Traumatic intracranial pseudoaneurysm treated with flow diverters: Case report and meta-analysis

Wei Huang, Department of Neurosurgery, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Qihang Pan, Department of Neurosurgery, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Zhao Ma, Department of Neurosurgery, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Jun Li, Department of Neurosurgery, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
Wen Chen, Department of Neurosurgery, the Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

Introduction: It is controversial to treat traumatic intracranial pseudoaneurysms (TIPAs) with flow diverters (FDs). We present an 18-year-old girl who underwent a transcranial carotid-cavernous fistula of ruptured TIPA treated with FDs, and then report the results of the largest meta-analysis aimed to evaluate the safety and effectiveness of flow diversions in this situation. Methods: A systematic search of Web of Science databases, Embase, and PubMed was performed for articles published between 2010 and September 2022. According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies reporting FD for TIPA with ≥ 3 patients were included. We assessed the complete occlusion rate, complications related to the operation, and clinical outcome. A meta-analysis based on heterogeneity was carried out using random or common effects models. Results: We included 7 non-comparative studies with a total of 58 target TIPAs. 17 aneurysms were explicitly described as being ruptured. All FDs were successfully released. Overall, 5 (8.6%) aneurysms were treated with overlapped diverters. During a mean angiographic follow-up of 17.3 months, the complete occlusion rate was 86.0% (46/56; 95% confidence interval [CI], 74-95%; I2 = 7%; p = 0.37). The operation -related complications rate was 9% (95% CI = 1-23%; I2 = 0.00%; p = 0.52). Two patients died of javascript: void(0); non-aneurysmal hemorrhage. The percentage of good clinical outcomes was 85.7% (95% CI = 78-98%; I2 = 23.7%; p = 0.25) at the last follow-up. Conclusions: FD provides significant advantages in the treatment of TIPA. Nevertheless, operation-related complications are not negligible. Additional prospective and randomized investigations are needed to determine the long-term effects of FD on TIPA.

Keywords: Traumatic intracranial pseudoaneurysm. Endovascular procedures. Flow diverter. Complication. Outcome. Meta-Analysis.