Document Detail

Lessons learned by personal failures in aneurysm surgery: what went wrong, and why?
MedLine Citation:
PMID:  19609480     Owner:  NLM     Status:  MEDLINE    
PURPOSE: To analyse the intraoperative complications of a single neurosurgeon, with emphasis on devastating intraoperative incidents, and how they possibly could have been avoided. METHODS: All the patients operated upon by the author between 1986 and 2002, i.e. 252 patients with 270 craniotomies for 294 aneurysms, were included. All intraoperative events that possibly could have influenced the clinical outcome were recorded prospectively. RESULTS: A total of 16 cases (6.3% of all the patients) with serious intraoperative incidents were identified. In 11 cases (3.6% of all aneurysms), an intraoperative rupture occurred that was judged to have had mild to severe consequences for the patient. In another four patients (1.6% of all patients), all with unruptured, large aneurysms (>15 mm) of the carotid or middle cerebral arteries, a major vessel occlusion occurred inadvertently. In one patient with a large, unruptured MCA aneurysm, a clip slipped after the closure of the wound, causing a fatal intracerebral haemorrhage. These events had a severe impact on the clinical outcome. In retrospect, most of these incidents could, and should have, been avoided. CONCLUSIONS: It is recommended to start the training of new aneurysm surgeons on patients with small, supratentorial, unruptured aneurysms, followed by ruptured aneurysms in all other supratentorial locations than the anterior communicating artery (ACOM), which is the supratentorial location that should be the last step in the training of independent aneurysm surgeons.
Knut Wester
Publication Detail:
Type:  Journal Article     Date:  2009-07-16
Journal Detail:
Title:  Acta neurochirurgica     Volume:  151     ISSN:  0942-0940     ISO Abbreviation:  Acta Neurochir (Wien)     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-08-25     Completed Date:  2009-11-13     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0151000     Medline TA:  Acta Neurochir (Wien)     Country:  Austria    
Other Details:
Languages:  eng     Pagination:  1013-24     Citation Subset:  IM    
Section for Neurosurgery, Department of Surgical Sciences, University of Bergen, 5021, Bergen, Norway.
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MeSH Terms
Aged, 80 and over
Carotid Artery, Internal / pathology,  surgery
Cerebrovascular Disorders / etiology
Iatrogenic Disease / epidemiology,  prevention & control
Intracranial Aneurysm / pathology,  radiography,  surgery*
Intraoperative Complications / etiology*,  mortality,  prevention & control
Middle Aged
Middle Cerebral Artery / pathology,  surgery
Neurosurgery / education
Neurosurgical Procedures / adverse effects,  mortality
Outcome Assessment (Health Care) / methods
Postoperative Hemorrhage / mortality,  prevention & control
Prospective Studies
Subarachnoid Hemorrhage / mortality,  prevention & control
Teaching / standards
Treatment Failure
Vascular Surgical Procedures / adverse effects,  mortality
Young Adult

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