomography scanning and imaging system for dental cast measurement were applied to statistically analyze the differences in dental-arch form among 30 adults with normal occlusion, 30 adult patients with operated unilateral complete cleft palate, and 30 adults with unoperated cleft palate. RESULTS: All maxillary arch widths and anterior arch length of the operated group are significantly smaller than those of the unoperated group (P < 0.01). In the unoperated group, the maxillary anterior arch width and maxillary and mandibular arch length are significantly smaller, whereas both maxillary and mandibular posterior arch widths are significantly larger as compared with the control group (P < 0.01). CONCLUSIONS: The influence of cleft palate on the development of maxillary arch is limited to the vicinity of the cleft in the anterior region only. Palatoplasty is the main cause resulting in the constriction of maxillary arch, while inhibiting the sagittal development of the anterior arch.