The combined approach to XXXX treatment.

@entity1 @entity439 @entity14600 @entity438
BACKGROUND: A consecutive series of @entity1 with @entity438 in the practice of one neurovascular surgeon was retrospectively reviewed to illustrate that one physician can become proficient in microneurosurgery as well as endovascular surgery and achieve favorable outcomes in both disciplines. This supports one model of training for cerebrovascular surgeons that includes the complimentary practice of open microneurovascular surgery with endovascular surgery. METHODS: The senior author ( @entity14600 ) treated 351 @entity1 with 413 @entity439 between July 2001 and March 2007. Of these, 172 @entity1 (216 @entity439 ) were treated with open microneurosurgical techniques and 179 @entity1 (197 @entity439 ) were treated using endovascular techniques. RESULTS: Complete obliteration was attained in 94.3% of clipped @entity439 , and 61.9% and 65.9% of coiled @entity439 immediately and after at least 6 months of follow-up, respectively. At latest evaluation, 93% of endovascular @entity1 and 90% of microneurosurgical @entity1 had good clinical outcomes (GOS, 4 or 5; mean follow-up, 23 months; combines ruptured and unruptured cohorts). Procedure-related mortality included 1 surgical @entity1 and 2 endovascular @entity1 . CONCLUSIONS: Because the fields of microvascular and endovascular surgeries are both technically complex, there has been concern that hybrid cerebrovascular surgeons cannot perform each technique with the skill necessary to achieve good outcomes. When compared to clipping and coiling reviews in the neurosurgical literature, we illustrate that one hybrid neurovascular surgeon is capable of attaining great facility in both techniques and that this type of physician will represent one practice model of cerebrovascular specialist in the future. This has potential implications for the training of hybrid cerebrovascular surgeons.
