Microsurgery for intracranial aneurysms: A qualitative survey on technical challenges and technological solutions.

Introduction: Microsurgery for the clipping of intracranial aneurysms remains a technically challenging and high-risk area of neurosurgery. We aimed to describe the technical challenges of aneurysm surgery, and the scope for technological innovations to overcome these barriers from the perspective of practising neurovascular surgeons. Materials and Methods: Consultant neurovascular surgeons and members of the British Neurovascular Group (BNVG) were electronically invited to participate in an online survey regarding surgery for both ruptured and unruptured aneurysms. The free text survey asked three questions: what do they consider to be the principal technical barriers to aneurysm clipping? What technological advances have previously contributed to improving the safety and efficacy of aneurysm clipping? What technological advances do they anticipate improving the safety and efficacy of aneurysm clipping in the future? A qualitative synthesis of responses was performed using multi-rater emergent thematic analysis. Results: The most significant reported historical advances in aneurysm surgery fell into five themes: (1) optimising clip placement, (2) minimising brain retraction, (3) tissue handling, (4) visualisation and orientation, and (5) management of intraoperative rupture. The most frequently reported innovation by far was indocyanine green angiography (84% of respondents). The three most commonly cited future advances were hybrid surgical and endovascular techniques, advances in intraoperative imaging, and patient-specific simulation and planning. Conclusions: While some surgeons perceive that the rate of innovation in aneurysm clipping has been dwarfed in recent years by endovascular techniques, surgeons surveyed highlighted a broad range of future technologies that have the potential to continue to improve the safety of aneurysm surgery in the future.

Neurosurgery as a first foundation year training post.

Neurosurgery has traditionally been regarded as a surgical speciality unsuitable for doctors in their first clinical year after graduation with limited prior experience of such patients. However, the advent of UK Modernising Medical Careers' Foundation Year training and the European Working Time Directive mean neurosurgery is now available as a clinical placement for newly qualified doctors. The authors describe the development of such a post, first implemented in August 2008, which both facilitated safe and effective care of neurosurgical patients and enabled the trainee to achieve many of the goals of UK Foundation training. Suggestions are made for the implementation of further similar posts.