title: The influence of surgical experience on the rate of intraoperative aneurysm rupture and its impact on aneurysm treatment outcome.
abstract: BACKGROUND
  The influence of surgical experience on the result of aneurysm surgery remains unclear. To determine the impact of surgical experience we considered the occurrence of intraoperative aneurysm rupture (IAR) during microneurosurgery for intracranial aneurysms as an objective factor that could be evaluated.
  
  
  METHODS
  A retrospective study was performed on 379 consecutive patients with 490 cerebral aneurysms operated upon from 1989 to 1995.
  
  
  RESULTS
  IAR occurred in 6.7% of aneurysms and 8.7% of patients. There was a direct inverse relationship between the annual caseload of the surgeon and the risk of IAR. New neurological deficits (NND) occurred in 21% of patients with IAR, which accounts for 1.8% of NND in all patients with aneurysms.
  
  
  CONCLUSIONS
  Although there seems to be a direct relationship between surgical experience and the risk of IAR, the impact on the overall treatment outcome of cerebral aneurysms is rather limited.
authors.affiliation: Neurosurgical Department, University of Mainz, Mainz, Germany.
authors.forename: E J
authors.initials: EJ
authors.lastname: van Lindert
authors.forename: H G
authors.initials: HG
authors.lastname: Böcher-Schwarz
authors.forename: A
authors.initials: A
authors.lastname: Perneczky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D005260:Female; D023261:Glasgow Outcome Scale; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D007431:Intraoperative Complications; D008297:Male; D008866:Microsurgery / Q000009:adverse effects; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D016526:Workload