Look at the patient, not the numbers: Keryn Davidson on clipping, spasm and subtle signs

Keryn Davidson is a vascular neurosurgeon at Royal North Shore Hospital, the first woman in the department’s history, and someone who will tell you plainly that she loves clipping aneurysms. She will also tell you that the correct operation is the one that serves the patient, and that the most important monitor in the unit is still a nurse who notices the patient is “a bit off”.

This is a practical conversation: what she is thinking in the first hours, why prognosis should wait for the resuscitated grade, what an overnight EVD really needs, and why open vascular surgery is more important, not less, as clipping volumes fall.

Worth listening for

• The subtle early signs of spasm: the GCS 15 patient who is picky and agitated, and the senior nurse who says “this one’s going to spasm” and is right.

• EVDs and the Goldilocks problem: under-drainage stretches ventricles, over-drainage causes subdurals, and four hours of not draining is never fine.

• Why stent-assisted coiling and dual antiplatelets change the whole plan for a patient who may later need a shunt.

• The technically perfect bypass that ended badly, and what it taught her about not letting one case distort every case after it.

Where this shows up in the program

On the workshop day, Tuesday 17 November, Keryn co-leads Vascular Neurosurgery for the Non-Surgeon with Leon Lai: a half-day for intensivists, neurologists, anaesthetists and interventionalists who want to see what their surgical colleagues are actually weighing up. Station one is Keryn and Jordan Jones on the microscope with an aneurysm model; station two is Andrew Gauden and Rumal Jayalath on EVD placement. If you have only ever seen the operation from the anaesthetic end, this is the window.

On Thursday, she presents in the Surgical Rescue After aSAH breakout on whether surgery can reduce shunt dependency, alongside David Bervini on refractory ICP and Johnny Wong on microsurgery for refractory vasospasm. The clip-or-coil question she reframes in the episode gets argued case by case on Wednesday, ruptured MCA, ACoA and posterior circulation each in turn, and Julian Maingard covers the CT perfusion evidence she is cautious about on Thursday morning.

Her point about subtle deterioration lands directly on the Wednesday debate Defining Deterioration After aSAH: Do We Need a New Consensus? If our trial endpoints only catch the obvious drop, we are measuring the wrong moment.

Listen above, or go to the full episode and transcript on NeuroResus.

ISAH 2026 runs 17–20 November at the Sheraton Grand Hyde Park, Sydney. See the program or register here.