Highlights
- •Trainee exposure to open aneurysm surgery for aSAH have significantly declined in both case volume and complexity.
- •There is an overall increase in the number of surgeries for elective aneurysms, but this varies widely from state-to-state.
- •As significantly more endovascular procedures are performed, there is an increasing expectation for trainees to manage post-procedural endovascular treatment.
- •As most endovascular cases are performed by interventional radiologists in Australia, it is reasonable to assume that neurosurgery trainees' overall exposure to the disease is incomplete.
- •Endovascular treatment should be considered a core component of the neurosurgical SET curriculum and an essential modality in the skillset of a cerebrovascular neurosurgeon.
Abstract
Background
Case volume and complexity for microsurgical treatment of cerebral aneurysms have
changed due to the growing use of endovascular therapy in clinical practice. The authors
sought to quantify the clinical exposure of Australian neurosurgery trainees to cerebral
aneurysm microsurgery.
Methods
This observational, retrospective cross-sectional study examined the Australian National
Hospital Morbidity database for all admissions related to microsurgical and endovascular
treatment of aneurysmal subarachnoid haemorrhage (aSAH) and unruptured intracranial
aneurysms (UIAs) for the years 2008 to 2018. Procedural volumes were compared with
neurosurgical trainee figures to investigate the rate of procedural exposure relative
to the neurosurgical workforce.
Results
A total of 8,874 (41.6%) microsurgical procedures (3,662 for aSAH, 5,212 for UIAs),
and 12,481 (58.4%) endovascular procedures (6,018 for aSAH, 6,463 for UIAs) were performed.
Trainee exposure to microsurgery in aSAH declined from 9.1 to 7.3 cases per trainee
per annum (mean 7.7), with case complexity confined mostly to simple anterior circulation
aneurysms. There are significant state-by-state differences in the preferred treatment
modality for aSAH. During the same study period, the number of microsurgical cases
for UIAs increased (from 8.9 to 13.5 cases per trainee per annum, mean 11.0). Significantly
more endovascular procedures are performed than microsurgery (10.7 to 17.0, mean 12.7
cases, for aSAH; 8.0 to 21.5, mean 13.7 cases, for UIAs).
Conclusions
Trainee exposure to open aneurysm surgery for aSAH have significantly declined in
both case volume and complexity. There is an overall increase in the number of surgeries
for elective aneurysms, but this varies widely from state-to-state.
Abbreviations:
aSAH (aneurysmal subarachnoid haemorrhage), EVT (endovascular treatment), IA (intracranial aneurysm), ICD-10 AM (International Statistical Classification of Disease, 10th edition, Australian modification), NHMD (National Hospital Morbidity Database), RACS (Royal Australasian College of Surgeons), SET (Surgical Education and Training), UIA (unruptured intracranial aneurysm)Keywords
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Article info
Publication history
Accepted:
January 2,
2023
Received:
November 8,
2022
Identification
Copyright
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