Published in: Journal of Neurosurgery
Authors: Ian A. Anderson; Ahilan Kailaya-Vasan; Richard J. Nelson; Christos M. Tolias
Year: 2018
Publication details: 130(5):1-7
DOI: 10.3171/2017.12.JNS172759
Publication type: Journal article
Topic: Aneurysm clipping, aneurysm coiling, subarachnoid haemorrhage, microsurgery, neurovascular centres

Simple summary

This study looks at national outcomes for aneurysmal subarachnoid haemorrhage and the relationship between microsurgical aneurysm activity and centre outcomes. It is relevant for explaining why complex aneurysm care benefits from close neurosurgical involvement and careful treatment selection.

Mr Kailaya-Vasan’s involvement

Mr Kailaya-Vasan, consultant neurosurgeon and neurovascular surgeon, is listed as a contributing author on this publication.

Published abstract

The following abstract is reproduced from the original publication and is provided for reference. It may include technical terminology intended for clinical or academic audiences.

Objective: Most intracranial aneurysms are now treated by endovascular rather than by microsurgical procedures. There is evidence to demonstrate superior outcomes for patients with aneurysmal subarachnoid hemorrhage (aSAH) treated by endovascular techniques. However, some cases continue to require microsurgery. The authors have examined the relationship between the number of aneurysms treated by microsurgery and outcome for patients undergoing treatment for aSAH at neurosurgical centers in England. METHODS The Neurosurgical National Audit Programme (NNAP) database was used to identify aSAH cases and to provide associated 30-day mortality rates for each of the 24 neurosurgical centers in England. Data were compared for association by regression analysis using the Pearson product-moment correlation coefficient and any associations were tested for statistical significance using the one-way ANOVA test. The NNAP data were validated utilizing a second, independent registry: the British Neurovascular Group's (BNVG) National Subarachnoid Haemorrhage Database. RESULTS Increasing numbers of microsurgical cases in a center are associated with lower 30-day mortality rates for all patients treated for aSAH, irrespective of treatment modality (Pearson r = 0.42, p = 0.04), and for patients treated for aSAH by endovascular procedures (Pearson r = 0.42, p = 0.04). The correlations are stronger if all (elective and acute) microsurgical cases are compared with outcome. The BNVG data validated the NNAP data set for patients with aSAH. CONCLUSIONS There is a statistically significant association between local microsurgical activity and center outcomes for patients with aSAH, even for patients treated endovascularly. The authors postulate that the number of microsurgical cases performed may be a surrogate indicator of closer neurosurgical involvement in the overall management of neurovascular patients and of optimal case selection.

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This publication page is provided for general information about Mr Kailaya-Vasan’s academic work. It is not medical advice and should not be used to guide individual diagnosis or treatment decisions. Patients should discuss their individual symptoms, diagnosis and treatment options with a specialist.