Elsevier

World Neurosurgery

Volume 104, August 2017, Pages 990-992
World Neurosurgery

Perspectives
Cerebral Aneurysm Clipping/Coiling 101

https://doi.org/10.1016/j.wneu.2017.05.043Get rights and content

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Credentialing

Credentialing to perform aneurysm clipping in the United States requires 2 separate items: a neurosurgical residency diploma and hospital board approval. Credentialing to perform aneurysm coiling/stenting requires only hospital board approval, as there currently is no well-recognized single entity that “vouches” for one's ability to perform endovascular treatment of an aneurysm. Most hospitals engage in neuroendovascular procedures would require some statement from either a fellowship program

Mastering a Skill Set

The process of becoming an independent aneurysm surgeon comprises 5 phases: 1) arranging the operating room and observing, witnessing with minimal hands-on involvement except for perhaps on the opening and closing and manipulation of retractors; 2) some assist under the microscope and/or noncritical time working under the microscope under direct supervision; 3) working with the microscope with a major role, such as fissure splitting or aneurysm dissection under direct supervision, but with the

Paradigm Shift

I think we need to better define our expectations for residency education regarding aneurysm clipping. Most residents are not ready for independent aneurysm clipping when they graduate. Most are stuck in phase 3. Individuals whose first job includes a senior partner with aneurysm clipping experience willing to take the new graduate through the treacherous phase 4 or who pursue a cerebrovascular fellowship can progress to phase 5 safely.

What is the expectation of a residency? Because most

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References (2)

Commentary on: Trends in Resident Operative Teaching Opportunities for Treatment of Intracranial Aneurysms by Piazza et al. World Neurosurg 103:194-200, 2017

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