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SHR Neuro Cancer Cardio Lipid Metab Microb

Al-Schameri, AR; Thakur, S; Kral, M; Schwartz, C; Pikija, S; Sherif, C; Weymayr, F; Richling, B.
Microsurgical and endovascular treatment of un-ruptured cerebral aneurysms by European hybrid neurosurgeons to balance surgical skills and medical staff management.
Acta Neurochir (Wien). 2021; 163(5): 1515-1524. Doi: 10.1007/s00701-021-04746-x [OPEN ACCESS]
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Co-authors Med Uni Graz
Pikija Slaven
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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.
Find related publications in this database (using NLM MeSH Indexing)
Adult - administration & dosage
Aged - administration & dosage
Clinical Competence - standards, statistics & numerical data
Combined Modality Therapy - statistics & numerical data
Embolization, Therapeutic - methods, statistics & numerical data
Endovascular Procedures - statistics & numerical data
Europe - administration & dosage
Humans - administration & dosage
Intracranial Aneurysm - surgery, therapy
Male - administration & dosage
Microsurgery - methods, statistics & numerical data
Middle Aged - administration & dosage
Neurosurgeons - education, standards, statistics & numerical data
Postoperative Complications - epidemiology

Find related publications in this database (Keywords)
Un-ruptured intracranial aneurysm
Microsurgery
Embolization
Hybrid neurosurgery
Outcome
Hospital economy
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