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Van Der Veken J, Van Velthoven V, Reuter G, De Vleeschouwer S, Menovsky T, Duerinck J, Bruneau M. From knife to needle - the trend of vascular neurosurgery in Belgium. BRAIN & SPINE 2024; 5:104158. [PMID: 39802865 PMCID: PMC11719377 DOI: 10.1016/j.bas.2024.104158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Revised: 11/30/2024] [Accepted: 12/08/2024] [Indexed: 01/16/2025]
Abstract
Introduction The management of neurovascular pathologies has changed globally over the last few decades. Endovascular treatments are increasing, and fewer surgical procedures are performed. Research question Evaluate the evolution of vascular neurosurgery in Belgium over the last 30 years and compare with other countries. Material and methods Belgian nationwide data was obtained from 1991 to 2021 via the National Institute for Health and Disability Insurance (INAMI-RIZIV). Cost of surgical and endovascular implants used in 2022 was obtained. Results Over a 30-year period a total of 37,504 procedures were performed in Belgium, consisting of 13,767 (36.7%) surgeries and 23,737 (63.3%) endovascular treatments (EVT).Adjusted to population per 100000, surgical management peaked at 6.02 in 1996 and gradually dropped below 3.0 in 2019. EVT increased from 1.06 in 1991 to 10.5 in 2021.Important regional differences are seen in terms of total number of procedures as well as ratio of surgery to endovascular surgery.The total cost of surgical implants in 2022 was the equivalent of 1% of the total cost of endovascular implants. Discussion and conclusions This data confirms a similar trend to other regions in the world: a reduction in surgical management and increase in endovascular management for CNS vascular pathologies.Important regional differences are noted in terms of volume and ratio of endovascular to surgery.A nationwide registry based on patient data and outcomes can help decide whether there should be centralization to manage vascular pathologies.
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Affiliation(s)
- Jorn Van Der Veken
- Department of Neurosurgery, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Vera Van Velthoven
- Department of Neurosurgery, Universitair Ziekenhuis Brussel (UZ Brussel) - Vrije Universiteit Brussel (VUB), Laarbeeklaan 101-103, 1090, Brussels, Belgium
| | - Gilles Reuter
- Department of Neurosurgery, University Hospital of Liège (CHU de Liège), Liège, Belgium
| | | | - Tomas Menovsky
- Department of Neurosurgery, Antwerp University Hospital (UZA), Edegem, Belgium
| | - Johnny Duerinck
- Department of Neurosurgery, Universitair Ziekenhuis Brussel (UZ Brussel) - Vrije Universiteit Brussel (VUB), Laarbeeklaan 101-103, 1090, Brussels, Belgium
| | - Michaël Bruneau
- Department of Neurosurgery, Universitair Ziekenhuis Brussel (UZ Brussel) - Vrije Universiteit Brussel (VUB), Laarbeeklaan 101-103, 1090, Brussels, Belgium
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Metayer T, Dumot C, Bernard F, Le Reste PJ, Bernat AL, Cebula H, Mallereau CH, Peltier C, le Guerinel C, Vivien D, Piotin M, Emery E, Gillard V, Leclerc A, Magro E, Proust F, Pelissou-Guyotat I, Derrey S, Aldea S, Barbier C, Borha A, Nadin L, Briant AR, Gaberel T. Clipping Versus Coiling for Ruptured MCA Aneurysms Associated with Intracerebral Hematoma Requiring Surgical Evacuation. Neurocrit Care 2023; 39:162-171. [PMID: 36991178 DOI: 10.1007/s12028-023-01702-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 02/14/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Ruptured middle cerebral artery aneurysm (MCAa) can lead to intracerebral hematoma, and surgical evacuation can be performed in these cases. MCAa can be treated by clipping or before by endovascular therapy (EVT). Our objective was to compare the impact on the functional outcome of MCAa in patients with intracerebral hematoma requiring evacuation. METHODS This is a multicenter, retrospective, cohort study with nine French neurosurgical units from January 1, 2013, to December 31, 2020. All participants were adult patients who required evacuation of an intracerebral hematoma. We looked for risk factors for poor outcomes by comparing the baseline characteristics and treatments performed by using the 6-month modified Rankin scale score. Poor outcomes were defined by an modified Rankin scale score of 3-6. RESULTS A total of 162 patients were included. A total of 129 (79.6%) patients were treated by microsurgery, and 33 (20.4%) patients were treated by EVT. In multivariate analysis, factors associated with poor outcomes included hematoma volume, realization of a decompressive craniectomy, occurrence of procedure-related symptomatic cerebral ischemia, occurrence of delayed cerebral ischemia, and EVT. In the propensity score matching analysis (n = 33 per group), poor outcomes were observed in 30% of the patients in the clipping group versus 76% in the EVT group (P < 0.001). These differences may have been related to a longer delay between hospital admission and hematoma evacuation in the EVT group. CONCLUSIONS In the specific subgroup of ruptured MCAa with intracerebral hematoma that requires surgical evacuation, clipping with concomitant hematoma evacuation could provide better functional outcomes than EVT followed by surgical evacuation.
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Affiliation(s)
- Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, Caen, France.
- Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain @ Caen-Normandie, Institut National de la Santé et de la Recherche Médicale, University of Caen Normandy, Cyceron, France.
