Lead author Dr. Brad Zacharia with Dr. E. Sander Connolly from the Cerebrovascular Center and colleagues received the Galbraith Award at this year’s annual meeting of the Congress of Neurological Surgeons (CNS) for their study of the treatment of brain aneurysms in the State of New York.
An aneurysm is a bulge in a blood vessel that is caused by weakening of the vessel wall. Aneurysms can be life threatening if they burst and often require surgical treatment. There are two types of surgery that are performed and it remains controversial which is best. Clipping has been the treatment of choice for the last 40 years. This involves a craniotomy and placement of a tiny clip at the base of the aneurysm. With the advent of endovascular surgery coiling has become another option. A small flexible coil is passed through blood vessels into the brain where it is placed in the aneurysm to keep it from bursting. Recent studies have suggested that endovascular coiling has a better outcome.
The authors used the New York Statewide Planning and Research Cooperative System (SPARCS) to look at all the patients that were discharged from a hospital in New York State that had a primary diagnosis of brain aneurysm between the years 2005 and 2007. They found about 3,000 patients with that diagnosis, discharged from over a hundred hospitals. They divided the hospitals into high and low volume based on the number of these kinds of patients treated. Then they looked at the general outcome for these patients and correlated it to whether the hospital was high volume or low and to the type of surgery the patient had.
The authors found that between surgical treatments, the best outcome was found in the group that had undergone endovascular coiling. Between high and low volume hospitals they found that more low volume medical centers were performing this procedure but, independent of surgical treatment a better outcome was found in the large volume medical centers.
When they compared the data during this three year period (2005-2007) to a previous five year period(1995-2000) they actually found no overall improvement in outcome despite the fact that the use of endovascular coiling (the procedure with a better outcome) had increased since 1995. The authors surmised that this is likely because more low volume centers (which overall had poorer outcomes regardless of procedure) are performing this kind of surgery. This result is of concern and the authors recommended that more research be done to look into this further.
A poster presentation of this research: Trends in Outcome for the Treatment of Intracranial Aneurysms in New York State: A 3-year Population Based Study
This study can be found in the August 2009, Vol. 65, issue 2 of Neurosurgery
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