Department of neurosurgery, CHU Caen, Caen University Hospital, avenue de la Côte-de-Nacre, 14033 Caen, France.
Department of neurosurgery, CHRU de la Cavale Blanche, Brest University Hospital, boulevard Tanguy-Prigent, 29609 Brest cedex, France.
Neurochirurgie. 2021 Sep;67(5):414-419. doi: 10.1016/j.neuchi.2021.03.003. Epub 2021 Mar 22.
Observational retrospective survey-based study.
Intracranial aneurysms (IA) can be treated with microsurgery or by endovascular treatments (EVT). EVT have taken an increasingly important part in IA management; the ability of neurosurgical teams to perform such surgery as well as the quality of their training is being questioned. We therefore wanted to assess the proportion of IA treated by microsurgery in France, the demography and caseload of surgeons trained in vascular neurosurgery.
A 60-question survey was sent to the 34 French neurosurgical centers treating IA. Twenty-seven questions dealt with the demography of neurovascular surgeons and caseload. Descriptive data are reported here.
Twenty-seven centers answered, giving us a response rate of 79.4%. A total of 209 neurosurgeons worked in these centers. Forty-six neurosurgeons were designated as referents in vascular neurosurgery, 47% of them were under 45 years old. Among the centers, 96.3% had at least one surgeon that was a referent in neurovascular surgery. A total of 88 surgeons performed IA surgery, but only 11 operated more than 20 IA per year. Two thousand four hundred and thirty seven unruptured IA were treated every year in these centers, 25% of which by microsurgery. A total of 2727 ruptured IA were treated in these centers, of which 15% were treated by microsurgery. The most common indications for microsurgical treatment of IA were: middle cerebral artery aneurysms, wide-neck intracranial aneurysms, and giant intracranial aneurysms, as well as aneurysms associated with a hematoma for the ruptured ones.
Demography of vascular neurosurgeons remains favorable, with a referent neurosurgeon in most centers, who, in half of the cases, is a young practitioner. The percentage of microsurgery in the treatment of IA is low, especially for ruptured ones. The most frequently operated types of intracranial aneurysm correspond to good practice recommendations.
观察性回顾性基于调查的研究。
颅内动脉瘤（IA）可通过显微手术或血管内治疗（EVT）进行治疗。EVT 在 IA 治疗中占有越来越重要的地位，因此人们对神经外科团队开展此类手术的能力及其培训质量提出了质疑。因此，我们希望评估法国采用显微手术治疗 IA 的比例、接受过血管神经外科培训的外科医生的人口统计学和病例量。
向 34 家治疗 IA 的法国神经外科中心发送了一份 60 个问题的调查问卷。其中 27 个问题涉及神经血管外科医生的人口统计学和病例量。这里报告的是描述性数据。
27 家中心做出了回应，回应率为 79.4%。共有 209 名神经外科医生在这些中心工作。46 名神经外科医生被指定为血管神经外科的参考医生，其中 47%的人年龄在 45 岁以下。在这些中心中，96.3%至少有一名神经血管外科的参考医生。共有 88 名外科医生进行了 IA 手术，但只有 11 名外科医生每年进行超过 20 例 IA 手术。这些中心每年治疗 2437 例未破裂的 IA，其中 25%采用显微手术治疗。这些中心共治疗了 2727 例破裂的 IA，其中 15%采用显微手术治疗。采用显微手术治疗 IA 的最常见适应证为：大脑中动脉动脉瘤、宽颈颅内动脉瘤和巨大颅内动脉瘤，以及破裂后伴血肿的动脉瘤。
血管神经外科医生的人口统计学特征仍然较为理想，大多数中心都有参考神经外科医生，其中一半是年轻医生。IA 治疗中采用显微手术的比例较低，尤其是破裂性 IA。最常进行的颅内动脉瘤类型符合良好实践建议。
