Clipping of Intracranial Aneurysms by Neurosurgical Trainees Is Safe and Effective: A Statewide Retrospective Cohort of 614 Consecutive Cases in Queensland, Australia.
Objective: Craniotomy and clipping of intracranial aneurysms remain some of the most technically challenging procedures in neurosurgical practice. There are no contemporary published data to describe the safety and efficacy of these procedures when performed by neurosurgical trainees. This study aims to report the outcomes of intracranial aneurysm clipping procedures performed by neurosurgical trainees.
Methods: All consecutive patients undergoing microsurgical clipping of intracranial aneurysms at public hospitals in Queensland in the period from 1/1/2018 to 1/1/2024 were identified from retrospective review of operating theater databases at all adult public/teaching neurosurgical hospitals. Procedures where the primary operator was a neurosurgical trainee were included. Clinical and radiological outcomes were assessed by review of the medical records and perioperative imaging, in duplicate.
Results: Six hundred fourteen patients underwent microsurgical clipping of intracranial aneurysms in the state of Queensland during the study period, 506 of which occurred in public teaching hospitals. One hundred twelve (22%) of these procedures were performed by neurosurgical trainees as the primary operator. A total of 63/112 (56%) were unruptured. A total of 74/112 (66%) aneurysms were on the middle cerebral artery. A downgrade of ≥1 point on the modified Rankin scale (mRS) occurred in 7/63 (11.1%) unruptured and 22/74 (44.9%) ruptured cases where a trainee was the primary operator. Complete aneurysm clipping was confirmed on postoperative angiography in 106/112 (95%) cases. Comparison with cases completed by senior neurosurgeons in the same institutions showed that cases performed by trainees were shorter in duration (mean 252 vs 299 min, P < .001), less likely to be ruptured (44% vs 58%, P = .02), and less likely to suffer an mRS downgrade (6-month mRS 0-2: 87% vs 76%, P = .02).
Conclusions: This series suggests that in appropriately selected cases and with appropriate supervision, the primary operator role in clipping of both ruptured and unruptured aneurysms can be safely performed by senior neurosurgical trainees.