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. 2021 May;163(5):1515-1524.
doi: 10.1007/s00701-021-04746-x. Epub 2021 Feb 10.

Microsurgical and endovascular treatment of un-ruptured cerebral aneurysms by European hybrid neurosurgeons to balance surgical skills and medical staff management

Abdul Rahman Al-Schameri  1 , Som Thakur  2 , Michael Kral  2 , Christoph Schwartz  2 , Slaven Pikija  3 , Camillo Sherif  4 , Friedrich Weymayr  5 , Bernd Richling  6
Affiliations

Microsurgical and endovascular treatment of un-ruptured cerebral aneurysms by European hybrid neurosurgeons to balance surgical skills and medical staff management

Abdul Rahman Al-Schameri et al. Acta Neurochir (Wien). 2021 May.

Abstract

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.

Keywords: Embolization; Hospital economy; Hybrid neurosurgery; Microsurgery; Outcome; Un-ruptured intracranial aneurysm.

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Conflict of interest statement

The authors declare no competing interests.

Comment in

References

    1. Al-Schameri AR, Baltsavias G, Winkler P, Lunzer M, Kral M, Machegger L, Weymayr F, Emich S, Sherif C, Richling B. Computerized angiographic occlusion rating for ruptured clipped aneurysms is superior to subjective occlusion rating. AJNR Am J Neuroradiol. 2015;36:1704–1709. doi: 10.3174/ajnr.A4399. - DOI - PMC - PubMed
    1. Alexander BL, Riina HA. The combined approach to intracranial aneurysm treatment. Surg Neurol. 2009;72:596–606. doi: 10.1016/j.surneu.2009.06.027. - DOI - PubMed
    1. Alshafai N, Falenchuk O, Cusimano MD. International differences in the management of intracranial aneurysms: implications for the education of the next generation of neurosurgeons. Acta Neurochir (Wien) 2015;157:1467–1475. doi: 10.1007/s00701-015-2494-5. - DOI - PubMed
    1. Bekelis K, Gottlieb D, Bovis G, Su Y, Tjoumakaris S, Jabbour P, MacKenzie TA. Unruptured cerebral aneurysm clipping: association of combined open and endovascular expertise with outcomes. J Neurointerv Surg. 2016;8:977–981. doi: 10.1136/neurintsurg-2015-011986. - DOI - PMC - PubMed
    1. Bekelis K, Gottlieb D, Labropoulos N, Su Y, Tjoumakaris S, Jabbour P, MacKenzie TA. The impact of hybrid neurosurgeons on the outcomes of endovascular coiling for unruptured cerebral aneurysms. J Neurosurg. 2017;126:29–35. doi: 10.3171/2015.11.JNS151725. - DOI - PMC - PubMed

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