Evidence map›Paper›PMID 33564907›Full record

ArticleActa neurochirurgica2021

Microsurgical and endovascular treatment of un-ruptured cerebral aneurysms by European hybrid neurosurgeons to balance surgical skills and medical staff management.

Abdul Rahman Al-Schameri, Som Thakur, Michael Kral, Christoph Schwartz, Slaven Pikija, Camillo Sherif, Friedrich Weymayr, Bernd Richling

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Acta neurochirurgica, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
0.7field-weighted citation impact, top 29% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 9 citations in OpenAlex.

  1. Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

8 authors at 2 institutions in 1 country.

Abdul Rahman Al-SchameriDepartment of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria. a.al-schameri@salk.at.ORCID 0000-0003-0555-8428
Som ThakurDepartment of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
Michael KralDepartment of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
Christoph SchwartzDepartment of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
Slaven PikijaDepartment of Neurology, Paracelsus Medical University, Salzburg, Austria.
Camillo SherifDepartment of Neurosurgery, Karl Landsteiner University of Health Sciences, University Hospital St. Poelten, St. Poelten, Austria.
Friedrich WeymayrDepartment of Neuroradiology, Paracelsus Medical University, Salzburg, Austria.
Bernd RichlingParacelsus Medical University, Salzburg, Austria.
Paracelsus Medical University · ATKarl Landsteiner University of Health Sciences · AT

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundIn 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.

methodsWe 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.

resultsThe 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).

conclusionHybrid 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.

Indexed as

AdultAgedClinical CompetenceCombined Modality TherapyEmbolization, TherapeuticEndovascular ProceduresEuropeHumansIntracranial AneurysmMaleMicrosurgeryMiddle AgedNeurosurgeonsPostoperative ComplicationsEmbolizationHospital economyHybrid neurosurgeryMicrosurgeryOutcomeUn-ruptured intracranial aneurysm

Identifiers

PMID33564907
PMCPMC8053657
OpenAlexW3127990137

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.