Microsurgical and endovascular treatment of un-ruptured cerebral aneurysms by European hybrid neurosurgeons to balance surgical skills and medical staff management.
Adult
Aged
Clinical Competence
/ standards
Combined Modality Therapy
/ statistics & numerical data
Embolization, Therapeutic
/ methods
Endovascular Procedures
/ statistics & numerical data
Europe
Humans
Intracranial Aneurysm
/ surgery
Male
Microsurgery
/ methods
Middle Aged
Neurosurgeons
/ education
Postoperative Complications
/ epidemiology
Embolization
Hospital economy
Hybrid neurosurgery
Microsurgery
Outcome
Un-ruptured intracranial aneurysm
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
05 2021
05 2021
Historique:
received:
20
09
2020
accepted:
27
01
2021
pubmed:
11
2
2021
medline:
9
7
2021
entrez:
10
2
2021
Statut:
ppublish
Résumé
In Europe, aneurysm treatment performed by dually trained neurosurgeons is extremely scarce. We provide outcome data for un-ruptured aneurysm patients treated at a European hybrid center to prove that hybrid neurosurgeons achieve clinical and angiographical results allowing to integrate hybrid neurosurgery into routine aneurysm treatment. This will not only help to maintain neurovascular microsurgical skills but will influence staff costs in related hospitals. We retrospectively analyzed all consecutively treated un-ruptured aneurysm patients between 2000 and 2016. The decision-making took into account the pros and cons of both modalities and considered patient and aneurysm characteristics. Clinical outcome was assessed by the modified Rankin scale (mRS). Occlusion rates were stratified into grade I for 100%, grade II for 99-90%, and grade III for <90% occlusion. To account for the introduction of stents, two treatment periods (p1, 2000 to 2008; p2, 2009 to 2016) were defined. The study population consisted of 274 patients (median age 55 years) harboring 338 un-ruptured aneurysms. Microsurgery (MS) was performed in 51.8% and endovascular therapy (EVT) in 43.1%; 5.1% required combined treatment. Overall, 93% showed a favorable clinical outcome (mRS 0-2), 94.3% after MS and 91.5% after EVT. Grade I aneurysm occlusion was achieved in 82.6% patients, 91.9% after MS and 72.9% after EVT. Procedure-related complications occurred after MS in 5.6% and after EVT in 4.4% patients. Mortality was recorded for five (1.8%) patients, one patient after MS and four after EVT. For the EVT cohort, significant improvement from p1 to p2 was seen with clinical outcomes (P=0.030, RR = 0.905, CI: 0.8351-0.9802) and occlusion rates (P=0.039, RR = 0.6790, CI: 0.499-0.923). Hybrid neurosurgeons achieve qualified clinical and angiographic results. Dual training will allow to maintain neurovascular caseloads and preserve future aneurysm treatment within neurosurgery. Furthermore economic benefits could be observed in hospital management.
Sections du résumé
BACKGROUND
In Europe, aneurysm treatment performed by dually trained neurosurgeons is extremely scarce. We provide outcome data for un-ruptured aneurysm patients treated at a European hybrid center to prove that hybrid neurosurgeons achieve clinical and angiographical results allowing to integrate hybrid neurosurgery into routine aneurysm treatment. This will not only help to maintain neurovascular microsurgical skills but will influence staff costs in related hospitals.
METHODS
We retrospectively analyzed all consecutively treated un-ruptured aneurysm patients between 2000 and 2016. The decision-making took into account the pros and cons of both modalities and considered patient and aneurysm characteristics. Clinical outcome was assessed by the modified Rankin scale (mRS). Occlusion rates were stratified into grade I for 100%, grade II for 99-90%, and grade III for <90% occlusion. To account for the introduction of stents, two treatment periods (p1, 2000 to 2008; p2, 2009 to 2016) were defined.
RESULTS
The study population consisted of 274 patients (median age 55 years) harboring 338 un-ruptured aneurysms. Microsurgery (MS) was performed in 51.8% and endovascular therapy (EVT) in 43.1%; 5.1% required combined treatment. Overall, 93% showed a favorable clinical outcome (mRS 0-2), 94.3% after MS and 91.5% after EVT. Grade I aneurysm occlusion was achieved in 82.6% patients, 91.9% after MS and 72.9% after EVT. Procedure-related complications occurred after MS in 5.6% and after EVT in 4.4% patients. Mortality was recorded for five (1.8%) patients, one patient after MS and four after EVT. For the EVT cohort, significant improvement from p1 to p2 was seen with clinical outcomes (P=0.030, RR = 0.905, CI: 0.8351-0.9802) and occlusion rates (P=0.039, RR = 0.6790, CI: 0.499-0.923).
