The Hybrid Neurosurgeon: The Japanese Experience

Yasuhiko Kaku; Takumi Yamada; Shouji Yasuda; Kiyomitsu Kanou; Naoki Oka; Jouji Kokuzawa

doi:10.1007/978-3-030-63453-7_21

The Hybrid Neurosurgeon: The Japanese Experience

Review

In: Trends in Cerebrovascular Surgery and Interventions [Internet]. Cham (CH): Springer; 2021.

2021 May 11.

Authors

Yasuhiko Kaku¹, Takumi Yamada¹, Shouji Yasuda¹, Kiyomitsu Kanou¹, Naoki Oka¹, Jouji Kokuzawa¹

Book Editors

Giuseppe Esposito¹, Luca Regli¹, Marco Cenzato², Yasuhiko Kaku³, Michihiro Tanaka⁴, Tetsuya Tsukahara⁵

Affiliation

¹ Department of Neurosurgery, Asahi University Hospital, Gifu, Japan

Book Affiliations

¹ Department of Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
² Department of Neurosurgery, Ospedale Niguarda Ca’ Granda, Milan, Italy
³ Department of Neurosurgery, Asahi University Hospital, Gifu, Japan
⁴ Department of Neuroendovascular Surgery, Kameda Medical Center, Chiba, Japan
⁵ Department of Neurosurgery, Kyoto Medical Center, Kyoto, Japan

Excerpt

Objective: In Japan, hybrid neurosurgeons who perform both open surgical clipping as well as endovascular embolization for the treatment of intracranial aneurysms are common. Although many Japanese neurosurgeons can perform surgical clipping of middle cerebral artery aneurysms or internal carotid artery—posterior communicating artery aneurysms and coil embolization of cerebral aneurysms using simple techniques—only a limited number of neurosurgeons are able to perform surgical clipping and endovascular procedures for anterior communicating artery aneurysms, paraclinoid, or posterior circulation aneurysms using both treatment modalities equally and safely. Materials and methods: The senior author’s personal experience of more than 500 cases each of surgical clipping and endovascular embolization over the past 25 years included 110 cases of basilar tip aneurysms and 104 cases of paraclinoid internal carotid artery (ICA) aneurysms. Results: The safety and efficacy of both treatments appears to be the same, while the durability of surgical clipping is superior to that of endovascular embolization. Among the 110 basilar tip aneurysms, 18 patients were treated by surgical clipping and 94 were treated by endovascular embolization. The initial results of endovascular therapy seemed to be better than those of surgical clipping, although the rate of retreatment was higher. Among the 104 cases of paraclinoid ICA aneurysm, 23 patients were treated by surgical clipping and 81 were treated by endovascular embolization. The results of both treatments seemed to be same, while surgical clipping had apparently good long-term durability. Over the past 15 years, the frequency of surgical clipping for basilar tip aneurysms has decreased, and the procedure may eventually be abandoned for this type of aneurysm. However, surgical clipping still offers several advantages in the treatment of paraclinoid aneurysms. Conclusions: Hybrid neurosurgeons can make reasonable decisions concerning the choice of treatment for cerebral aneurysms, as they perform both treatments and understand the benefits and drawbacks of each modality.

Sections

Publication types

Review