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Objective: To explore the microsurgical surgical clipping and endovascular intervention of the safety and efficacy of the treatment of intracranial aneurysms. Method: follow the principles of evidence-based medicine, the Cochrane systematic review method, using a combination of computer searches and manual searches, literature database search from January 1995 to December 2009, MEDLINE, EMBASE, the Cochrane Library, CNKI . Included in the surgical clipping and endovascular interventional treatment of intracranial aneurysms randomized controlled trials (randomized controlled trials, RCT). By two evaluators jointly evaluating the quality of the included studies, met the inclusion criteria Meta-analysis was performed using Rev Man 4.2 software. Results: (1) were included 20 to meet the requirements of the RCT, including the total number of cases of 6037. (2) are included in the study based on a random method, allocation concealment and blinding describe the three indicators of research quality score, the grading results of Class B 8, C grade 12. (3) Meta analysis showed that: (I) surgical clipping and endovascular interventional treatment of intracranial aneurysms in patients with poor prognosis (death and can not live independently) ratio to value ratio (odds ratio, OR) (95% CI) in 1, 3, 6, and 12 months, respectively, 1.01 (0.68,1.50) 1.27 (0.87,1.86) 1.26 (0.64,2.50) 2.23 (1.23,4.05), 1, 3, and 6 months, the difference was not statistically significance (P gt; 0.05), 12 months, the difference was statistically significant (P lt; 0.05). (Ⅱ) preoperative Hunt-Hess grade of poor prognosis: preoperative Hunt-Hess grade 1 to 2, surgery and endovascular intervention group, the OR (95% CI) 1.14 (0.54,2.44) the difference was not statistically significant (P gt; 0.05). Preoperative Hunt-Hess grade 3-5 level, OR values ??(95% CI) 0.88 (0.50,1.56) showed no statistical significance (P gt; 0.05). (III) aneurysm location poor prognosis: aneurysm located in the anterior cerebral artery (the anterior cerebral artery, ACA), middle cerebral artery (middle cerebral artery, MCA), internal carotid artery (internal carotid artery, ICA), vertebrobasilar artery (vertebrobasilar arteries, VBA), OR, value (95% CI) were 0.85 (0.39,1.85) 1.72 (0.35,8.42) 1.08 (0.35,3.28) 1.13 (0.18,7.17), the difference was not statistically significant (P gt; 0.05). (Ⅳ) surgical clipping and endovascular interventional treatment of intracranial aneurysms after complete occlusion rate (aneurysmal obliteration rate) OR values ??(95% CI) 3.51 (2.22,5.55) difference was statistically significant (P lt; 0.05). The difference was statistically significant (P lt; 0.05) (V) postoperative incidence of hydrocephalus OR value (95% CI) 0.73 (0.56,0.97). Conclusion: The available studies show: (1) surgical clipping and endovascular interventional treatment of intracranial aneurysms poor prognosis of patients with no significant difference in 1,3,6 months, but endovascular intervention group reduced The trend of adverse events, especially in the 12 months after surgery, endovascular intervention the adverse prognostic incidence was significantly lower than surgical clipping. (2) For the subgroup analysis: the different preoperative Hunt-Hess grade, aneurysm location, surgical clipping and endovascular intervention affect the poor prognosis of patients with no significant difference. (3) surgical clipping of the postoperative angiography intracranial aneurysm complete occlusion rate was significantly higher than endovascular intervention. (4) The incidence of surgical clipping than endovascular intervention with lower postoperative hydrocephalus. (5) Due to the height of the possibility of selection bias and measurement bias included studies, is bound to have some impact on the strength of the evidence of the results of this study. Expect more high-quality randomized, double-blind, controlled trial, in order to provide a solid, reliable evidence.
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