Education & TrainingEndovascular Neurosurgery in the United States: A Survey of 59 Vascular Neurosurgeons with Endovascular Training
Introduction
Following the efforts of a few pioneers in the late 1980s and early 1990s, endovascular neurosurgery has become an integral part of neurosurgery practice in the United States. Today many large neurosurgery practices have a vascular neurosurgeon on staff who has undergone endovascular training. In April 2009, we conducted a nationwide survey of endovascular neurosurgery practices to examine the training of endovascular neurosurgeons, identify practice patterns, and determine the management of the most common cerebrovascular diseases. Although surveys and polling questions cannot substitute for scientific research and are not necessarily a true reflection of actual practices, they can provide perspective on the various practices and give insight on the interpretation and application of available evidence.
In this report, we summarize the answers to the survey questions to provide a contemporary snapshot of neurointervention in the United States as practiced by neurosurgeons. Answers are presented in a descriptive manner, and we use illustrative figures when appropriate.
Section snippets
Methods
An electronic survey containing questions about training, practice patterns, and management of various cerebrovascular diseases was prepared and sent to 80 vascular neurosurgeons with endovascular training throughout the United States. The addresses were obtained from an informally maintained list of vascular neurosurgeons with endovascular training across the United States. The invitation to participate in the survey was sent with a hyperlink from the research center of our institution.
Demographics
Fifty-five percent of the responders were in academic practice, 38% in private practice, and the rest in government-run institutions (2%) or in various combinations of practice settings (5%). Almost 58% of participants had more than 5 years of experience in interventional practice (Figure 1).
Training
Most (74%) of the respondents had completed a two-year endovascular fellowship as their subspecialty training. Of these, 22% had also completed a one-year cerebrovascular surgery fellowship. A small
General Practice and Training
Endovascular neurosurgery has rapidly gained ground as one of the neurosurgical subspecialties in the United States. This subspecialty is still relatively young, and almost one-half of our respondents had been in practice for less than five years. All of the polled neurosurgeons had received some degree of formal endovascular training. However, as might be expected of a young field, the extent of endovascular training and its relation to open neurosurgical residency varied. Most of the
Conclusions
Despite the numerous limitations of a survey study, the responses of participants provide a fairly comprehensive snapshot of current neurosurgical endovascular practices across the United States. Variability in individual practice is quite often the result of a lack of consensus about the effectiveness and safety of available devices and a lack of evidence-based data, but it also reflects personal and training biases. We hope that some of the observations reported in this report will prompt
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Conflict of interest statement: Dr. Lanzino has received unrestricted educational grants from ev3, Inc, Plymouth, Minnesota, and serves on the Advisory Board of Actelion Ltd, Allschwil, Switzerland.