Medical Student Washington University School of Medicine St. Louis, Missouri, United States
Introduction: Intracranial aneurysms of the middle cerebral artery are treated using several open and endovascular approaches. There is a need to assess the costs associated with available approaches in order to reduce the population and healthcare burden of elective treatment for these aneurysms.
Methods: Consecutive patients undergoing elective endovascular or open treatment of aneurysms located in the MCA were included. The open surgical group was divided into a pterional approach group and a lateral supraorbital approach group for analysis. The endovascular group and both surgical groups were first compared via ANOVA test. Groups were then compared using the Tukey’s multiple comparisons test.
Results: In total, 136 MCA aneurysms were treated electively. This comprised 58 aneurysms treated with open surgery using the pterional craniotomy, 40 aneurysms treated with open surgery using the lateral supraorbital approach, and 38 aneurysms treated endovascularly. Median cost was $37,152 (IQR $31,318-$44,947) for aneurysms treated with the pterional approach, $29,452 (IQR $27,779-$32,826) for aneurysms treated with the LSO approach, and $19,587 (IQR $14,125-$30,521) for aneurysms treated with endovascular approaches. The median total cost was $39,737 (IQR $33,891-$62,259) for aneurysms treated with the pterional approach, $31,785 (IQR $29,513-$41,099) for aneurysms treated with the LSO approach, and $24,578 (IQR $18,977-$34,547) for aneurysms treated with endovascular approaches. ANOVA test demonstrated variance across groups for both initial and total cost (p = 0.004, p = 0.008, respectively). In our subsequent analysis, initial cost and total cost were higher in the pterional group than the endovascular group (p = 0.003 and p = 0.006, respectively).
Conclusion : Endovascular treatment of elective aneurysms has a lower cost than open treatment using the pterional approach. The benefit of lower cost with endovascular treatment is mitigated when the lateral supraorbital approach is employed.
