Aneurysm treatment practice patterns for newly appointed dual-trained cerebrovascular/endovascular neurosurgeons: Comparison of open surgical to neuroendovascular procedures in the first 2 years of academic practice

Abstract

Background:The practice patterns of a hybrid open cerebrovascular/neuroendovascular (CVNV) neurosurgeon in early academic practice is unknown.Methods:We performed a multi-institutional retrospective cohort study of patients with cerebral aneurysms that were treated within the first 24 months of the neurosurgeon’s practice.Results:A total of 533 aneurysms were treated by the three senior authors within the first 24 months of their academic practice. Of these aneurysms, 172 were treated with microsurgical clipping, 191 with coiling, and 170 with flow diversion. Treatment in the setting of acute subarachnoid hemorrhage (SAH) occurred in 23% (122/533) of the aneurysms. Majority of the clipped aneurysms (70%, 121/172) were anterior cerebral artery (ACA), anterior communicating artery (ACOM), or middle cerebral artery (MCA) in location. In comparison, only 23% (82/361) of aneurysms treated with coiling or flow diversion therapy were ACA, ACOM, or MCA in location (P < 0.05). Additionally, majority of the flow diverted aneurysm (65%, 111/170) were cavernous or ophthalmic/paraophthalmic in location. During the second year of practice, there appeared to be a trend towards more aneurysms treated with neuroendovascular techniques (22% increase), particularly in flow diversion.Conclusion:Although the CVNV neurosurgeon treats cerebral aneurysms more commonly with neuroendovascular techniques, a third of the cerebral aneurysms are still selected for microsurgical clipping. Aneurysms located along the ACA/ACOM or MCA are the most frequent aneurysms reserved for microsurgical clipping. The CVNV neurosurgeon must be prepared to manage a high percentage of ACA/ACOM or MCA aneurysms microsurgically.

Training Cerebrovascular and Neuroendovascular Surgery Residents: A Systematic Literature Review and Recommendations

“…Cerebrovascular neurosurgery is increasingly managed via minimally invasive endovascular procedures, [55][56][57][58] so current trainees must obtain competency in 2 separate technical skills prior to practice. 56 Despite annual increases in neuroendovascular volume at teaching facilities, exposure is often limited to condensed rotations and/or fellowship training.…”

“…Cerebrovascular neurosurgery is increasingly managed via minimally invasive endovascular procedures, [55][56][57][58] so current trainees must obtain competency in 2 separate technical skills prior to practice. 56 Despite annual increases in neuroendovascular volume at teaching facilities, exposure is often limited to condensed rotations and/or fellowship training. 57,[59][60][61][62][63] Conversely, teaching opportunities in open techniques have steadily declined annually to the point where program minimum case requirements have shifted to prevent centers from losing accreditation.…”

“…57,[59][60][61][62][63] Conversely, teaching opportunities in open techniques have steadily declined annually to the point where program minimum case requirements have shifted to prevent centers from losing accreditation. 9,56,57 As such, many programs have trialed various supplemental educational tools, ranging from complex simulators to anatomic models.…”

Endovascular embolization versus surgical clipping in a single surgeon series of basilar artery aneurysms: a complementary approach in the endovascular era

“…Early career dual-trained neurosurgeons are more likely to treat cerebral aneurysms with neurointerventional techniques [ 16 ]. With continued evolution of endovascular technologies, the proportion of intracranial aneurysms treated with open surgery continues to decline.…”