- Service de Neurochirurgie, CHU de Caen, Avenue de la Côte de Nacre, 14000, Caen, France.
| | - Chloe Dumot
- Department of Neurosurgery, Hospices Civils de Lyon, Lyon, France
| | - Florian Bernard
- Department of Neurosurgery, University Hospital of Angers, Angers, France
| | | | - Anne-Laure Bernat
- Department of Neurosurgery, Lariboisière Hospital, University of Paris Diderot, Paris, France
| | - Helene Cebula
- Department of Neurosurgery, University Hospital of Strasbourg, Strasbourg, France
| | | | - Charles Peltier
- Department of Neurosurgery, University Hospital of Brest, Brest, France
| | | | - Denis Vivien
- Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain @ Caen-Normandie, Institut National de la Santé et de la Recherche Médicale, University of Caen Normandy, Cyceron, France
| | - Michel Piotin
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, France
- Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain @ Caen-Normandie, Institut National de la Santé et de la Recherche Médicale, University of Caen Normandy, Cyceron, France
| | - Vianney Gillard
- Department of Neuroradiology, University Hospital of Rouen, Rouen, France
| | - Arthur Leclerc
- Department of Neurosurgery, University Hospital of Caen, Caen, France
| | - Elsa Magro
- Department of Neurosurgery, University Hospital of Brest, Brest, France
| | - Francois Proust
- Department of Neurosurgery, University Hospital of Strasbourg, Strasbourg, France
| | | | - Stephane Derrey
- Department of Neuroradiology, University Hospital of Rouen, Rouen, France
| | - Sorin Aldea
- Department of Neurosurgery, Rothschild Foundation Hospital, Paris, France
| | - Charlotte Barbier
- Department of Neuroradiology, University Hospital of Caen, Caen, France
| | - Alin Borha
- Department of Neurosurgery, University Hospital of Caen, Caen, France
- Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain @ Caen-Normandie, Institut National de la Santé et de la Recherche Médicale, University of Caen Normandy, Cyceron, France
| | - Lawrence Nadin
- Biostatistics and Clinical Research Unit, University Hospital of Caen Normandy, Caen, France
| | - Anais R Briant
- Biostatistics and Clinical Research Unit, University Hospital of Caen Normandy, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, France
- Physiopathology and Imaging of Neurological Disorders, Institut Blood and Brain @ Caen-Normandie, Institut National de la Santé et de la Recherche Médicale, University of Caen Normandy, Cyceron, France
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Lopez C, Frechon P, Seizeur R, Emery E, Pelissou-Guyotat I, Proust F, Thines L, Gaberel T, Magro E. What is the role of neurosurgeons in the current management of intracranial aneurysm in France? An analysis of professional practices. Neurochirurgie 2021; 68:16-20. [PMID: 34246662 DOI: 10.1016/j.neuchi.2021.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/27/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
STUDY DESIGN Retrospective observational survey-based study. INTRODUCTION In France, intracranial aneurysm (IA) patients are managed by neurosurgeons and by interventional neuroradiologists. The growth of endovascular treatment led us to reflect on the role of neurosurgeons in the management of patients with IA. The present study aimed to highlight the current organization of IA management in France. METHOD A 60-question survey was sent to the neurosurgeons in 34 hospitals managing IA patients. Thirty-three questions dealt with standards of care, follow-up procedures and the involvement of the specific specialist. RESULTS Twenty-seven centers (79.4%) responded to the survey. A Vascular Multidisciplinary Discussion Team was organized, including both surgeons and neuroradiologists, in 92% of responding centers. There were department protocols in 66% of centers, a local registry in 33% and clinical trials in IA in 60%. Patients with unruptured IA were first seen by a neurosurgeon or by an interventional neuroradiologist, with different practices. For ruptured IA, the neurosurgeons were contacted first in 93% of cases, and were systematically involved in initial intensive care unit management. The patients were hospitalized in the neurosurgery department in 89% of the centers. The neurosurgeons took care of initial follow-up in 85% of the centers, and of lifetime follow-up in 36%. In most centers, radiological monitoring of IA was based on MRI angiography for patients who were embolized or under surveillance, and on CT angiography after microsurgery. CONCLUSION Despite the growth of endovascular treatments, the present survey and the literature highlight a major role of neurosurgeons in treatment, follow-up and care coordination.
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Affiliation(s)
- C Lopez
- Department of Neurosurgery, CHRU de la Cavale Blanche, Boulevard Tanguy-Prigent, 29609 Brest cedex, France.
| | - P Frechon
- CHU Caen, Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France
| | - R Seizeur
- Department of Neurosurgery, CHRU de la Cavale Blanche, Boulevard Tanguy-Prigent, 29609 Brest cedex, France; Université de Bretagne Occidentale, INSERM, UMR 1101, LaTIM, Laboratoire de Traitement de l'Information Médicale, 29200 Brest, France
| | - E Emery
- CHU Caen, Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France; Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, 14000 Caen, France
| | - I Pelissou-Guyotat
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Department of Neurosurgery, 59, Boulevard Pinel, 69667 Bron, France
| | - F Proust
- Department of Neurosurgery, Hautepierre Hospital Strasbourg, University Hospital, 67098 Strasbourg, France
| | - L Thines
- Neurosurgery Department, Besançon University Hospital, 3, Boulevard Alexandre Fleming, 25030 Besançon cedex, France
| | - T Gaberel
- CHU Caen, Department of Neurosurgery, Caen University Hospital, Avenue de la Côte de Nacre, 14033 Caen, France; Normandie Université, UNICAEN, INSERM, UMR-S U1237, Physiopathology and Imaging of Neurological Disorders (PhIND), GIP Cyceron, 14000 Caen, France
| | - E Magro
- Department of Neurosurgery, CHRU de la Cavale Blanche, Boulevard Tanguy-Prigent, 29609 Brest cedex, France; Université de Bretagne Occidentale, INSERM, UMR 1101, LaTIM, Laboratoire de Traitement de l'Information Médicale, 29200 Brest, France
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