One of the most impressive studies on the outcomes of the two treatments for intracranial aneurysms, the International Subarachnoid Aneurysm Trial (ISAT) was presented in 2002 1). It suggested that the ruptured intracranial aneurysm treated endovascularly had a better one-year outcome, maintained at seven years, in terms of neurodisability and seizures. An increased risk of delayed rebleeding compared with the aneurysm treated surgically was seen. The practice of radiological follow up to identify the possible recurrence was encouraged, and rates of prophylactic retreatment following endovascular therapy were noted to be higher that for open surgery.
The Food and Drug Administration (FDA) approved Deep brain stimulation DBS as a treatment for essential tremor in 1997, for Parkinson's disease in 2002, dystonia in 2003, and obsessive compulsive disorders, in 2009. DBS is also used in research studies to treat chronic pain, PTSD, and has been used to treat various affective disorders, including major depression; neither of these applications of DBS have yet been FDA-approved. While DBS has proven effective for some patients, potential for serious complications and side effects exists.
In 2002, Lindsay et al.in the United Kingdom mentioned that performing many operative procedures does not necessarily mean that the trainee has received good training; nor does it ensure that the procedures were performed well. Furthermore, they underscored that if a training committee were to set a target number of procedures, the danger is that trainees would spend their time chasing operative numbers rather than ensuring that they obtain balanced neurosurgical training 2).