Treatment of patients with ruptured aneurysm by neurosurgeons that perform both open surgical and endovascular techniques is safe and effective: results of a single centre in Europe

Acta Neurochir (Wien). 2014 Jul;156(7):1259-66; discussion 1266. doi: 10.1007/s00701-014-2101-1. Epub 2014 May 1.

Abstract

In Europe only few neurosurgeons are trained in both open surgical clipping as well as in endovascular techniques for treatment of intracranial aneurysms. To investigate the safety and efficacy of performing both techniques we, two dual trained neurosurgeons, analyzed our results in repairing ruptured intracranial aneurysms. Prospectively collected data from 356 patients that underwent open surgical or endovascular repair of a ruptured intracranial aneurysm at the Neurosurgical Centre Nijmegen from 2006 to 2012 by two dual trained neurosurgeons were retrospectively analyzed. Complication rates, occlusion rates, and retreatment rates were obtained. Combined procedural persistent neurological morbidity and mortality after endovascular treatment and open surgical clipping were 2.1 % and 1.4 %, respectively. Overall procedure-related clinical complication rate for endovascular treatment was 5.9 % in 285 procedures for 295 aneurysms. Overall procedure-related clinical complication rate for open treatment was 9.9 % in 71 procedures for 72 aneurysms. Follow-up was available for 255 out of 295 coiled aneurysms, 48 aneurysms recurred and 34 needed retreatment. For clipping 54 out of 72 treated aneurysms had follow-up; four aneurysms were incompletely clipped. One aneurysm was retreated. Treatment of ruptured intracranial aneurysms by neurosurgeons that perform both open surgical clipping as well as endovascular techniques is safe and effective. Developing training programs in Europe for hybrid neurosurgeons that can provide comprehensive patient care should be considered.

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Ruptured / mortality
  • Aneurysm, Ruptured / surgery*
  • Endovascular Procedures / adverse effects
  • Endovascular Procedures / methods*
  • Europe
  • Female
  • Follow-Up Studies
  • Humans
  • Intracranial Aneurysm / mortality
  • Intracranial Aneurysm / surgery*
  • Male
  • Middle Aged
  • Neurosurgical Procedures / adverse effects
  • Neurosurgical Procedures / methods*
  • Prospective Studies
  • Reoperation
  • Retrospective Studies
  • Surgical Instruments
  • Survival Rate
  • Treatment Outcome