Comparison of intracranial aneurysm management modalities

Brendan W Davis, Michael J Stuart, Pravitha Jayapratap, Bruce I Hall

Structured multidisciplinary care is an increasingly popular tool in the management of many complex disease processes; however, there is little published data regarding the effects of such a process on management of intracranial aneurysms and neurosurgical case loads. There is some resistance in the neurosurgical community to routine involvement of interventional neuroradiologists in the care of patients with intracranial aneurysms due to concerns regarding maintenance of neurosurgical case loads and training capabilities. At our tertiary Australian hospital, we have implemented a weekly multidisciplinary cerebrovascular meeting (MDCVM) facilitating routine discussion of these cases between neurosurgeons and interventional neuroradiologists. This study identified management modalities for ruptured and unruptured cerebral aneurysms diagnosed at our centre for a 2-year period before and after the implementation of MDCVM culminating in a 4-year retrospective cohort study. The pre- and post-MDCVM cohorts were well matched for demographics with 162 and 224 patients, respectively. There is no significant difference in percentage or absolute numbers of endovascular or surgical cases in the pre-MDCVM (103; 73.0% versus 38; 27.0%, respectively) or post-MDCVM cohorts (105; 79.5% versus 27; 20.5%, respectively), reflecting a maintained surgical case load after the implementation of MDCVM (P = 0.21). There were no significant differences in any confounding variables including age, sex, aneurysm size/location, Fisher or World Federation of Neurosurgical Societies (WFNS) grade. Implementation of MDCVM did not impact on active management case loads with consistent numbers and percentages for both endovascular and microsurgical management.