Intracranial aneurysm treatment in France

The prevalence of brain aneurysms is rising in many European countries. For instance, in France, ~2.5% of the adult population suffers from intracranial aneurysms. Further, certain strategic initiatives by the government to treat patients suffering from brain aneurysms are also driving the growth of the brain aneurysm market in Europe. For instance, the French government implemented an analysis of treatment by the endovascular approach of non ruptured aneurysms. The program was conducted to check the feasibility of the endovascular approach for the treatment of non-ruptured brain aneurysms 1)

Frechon et al. wanted to assess the proportion of Intracranial aneurysm surgery in France, the demography and caseload of surgeons trained in vascular neurosurgery.

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.

27 centers answered, giving 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.

Demography of vascular neurosurgeons remains favorable, with a referent neurosurgeon in most centers, who is 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 2).

A prospective French Observatory study showed very good safety of aneurysm treatment with the Woven EndoBridge WEB, with a high rate of adequate aneurysm occlusion at 1 year (79.3%) 3).

Endovascular treatment of intracranial aneurysms by using Matrix detachable coils is feasible and demonstrated initial angiographic results and overall morbidity and mortality rates that are within the ranges found in the literature in the use of bare platinum coils 4).

Frechon P, Lopez C, Emery E, Seizeur R, Pelissou-Guyotat I, Proust F, Thines L, Magro E, Gaberel T. Management of intracranial aneurysms in France: place of microsurgery and demography of vascular neurosurgeons. Neurochirurgie. 2021 Mar 22:S0028-3770(21)00073-4. doi: 10.1016/j.neuchi.2021.03.003. Epub ahead of print. PMID: 33766562.
Pierot L, Moret J, Turjman F, Herbreteau D, Raoult H, Barreau X, Velasco S, Desal H, Januel AC, Courtheoux P, Gauvrit JY, Cognard C, Molyneux A, Byrne J, Spelle L. WEB Treatment of Intracranial Aneurysms: Clinical and Anatomic Results in the French Observatory. AJNR Am J Neuroradiol. 2016 Apr;37(4):655-9. doi: 10.3174/ajnr.A4578. Epub 2015 Oct 29. PMID: 26514608; PMCID: PMC7960156.
Pierot L, Bonafé A, Bracard S, Leclerc X; French Matrix Registry Investigators. Endovascular treatment of intracranial aneurysms with matrix detachable coils: immediate posttreatment results from a prospective multicenter registry. AJNR Am J Neuroradiol. 2006 Sep;27(8):1693-9. PMID: 16971616.
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