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|NI FEATURE: THE EDITORIAL DEBATE IV-- PROS AND CONS
|Year : 2018 | Volume
| Issue : 6 | Page : 1617-1618
The ‘hybrid’ vascular neurosurgeon: The need of the hour
Veer Singh Mehta
Department of Neurosurgery, Paras Hospitals, Gurugram, Haryana, India
|Date of Web Publication||28-Nov-2018|
Dr. Veer Singh Mehta
Department of Neurosurgery, Paras Hospitals, Gurugram, Haryana
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Mehta VS. The ‘hybrid’ vascular neurosurgeon: The need of the hour. Neurol India 2018;66:1617-8
Dr. Laligam N. Sekhar has elegantly presented his series of 76 cases of very large and giant aneurysms treated surgically over a period of 13 years.
The treatment of aneurysms has been a matter of debate among Neurosurgeons and Neuro- interventionalists since 1990, but till recently, the treatment of choice for giant aneurysms has been surgery. Surgical intervention has been preferred over endovascular treatment because of the low occlusion rates and high recurrence rates associated with endovascular treatment., However, with recent advancements in endovascular techniques and the introduction of devices like flow diverters, an increased scope of endovascular treatment of these types of aneurysms has been in practice.
Xianli Lv et al., in 2017, presented his systemic review of pipeline embolization devices (PED) for giant intracranial aneurysms that was updated until November 20th, 2015. In a total of 9 eligible studies, 40 patients treated with PED were analysed. In a 6-to-34 month follow up duration, complete occlusion was achieved in 23 (57.5%) cases only. Seven (17.5%) patients developed intracranial haemorrhage, 5 (12.5%) developed an ischaemic attack and 13 (32.5%) developed a mass effect after PED treatment.
Chae Wook Huh et al., in 2018, have reported the results of endovascular treatment of very large and giant intracranial aneurysms with parent artery preservation in 24 patients. The immediate occlusion of the aneurysm was possible in 9 (37.5%) cases only, with a remnant neck being found in 6 (25%) and a remnant sac being found in another nine (37.5%) cases. The overall procedure related morbidity and mortality rates were 12.5% and 4%, respectively. The follow-up was available in 16 cases, of which 12 (75%) had a stable occlusion whereas 25% aneurysmal sacs had recanalized.
In the series reported by Sekhar et al., presented in the current issue, a bypass graft was required in 80% of patients having an anterior circulation aneurysm, and in 100% of patients having a posterior circulation aneurysm. The revascularization procedure was performed to occlude the aneurysm, to achieve high success rates with minimal possibility of recurrence. A revascularization procedure came in handy not only in patients undergoing surgery but also in those undergoing an endovascular proximal vessel occlusion as a treatment for a giant aneurysm. It also served as an adjunctive procedure to preserve the distal circulation in patients during the act of implantation of the pipeline device or of coiling of the aneurysm, especially when the circulation through the main blood vessel was occluded for a limited period of time.
It confirms that younger neurosurgeons have to mandatorily learn the bypass techniques, as suggested by Dr. Sekhar.
To my mind, an ideal person dealing with these types of aneurysms is the one who has expertise in both the microsurgical as well as the endovascular techniques, as he/she will be able to perform a correct selection of cases, and tailor the procedure adopted in the best interest of the patient.
| » References|| |
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