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Results from first IML: Aneurysm Coiling v. Clipping Still a Toss up

CerebroAneurysm_image1IML_imageTwo years ago at their annual meeting the Congress of Neurological Surgeons (CNS) introduced Integrated Medical Learning (IML), a great new way to make the most of having so many neurosurgeons in the same place at the same time.  According to the CNS website, “Integrated Medical Learning® allows participants to define the content and direction of sessions targeted at the most practical and important clinical and scientific questions of the day.  Learners evaluate key evidence, interact with faculty, and define current and future practice.”  They do this using online surveys before and after the meeting and handheld interactive devices during the meeting.
Dr. E. Sander Connolly from the Cerebrovascular Center and colleagues were involved in this program and were particularly interested in how this large group of neurosurgeons would divide in terms of treatment for brain aneurysms.  Their results were presented as one of the top ten abstracts at this year’s CNS meeting.
An aneurysm occurs when part of a blood vessel weakens and bulges or b alloons out.  Most of the time this causes what is called a berry aneurysm that is at risk for bursting. When this happens in the brain, surgeons usually treat it one of two ways: Clipping, where, in an open brain procedure, they place a small clip at the base of the aneurysm, or coiling, where they go into the brain using tiny instruments via blood vessels and fill the aneurysm with a flexible coil to keep it from rupturing.
Before the 2007 meeting, attendees were given access to review articles highlightingCerebro_image2 the latest research on this topic. Then, at the meeting surgeons were presented with 8 patient-cases that could be treated either by coiling or clipping.  The surgeons used handheld interactive devices to answer questions about these cases.  Specifically they were asked which procedure they would choose to perform in each case.  At this year’s meeting Dr. Connolly and his colleagues presented the results: 328 surgeons responded and though individually they tended to have strong opinions one way or the other, the group was for the most part evenly split.  A condition known as clinical equipoise.
With the use of IML these researchers took advantage of the coming together of neurosurgeons from around the world to find out the current state of treatment for a very particular problem.  This is useful information, especially for those trying to decipher whether one treatment is better than another.  IML was an enriching experience for those involved and is a great tool to help further the science of neurosurgery.  We look forward to the results from this year’s IML.
To learn more see the article: Community and Individual Equipoise for Ruptured Intracranial Aneurysm Clipping versus Coiling: Results form Integrated Medical Learning. The full article can be found in Neurosurgery volume 65(2), August 2009, p 407
Dr. Robert Solomon, chairman of the Department of Neurosurgery, in a video series on Cerebral Aneurysms.

patient journey

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