gms | German Medical Science

Objective: After the ISAT study was published in October 2002, the results were discussed controversially in regard to the impact on the clinical practice of the treatment of intracranial aneurysms and to the changes in teaching and training of vascular neurosurgeons. To quantify the changes, we analyzed the development of aneurysm treatment in our centre after the publishing of the ISAT study.

Methods: 684 patients with an intracranial aneurysm were evaluated in retrospective. The were treated either by endovascular or by theneurosurgical method in our centre between January 2000 and June 2005.

Results: 481 of the patients were female, 203 male. Mean age of the endovascular patients was 51,9 years and 51,4 years in surgical group, respectively. There was no significant change in regard to the age of the treated patients from 2000 to 2005. The total number of surgical treated aneurysms has been consistent in our centre with 63 patients in 2000 and 57 in 2004, respectively. However, the number of coil treatments in 2004 (111 treatments) was almost 3-fold higher than in 2000 (41). Thus, only 39% of the patients with an intracranial aneurysm were treated by coiling in 2000, whereas already about two third (66%) of the patients underwent endovascular treatment in 2004. According to the first half-year, this seems to be similar in 2005. The crucial change occurred in the treatment of aneurysms of the anterior (ACA) and internal cerebral artery (ICA), the majority of whom were in the endovascular group in 2004 (71% and 84%, respectively) in contrast to the year 2000 (29% and 16%). However, aneurysms of the middle cerebral artery (MCA) were still treated more often by clipping than by coiling in our centre in 2004 (87% vs. 13%). In regard to the clinical condition at admission, only the patients who were in Hunt and Hess grade I or II underwent clipping as often as coiling (49 vs. 51%) in 2004, whereas the patients in poor clinical condition (Hunt and Hess grade IV and V) underwent coiling in 93% of the cases. Clipping was performed in 35% of the unruptured aneurysms in 2004 and the first half-year of 2005 compared to 55% in the year 2000.

Conclusions: Aneurysm treatment has changed increasingly during the last years. Although the total number of clipped aneurysms has been consistent in our centre since 2000, the percentage of complex aneurysms of the MCA has increased. Thus, the teaching and maintaining of vascular neurosurgical skills has become much more difficult.