Reduced Length of Stay and Hospital Cost for Unruptured Anterior Circulation Aneurysms Treated with Endovascular Coiling or a Minimally Invasive Thumb-Sized Pterional Craniotomy: Single Center Experience and Nationwide Inpatient Sample Data Analysis

Cost-benefit analysis of endovascular treatment compared to open-surgical treatment of cerebral aneurysms in the setting of global economic restrictions is of growing importance. We present our experience with coil embolization and a modified thumb-sized pterional craniotomy for clip ligation of unruptured anterior circulation cerebral aneurysms performed in a major tertiary cerebrovascular center; our experience is then compared to a matched dataset from the Nationwide Inpatient Sample (NIS). In our institutional analysis, all patients were aged 55 years and treated electively for unruptured anterior circulation aneurysms. A matched dataset from the NIS was constructed using patients 55 years with unruptured aneurysms. At our institution, length of stay was half that of NIS for both the surgical clipping group and the endovascular group. Additionally, hospital charges were reduced by one-third for surgical clipping and by approximately one-fourth for endovascular coiling. The cost of clipping vs coiling for unruptured cerebral aneurysms should not undermine the ethics of decision making, but rather should be used as a guide in allocation of hospital resources, manpower and funds. Thumb-sized craniotomies without use of cerebral retractors for clipping provide excellent recovery and show a significant decrease in the postoperative hospital stay as well as a lower cost of hospitalization compared to the national average. High volume centers for treatment of cerebral aneurysms, like ours which is managed by the same neurovascular staff for both treatment options, is an important factor in lowering the length of stay and hospitalization cost.