دورية أكاديمية
Initial experience in the microsurgical treatment of ruptured brain aneurysms in the endovascular era: characteristics and safety of the learning curve in the first 300 consecutively treated patients.
| العنوان: | Initial experience in the microsurgical treatment of ruptured brain aneurysms in the endovascular era: characteristics and safety of the learning curve in the first 300 consecutively treated patients. |
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| المؤلفون: | Vieira E; Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil. evcj2005@gmail.com., Guimarães TC; Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil., Pontes ECA; Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil., Silva ACV; Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil., Carneiro MC; Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil., Netto AU; Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil., Pereira L; Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil., Cezar AB Jr; Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil., Faquini I; Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil., Almeida NS; Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil., Griz MFL; Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil., Azevedo-Filho HRC; Department of Neurological Surgery, Hospital da Restauração, Recife, Brazil. |
| المصدر: | Acta neurochirurgica [Acta Neurochir (Wien)] 2022 Apr; Vol. 164 (4), pp. 973-984. Date of Electronic Publication: 2022 Mar 03. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Springer Country of Publication: Austria NLM ID: 0151000 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 0942-0940 (Electronic) Linking ISSN: 00016268 NLM ISO Abbreviation: Acta Neurochir (Wien) Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: Wien, Springer. |
| مواضيع طبية MeSH: | Aneurysm, Ruptured*/etiology , Endovascular Procedures*/adverse effects , Intracranial Aneurysm*/complications , Subarachnoid Hemorrhage*/complications, Humans ; Learning Curve ; Microsurgery/adverse effects ; Microsurgery/methods ; Retrospective Studies ; Treatment Outcome |
| مستخلص: | Purpose: Currently, there is an increasing tendency to refer only complex aneurysms for microsurgery. The formation of new neurosurgeons dedicated to open vascular neurosurgery becomes challenging in a situation in which complex aneurysms must be dealt with early in the career, raising questions about the safety of the learning curve. Methods: We analyzed the characteristics and surgical results of the first 300 consecutively treated patients after subarachnoid hemorrhage by a single neurosurgeon. The incidence of surgical complications and clinical outcomes during the learning curve were analyzed, looking for critical periods regarding patient safety. Microsurgical operative times were also studied. Results: A high frequency of wide-necked aneurysms was observed (70.3%), and, as a result, large (> 10 mm), MCA and paraclinoid aneurysms were overrepresented. A statistically significant correlation between surgical experience and clinical outcomes was observed, with progressive surgical experience resulting in a lower incidence of unfavorable outcomes. We also observed a higher frequency of major surgical complications, unfavorable clinical outcomes, and lower complete occlusion rates among the first 40 patients. Microsurgical operative times progressively and significantly decreased during the learning curve. Conclusions: We observed a high prevalence of wide-necked aneurysms. Young neurosurgeons must be trained and prepared to deal with these aneurysms early in their careers. Although we observed a decrease in unfavorable results with cumulative surgical experience, the first 40 cases were associated with higher rates of major surgical complications, worse clinical outcomes, and lower complete occlusion rates, indicating that this period may be more critical to patient safety. (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.) |
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| فهرسة مساهمة: | Keywords: Learning curve; Microsurgery; Ruptured aneurysm; Subarachnoid hemorrhage |
| تواريخ الأحداث: | Date Created: 20220303 Date Completed: 20220401 Latest Revision: 20220608 |
| رمز التحديث: | 20240628 |
| DOI: | 10.1007/s00701-022-05165-2 |
| PMID: | 35239013 |
| قاعدة البيانات: | MEDLINE |
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