More than meets the eye: A meta-analysis of visual outcomes following clipping, coiling, and flow diversion for visually symptomatic paraclinoid aneurysms.

In 30 seconds

This PRISMA-compliant systematic review and random-effects meta-analysis compared visual outcomes after clipping, coiling, and flow diversion for paraclinoid aneurysms, drawing on 21 studies. Among patients with visual symptoms, clipping was associated with greater odds of visual improvement than coiling (OR 2.28; 95 % CI: 1.19-4.37; p = 0.013), but this result was not robust in sensitivity analyses. Across 16 studies, clipping was also associated with more new visual deficits and permanent deficits than coiling. Overall certainty of evidence was graded very low.

Key findings

• Compared with coiling, clipping was associated with greater odds of visual improvement (OR 2.28; 95 % CI: 1.19-4.37; p = 0.013); sensitivity analyses generally did not reproduce this result.
• Clipping was associated with increased risk of new visual deficits versus coiling (OR 2.28; 95 % CI: 1.21-4.33; p = 0.011) and permanent deficits (OR 3.10; 95 % CI: 1.40-6.87; p = 0.005).
• Compared with flow diversion, clipping and coiling were associated with greater visual worsening, based on data from only 2 studies.
• The overall certainty of evidence was graded very low.

Why it matters

Visual recovery and preservation are important considerations when selecting an approach for paraclinoid aneurysms. The findings suggest a possible trade-off: clipping may improve existing deficits in some symptomatic patients, while also carrying greater risk of new or permanent visual complications than coiling. The fragile results and very low certainty underscore the need for cautious interpretation and informed patient counseling.

What to keep in mind

The evidence base was retrospective and graded very low certainty. The visual-improvement finding was fragile in sensitivity analyses, and comparisons with flow diversion relied on only 2 studies.