Introduction: Background: For sustainability of AVM surgery, results from early career
cerebrovascular neurosurgeons (ECCNs) must be acceptably safe.
Objective: To determine whether, ECCNs performance of SPC A resection can be
Methods: ECCNs completing a cerebrovascular Fellowship (2004-2015) with the last
author were included. Inclusion of the ECCN cases occurred if they: had a prospective
database of all AVM cases since commencing independent practice; were the primary
surgeon on SPC A; and had made the significant management decisions. All SPC A
surgical cases from the beginning of ECCN's independent surgical practice to a
maximum of eight years. An adverse outcome was considered a complication of
surgery leading to a new permanent neurological deficit with a last modified Rankin
Scale score >1. A cumulative summation (Cusum) plot examined the performance of
each surgery. The highest acceptable level of adverse outcomes for the Cusum was
3.3%, derived from the upper 95% CI of the last author's reported series.
Results: 6 ECCNs contributed 110 cases for analysis. The median number of SPC A
cases operated by each ECCN was 16.5 (range 4-40). Preoperative embolization was
performed in 5 (4.5%). The incidence of adverse outcomes was 1.8% (95%CI: <0.01-
6.8%). At no point during the accumulated series did the combined cohort become
unacceptable by the Cusum plot.
Conclusions: ECCNs with appropriate training appointed to large-volume
cerebrovascular centers can achieve results for surgery for SPC A that are not
appreciably worse than those published from high-volume neurosurgeons. Surgical techniques can codified, be learned and applied for good results early in a one's career, justify continuing surgical care.
Patient Care: Keeping track of surgical results is paramount to delivering the best possible care. This study helps benchmark results of early career neurosurgeons. This information is necessary when making a management decisision for brain AVMs.
Learning Objectives: Results of brain avm surgery for grades 1 and 2. Fellowship training is helpful in achieving good results. Techniques of brain avm resection will be reviewed.