Is surgical clipping becoming underused?

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Neurology

Background:

• Coil embolization is a common treatment for intracranial aneurysms, particularly those in the posterior circulation.
• Despite technological advancements and a minimally invasive approach, coil embolization has inherent limitations.
• The widespread adoption of coil embolization may overshadow alternative treatments.

Purpose of the Study:

• To analyze the impact of coil embolization's rise on the utilization of surgical clipping for intracranial aneurysms.
• To highlight potential underuse of surgical clipping due to evolving treatment trends and surgeon expertise.

Main Methods:

• Review of data concerning the introduction and diffusion of coil embolization since 1991.
• Analysis of trends in the application of surgical clipping for intracranial aneurysms.
• Assessment of the availability of trained vascular neurosurgeons for surgical clipping.

Main Results:

• Coil embolization, introduced in 1991, has seen progressive diffusion as a treatment for intracranial aneurysms.
• There is a concern that surgical clipping may be underused.
• A shortage of vascular neurosurgeons trained and experienced in surgical clipping is a contributing factor.

Conclusions:

• While coil embolization is effective for select intracranial aneurysms, its limitations should not be overlooked.
• The increasing reliance on coil embolization may lead to the underutilization of surgical clipping.
• Addressing the shortage of experienced vascular neurosurgeons is crucial for maintaining surgical clipping as a viable treatment option.