Abstract
In the treatment of cerebral aneurysm, both clipping and coiling are recognized as effective treatments. In Europe and America, clipping is often performed by neurosurgeons and coiling is often performed by neuroradiologists, and they say that coiling is the first choice after a report of ISAT. In Japan, clipping is done by neurosurgeons and coiling is often done by neuroendovascular therapists. Neurosurgeons are also neuroendovascular therapists, so in many hospital's neurosurgeons perform both clipping and coiling. However, in institutions with a high case load, specialization and sharing of roles, has been proceeding nowadays. I have experienced about five hundred cases of clipping and about nine hundred cases of coiling in the treatment of cerebral aneurysm. Recently, I have treated 30〜40 cases with clipping and 110〜120 cases with coiling as the main operator per year. Here I report the selection bias of these cases. As factors in order to decide take between clipping and coiling, there are several elements to consider: the size, shape and position of the aneurysm and patient characteristics (age, complications, severity when ruptured, request for treatment) etc. In fact, this is the result of decision as to which is more profitable. This report is based on my own experiences and I report the selection bias present when both clipping and coiling are done by one neurosurgeon who has plenty of cases.
