title: Influence of cumulative surgical experience on the outcome of poor-grade patients with ruptured intracranial aneurysm.
abstract: BACKGROUND
  The expansion of endovascular techniques for intracranial aneurysms has led to a global decrease in vascular neurosurgery activity. This situation might impact neurosurgeons' level of expertise, even though they all might have to deal with this surgically challenging pathology. In that context, we wanted to assess the impact of cumulative surgical experience on the outcome of patients with poor-grade subarachnoid haemorrhage (SAH) and intracerebral haemorrhage (ICH) treated by microsurgery.
  
  
  METHODS
  Sixty-seven patients who underwent surgery for a ruptured aneurysm with SAH and ICH, and a WFNS scale of IV/V, were included. Surgeries were performed by five surgeons, whose experience was judged by the total number of aneurysm surgeries performed. The outcome was assessed by three indicators: intraoperative rupture (IOR), early mortality, and the modified Rankin Scale at last follow-up. The time of IOR was reported on an IOR score. The correlation between surgical experience and outcome was assessed by linear regression. Nonlinear regression was used to assess the correlation of the data with a learning curve model.
  
  
  RESULTS
  The analysis showed an influence of surgical experience on intraoperative rupture, with no effect on long-term outcome. No influence was found on early mortality. Increased surgical experience seems to reduce IOR during aneurysm dissection and clip repositioning. Intraoperative rupture data fit Wright's learning curve model.
  
  
  CONCLUSIONS
  This study suggests a direct impact of cumulative experience on the course of ruptured aneurysm surgery and pleads for the use of training and simulation programmes dedicated to neurovascular surgery.
authors.affiliation: Department of Neurosurgery, Pontchaillou University Hospital, 2, Rue Henri Le Guilloux, Rennes, France, pierre-jean.le.reste@chu-rennes.fr.
authors.forename: Pierre-Jean
authors.initials: PJ
authors.lastname: Le Reste
authors.forename: Pierre-Louis
authors.initials: PL
authors.lastname: Henaux
authors.forename: Laurent
authors.initials: L
authors.lastname: Riffaud
authors.forename: Claire
authors.initials: C
authors.lastname: Haegelen
authors.forename: Xavier
authors.initials: X
authors.lastname: Morandi
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D002983:Clinical Competence; D057510:Endovascular Procedures / Q000592:standards*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008866:Microsurgery / Q000592:standards*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000592:standards*; D013345:Subarachnoid Hemorrhage / Q000601:surgery*; D066231:Surgeons / Q000592:standards*; D016896:Treatment Outcome