CONCLUSION
Hybrid neurosurgeons achieve qualified clinical and angiographic results. Dual training will allow to maintain neurovascular caseloads and preserve future aneurysm treatment within neurosurgery. Furthermore economic benefits could be observed in hospital management.
Identifiants
pubmed: 33564907
doi: 10.1007/s00701-021-04746-x
pii: 10.1007/s00701-021-04746-x
pmc: PMC8053657
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1515-1524Commentaires et corrections
Type : CommentIn
Références
Acta Neurochir (Wien). 2014 Jul;156(7):1289-95
pubmed: 24806533
Neurosurgery. 2014 Feb;74 Suppl 1:S191-7
pubmed: 24402487
J Neurosurg. 1994 Dec;81(6):837-42
pubmed: 7965113
Surg Neurol. 2007 May;67(5):457-64; discussion 464-6
pubmed: 17445600
AJNR Am J Neuroradiol. 2010 Jan;31(1):140-4
pubmed: 19729540
Neurosurgery. 2006 Nov;59(5 Suppl 3):S277-81; discussion S3-13
pubmed: 17053613
Acta Neurochir (Wien). 2007 Jun;149(6):613-6; discussion 616
pubmed: 17514350
J Neurosurg. 2017 Jan;126(1):29-35
pubmed: 26918479
Acta Neurochir (Wien). 2019 Sep;161(9):1755-1761
pubmed: 31309305
J Neurointerv Surg. 2016 Sep;8(9):977-81
pubmed: 26385788
Stroke. 2012 Oct;43(10):2810-3
pubmed: 22910895
Acta Neurochir (Wien). 2015 Sep;157(9):1467-75
pubmed: 26231628
Stroke. 1998 Aug;29(8):1531-8
pubmed: 9707188
Surg Neurol. 2009 Dec;72(6):596-606; discussion 606
pubmed: 19818994
Neurosurgery. 2006 Nov;59(5 Suppl 3):S282-6; discussion S3-13
pubmed: 17053614
Acta Neurochir (Wien). 2014 Jul;156(7):1259-66; discussion 1266
pubmed: 24789710
World Neurosurg. 2017 Apr;100:85-99
pubmed: 28057589
World Neurosurg. 2018 Sep;117:e580-e587
pubmed: 29935315
World Neurosurg. 2011 May-Jun;75(5-6):580-5
pubmed: 21704910
World Neurosurg. 2019 Oct;130:e542-e550
pubmed: 31254710
Neurosurgery. 2015 May;76(5):540-50; discussion 550-1
pubmed: 25635884
Lancet. 2003 Jul 12;362(9378):103-10
pubmed: 12867109
J Neurointerv Surg. 2016 Oct;8(10):989-91
pubmed: 26888954
AJNR Am J Neuroradiol. 2015 Sep;36(9):1704-9
pubmed: 26228876
Neurosurgery. 2008 Jun;62(6 Suppl 3):1503-15
pubmed: 18695569
Eur Radiol. 2016 Jul;26(7):2369-77
pubmed: 26471273
Can Fam Physician. 2008 Nov;54(11):1535-8
pubmed: 19005121
World Neurosurg. 2016 May;89:666-671.e1
pubmed: 26732965
Stroke. 2001 Sep;32(9):1998-2004
pubmed: 11546888
AJNR Am J Neuroradiol. 2010 Jun;31(6):1010-4
pubmed: 20093308
Neuroradiol J. 2015 Aug;28(4):365-75
pubmed: 26314872
Zentralbl Neurochir. 2002;63(2):70-6
pubmed: 12224033
Acta Neurochir (Wien). 1998;140(11):1153-9
pubmed: 9870061
World Neurosurg. 2012 Feb;77(2):248-51
pubmed: 22120373
World Neurosurg. 2012 Feb;77(2):257-8
pubmed: 22120248
Stroke. 1988 May;19(5):604-7
pubmed: 3363593
Neurosurg Focus. 2004 Nov 15;17(5):E1
pubmed: 15633974
Neurosurg Rev. 2014 Oct;37(4):643-51
pubmed: 25005630
Acta Neurochir Suppl. 2002;82:41-6
pubmed: 12378989
AJNR Am J Neuroradiol. 2015 Jan;36(1):108-15
pubmed: 25355814