PerspectivesCerebral Aneurysm Clipping/Coiling 101
Section snippets
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
References (2)
- et al.
Trends in resident operative teaching opportunities for treatment of intracranial aneurysms
World Neurosurg
(2017) - et al.
Unruptured cerebral aneurysm clipping: association of combined open and endovascular expertise with outcomes
J Neurointerv Surg
(2016)
Cited by (2)
Use of Per-Operative Angiogram and Doppler Ultrasound as an Adjunct to Assess the Cerebral Vessels Following Aneurysmal Brain Surgery
2023, Pakistan Armed Forces Medical JournalAnalysis on Characteristics of Magnetic Resonance Imaging Image under Low-Rank Matrix Denoising Algorithm in the Diagnosis of Cerebral Aneurysm
2021, Computational and Mathematical Methods in Medicine
Commentary on: Trends in Resident Operative Teaching Opportunities for Treatment of Intracranial Aneurysms by Piazza et al. World Neurosurg 103:194-200, 2017