J Neurosurg 143:654–667, 2025
This systematic review and meta-analysis found that microsurgical management of previously coiled intracranial aneurysms is effective and safe in well-selected patients, achieving high complete occlusion and good functional outcomes, especially with delayed direct clipping, small aneurysm size, and anterior location.
• Microsurgical management of previously coiled intracranial aneurysms (IAs) is effective and safe in well-selected patients.
• Meta-analysis included 874 patients with 883 previously coiled IAs; most underwent direct clipping.
• Complete occlusion rate was 97.2%, good functional outcome 82.9%, and perioperative mortality 3.7%.
• Direct clipping had the best safety and efficacy, with the lowest rates of complications and highest rates of good outcomes.
• Smaller, anteriorly located, and unruptured aneurysms were associated with the most favorable outcomes.
• Early microsurgery (within 1 month of coiling) and Gurian group C IAs had higher perioperative death rates.
• Key management factors: IA size, location, rupture status, indication, and timing/type of microsurgery.
• Most studies were retrospective case series, limiting subgroup analysis and introducing some heterogeneity.
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