Management of intracranial aneurysms in France: place of microsurgery and demography of vascular neurosurgeons.

Abstract Study design: Observational retrospective survey-based study Introduction: Intracranial Aneurysms (IA) can be treated with microsurgery or by endovascular treatments (EVT). EVT have taken an increasingly important part in IA management; the ability of neurosurgical teams to perform such surgery as well as the quality of their training is being questioned. We therefore wanted to assess the proportion of IA treated by microsurgery in France, the demography and caseload of surgeons trained in vascular neurosurgery. Methodology: A 60-question survey was sent to the 34 French neurosurgical centers treating IA. 27 questions dealt with the demography of neurovascular surgeons and caseload. Descriptive data are reported here. Results: 27 centers answered, giving us a response rate of 79.4%. A total of 209 neurosurgeons worked in these centers. 46 neurosurgeons were designated as referents in vascular neurosurgery, 47% of them were under 45 years old. 96.3% of the centers had at least one surgeon that was a referent in neurovascular surgery. A total of 88 surgeons performed IA surgery, but only 11 operated more than 20 IA per year. 2437 unruptured IA were treated every year in these centers, 25% of which by microsurgery. A total of 2727 ruptured IA were treated in these centers, of which 15% were treated by microsurgery. The most common indications for microsurgical treatment of IA were: middle cerebral artery aneurysms, wide-neck intracranial aneurysms, and giant intracranial aneurysms, as well as aneurysms associated with a hematoma for the ruptured ones. Conclusion: Demography of vascular neurosurgeons remains favorable, with a referent neurosurgeon in most centers, who in half of the cases is a young practitioner. The percentage of microsurgery in the treatment of IA is low, especially for ruptured ones. The most frequently operated types of intracranial aneurysm correspond to good practice recommendations.