Traumatic Intracranial Pseudoaneurysm Treated with Flow Diverters: Case Report and Meta-Analysis

Abstract

BACKGROUNDIt is controversial to treat traumatic intracranial pseudoaneurysms (TIPAs) with flow diverters (FDs). We present an 18-year-old girl who underwent a TCCF of ruptured TIPA treated with flow-diverters, and then report the results of the largest meta-analysis aimed to evaluate the safety and effectiveness of flow diversions in this situation. METHODSA systematic search of Web of Science databases, Embase, and PubMed was performed for articles published between 2010 and Sep 2022. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, studies reporting FD for TIPA with ≥3 patients were included. Weassessedthecomplete occlusion rate, complicationsrelatedtothe operation, and clinical outcome. Ameta-analysisbased onheterogeneitywascarriedoutusing random or common effectsmodels. RESULTSWe 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% CI, 74%–95%; I2=7%; P=0.37). The operate-related complications rate was 9% (95% CI=1–23%; I2=0.00%; P=0.52). Two patients died of non-aneurysmal hemorrhage. The percentageofgoodclinical outcome was 85.7% (95% CI=78–98%; I2=23.7%; P=0.25) at the last follow-up. CONCLUSIONFD 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.