title: The combined approach to intracranial aneurysm treatment.
abstract: BACKGROUND
  A consecutive series of patients with intracranial aneurysms in the practice of one neurovascular surgeon was retrospectively reviewed to illustrate that one physician can become proficient in microneurosurgery as well as endovascular surgery and achieve favorable outcomes in both disciplines. This supports one model of training for cerebrovascular surgeons that includes the complimentary practice of open microneurovascular surgery with endovascular surgery.
  
  
  METHODS
  The senior author (HAR) treated 351 patients with 413 aneurysms between July 2001 and March 2007. Of these, 172 patients (216 aneurysms) were treated with open microneurosurgical techniques and 179 patients (197 aneurysms) were treated using endovascular techniques.
  
  
  RESULTS
  Complete obliteration was attained in 94.3% of clipped aneurysms, and 61.9% and 65.9% of coiled aneurysms immediately and after at least 6 months of follow-up, respectively. At latest evaluation, 93% of endovascular patients and 90% of microneurosurgical patients had good clinical outcomes (GOS, 4 or 5; mean follow-up, 23 months; combines ruptured and unruptured cohorts). Procedure-related mortality included 1 surgical patient and 2 endovascular patients.
  
  
  CONCLUSIONS
  Because the fields of microvascular and endovascular surgeries are both technically complex, there has been concern that hybrid cerebrovascular surgeons cannot perform each technique with the skill necessary to achieve good outcomes. When compared to clipping and coiling reviews in the neurosurgical literature, we illustrate that one hybrid neurovascular surgeon is capable of attaining great facility in both techniques and that this type of physician will represent one practice model of cerebrovascular specialist in the future. This has potential implications for the training of hybrid cerebrovascular surgeons.
authors.affiliation: Department of Anesthesiology, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, NY 10021, USA.
authors.forename: Brian L
authors.initials: BL
authors.lastname: Alexander
authors.forename: Howard A
authors.initials: HA
authors.lastname: Riina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D002983:Clinical Competence; D003131:Combined Modality Therapy; D003399:Craniotomy; D003479:Curriculum; D004621:Embolization, Therapeutic; D005260:Female; D005500:Follow-Up Studies; D023261:Glasgow Outcome Scale; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D002532:Intracranial Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000193:education; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000193:education; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D013038:Specialization; D013345:Subarachnoid Hemorrhage / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D055815:Young Adult