The development of endovascular procedures has added embolization using coils to surgical clipping as an option for treatment of cerebral aneurysms. To determine trends in incidence of coiling procedures compared to craniotomies for aneurysm clipping, we retrospectively reviewed Medicare data for 1996–2006. The Medicare database collects the CPT codes submitted for Medicare payment. The craniotomy codes for clipping of cerebral aneurysm (61697, 61698, 61700, 61702) and for endovascular embolization (61624) were tabulated for each of the 11 years studied. An ordinary regression model was created to capture the trend in the number of craniotomies performed during the period studied. The number of craniotomies decreased from 3,204 in 1996 to 1,702 in 2006, declining at a rate of 131 per year (95 percent CI). Conversely, the number of endovascular embolizations increased from 808 in 1996 to 5,152 in 2006. The change in the frequency of each type of procedure has significant consequences for neurosurgical training and treatment of cerebral aneurysms.

Read More...