Flow-diverter versus bypass for cavernous carotid aneurysm: A systematic review and meta-analysis

INTRODUCTION Cavernous carotid aneurysms (CCAs) are generally considered benign lesions, often remaining asymptomatic and associated with a natural history that carries a low risk of life-threatening complications. Due to the complex anatomy of the internal carotid artery in the cavernous sinus region, these aneurysms often pose a formidable challenge for microsurgical treatment. OBJECTIVE To evaluate the efficacy of flow diversion versus bypass based on clinical and surgical outcomes in patients with CCAs. MATERIAL AND METHODS This systematic review and meta-analysis followed the recommendations of the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. A comprehensive search was conducted in the PubMed, Embase, and Web of Science databases for relevant studies published up to October 2023 that compared the effectiveness of flow diversion versus bypass in the management of CCAs. RESULTS AND CONCLUSIONS A total of 709 records were initially identified: 228 from PubMed, 281 from Web of Science, and 200 from Embase. After the removal of 293 duplicates, 416 records were screened based on titles and abstracts. A total of 104 articles were selected for full-text evaluation, of which 24 met the inclusion criteria and were included in the analysis. In the flow diversion group, 261 patients were included. The aneurysm obliteration rate was 80% (95%CI 67–93; I2=87%), while the complication rate was 21% (95%CI 11–31; I2=73%), including intracranial hemorrhage, ischemia, and vasospasm. The recovery rate was 56% (95%CI 28–85; I2=97%). In the bypass group, 187 patients were included. The aneurysm obliteration rate was 95% (95%CI 91–99; I2=24%), while the complication rate was 18% (95%CI 9–27; I2=61%), primarily involving postoperative ischemia. The recovery rate was 79% (95%CI 57–100; I2=75%). Bypass procedures demonstrated higher aneurysm obliteration rates and fewer complications compared to flow diversion (Figura 1).