Introduction: There is a profound role for neurosurgeons’ involvement in the comprehensive treatment of cerebrovascular patients. This specific population encompasses a variety of pathology including intracranial hemorrhage, arteriovenous malformations, cerebral aneurysms and stroke. Recent clinical trials for endovascular treatment of large-vessel occlusion have expanded therapeutic options for acute stroke and requires exposure during neurosurgical residency. Resident education, in being properly prepared to treat and manage these patients, requires a dedicated rotation with exposure to both open and endovascular interventions. We investigated the role of a senior neurosurgical resident during a separate 3- and 12-month neurovascular rotation at a single institution.
Methods: separate 3- and 12-month neurovascular rotation at a single institution.
A post-graduate year 4 resident completed a 12-month rotation or a separate 3-month on the cerebrovascular service at Washington Hospital Center with senior supervising surgeons (RAA, RBM, EFA, AHL). During this time period, the resident was responsible for all patients being managed by the neurosurgical service with attention to vascular-related pathology. The resident was the main focal point for seeing and evaluating vascular patients, communicating issues with the cerebrovascular attendings, and participating in any potential interventions.
Results: For a 12-month block, one resident completed 136 diagnostic cerebral angiograms, 81 therapeutic endovascular interventions along with 30 open neurosurgical procedures. For a separate three-month rotation, another resident completed a total of: 61 diagnostic angiograms, 26 therapeutic interventions, and 15 open neurosurgical operations.
Conclusions: Being facile with both open and endovascular techniques is important in training neurosurgical residents to be adequately prepared managing patients with cerebrovascular disease.. We found that a dedicated neurovascular rotation for a 3-month block provides sufficient exposure in meeting neurosurgical residency mandated minimal requirements. In addition, during a 12-month rotation a resident can begin to develop the necessary skill set to be able to become facile in endovascular or open cerebrovascular techniques.
Patient Care: Our work will show the value of having a dedicated neurovascular experience as part of the neurosurgical curriculum. This in turn will enable the trainee to become more adept at treating and managing complex cerebrovascular patients.
Learning Objectives: 1. Residency programs should formalize in their curriculum a dedicated 3-month neurovascular rotation during the mid-level years.
2. Three months provides sufficient exposure to both open and endovascular interventions to meet ACGME requirements for training.
3. Increased time on the rotation will allow senior residents to begin to develop skills in both open and endovascular techniques.
4. Neurosurgery residents should be an active part of endovascular treatments of cerebrovascular patients.