title: Routine multidisciplinary cerebrovascular meetings do not reduce aneurysm clipping case load: a cohort study.
abstract: BACKGROUND
  Structured multidisciplinary care is an increasingly popular tool in the management of many complex disease processes; however, there is little published data regarding the effects of such a process on management of intracranial aneurysms and neurosurgical case loads. There is some resistance in the neurosurgical community to routine involvement of interventional neuroradiologists in the care of patients with intracranial aneurysms due to concerns regarding maintenance of neurosurgical case loads and training capabilities. At our tertiary Australian hospital, we have implemented a weekly multidisciplinary cerebrovascular meeting (MDCVM) facilitating routine discussion of these cases between neurosurgeons and interventional neuroradiologists.
  
  
  METHODS
  This study identified management modalities for ruptured and unruptured cerebral aneurysms diagnosed at our centre for a 2-year period before and after the implementation of MDCVM culminating in a 4-year retrospective cohort study. The pre- and post-MDCVM cohorts were well matched for demographics with 162 and 224 patients, respectively.
  
  
  RESULTS
  There is no significant difference in percentage or absolute numbers of endovascular or surgical cases in the pre-MDCVM (103; 73.0% versus 38; 27.0%, respectively) or post-MDCVM cohorts (105; 79.5% versus 27; 20.5%, respectively), reflecting a maintained surgical case load after the implementation of MDCVM (P = 0.21). There were no significant differences in any confounding variables including age, sex, aneurysm size/location, Fisher or World Federation of Neurosurgical Societies (WFNS) grade.
  
  
  CONCLUSIONS
  Implementation of MDCVM did not impact on active management case loads with consistent numbers and percentages for both endovascular and microsurgical management.
authors.affiliation: Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Brendan W
authors.initials: BW
authors.lastname: Davis
authors.affiliation: Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Stuart
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Pravitha
authors.initials: P
authors.lastname: Jayapratap
authors.affiliation: Department of Neurosurgery, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Bruce I
authors.initials: BI
authors.lastname: Hall
mesh_terms: D017542:Aneurysm, Ruptured / Q000601:surgery*; D001315:Australia; D015331:Cohort Studies; D003226:Congresses as Topic; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: aneurysm; clipping; coiling; multidisciplinary; stenting