Management and Outcomes in a Low-volume Cerebral Aneurysm Practice

Treatment of ruptured intracranial aneurysms: Report from a low-volume center

“…Our results are comparable to the results from other similar studies [5][6][7][8][9]. Perioperative mortality was defined as mortality related to various intraoperative complications (poor control of intraoperative aneurysmal bleeding, uncontrollable brain edema before the aneurysmal exclusion, lesions of cerebral arteries near the aneurysmal location etc.)…”

“…The same was also true for postoperative mortality for reasons unrelated to SAH (3% in our series). On the basis of these comparisons we can conclude that the result of our treatment of ruptured intracranial aneurysms is acceptable and similar to reports from other low-volume neurosurgical centers [5].…”

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

“…116 Low-volume centers have been found to treat SAH with acceptable outcomes. 350 Highvolume centers may already be taxed in terms of the severity of illness of their patients and the availability of resources and staff. 351 Nevertheless, further studies should be performed that would include a more detailed prospective cohort analysis delineating the differences in outcomes between lowand high-volume hospitals and the risks associated with transfer.…”

Case Volume Does Not Correlate With Outcome After Cerebral Aneurysm Clipping: A Nationwide Study in Japan

“…1,3,5,6,15,18,19) The relationships between case volume and outcome were analyzed in 12,804 surgeries for ruptured cerebral aneurysms performed at 390 centers in California from 1990 to 1999. 1) Without distinguishing clipping from endovascular surgery, the mortality rate at centers performing AE19 surgeries/year was 32.3%, compared to 48.8% at centers performing º8 surgeries/year (p º 0.001), whereas the totals of deceased patients and patients transferred to rehabilitation or long-term nursing care facilities were 55.9% and 76.4%, respectively (p º 0.001).…”

“…2,4,16,20) Several studies have investigated the relationships between case volume and outcome in cerebral aneurysm clipping in the United States (US). 1,3,5,6,15,18,19) However, the results of studies conducted in countries with different medical systems, medical standards, and specialist training systems cannot necessarily be used to establish center standards in Japan.…”