Endovascular Question

[TUGM]

Any one have any insight into endovascular neurosurgery practice models? Are 100% endovascular practices common? Lifestyle? Salary? What are the bread and butter cases?

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[Zedor]

Idk but I'd assume 100 percent endovascular is possible given the pathway of interventional neuro IR. Nsg allows for both the surgical and endovascular components of a procedure..ie. being able to embolize an arm and subsequently take pt to OR for resection. An or guy would only be able to embo and then nsg would have to resect.

 

[TUGM]

Idk but I'd assume 100 percent endovascular is possible given the pathway of interventional neuro IR. Nsg allows for both the surgical and endovascular components of a procedure..ie. being able to embolize an arm and subsequently take pt to OR for resection. An or guy would only be able to embo and then nsg would have to resect.

No offense, but I'm not sure if this is accurate, and slightly confusing. Endovascular and Cerebrovascular/Skull Base fellowships remain distinct specialties. There are some combined "clip-and-coil" fellowships available, but they seem to be rarities. Though I'm sure surgeons with excellent general neurosurgery training can perform basic angiography and uncomplicated cerebrovascular/skull base cases, to perform any complicated procedure, they should be fellowship trained. Unless you are trained in endovascular AND cerebrovascular/skull base, you would NOT be able to embolize an AVM and subsequently take a patient to the OR for resection. (On a slight tangent, I think AVMs are treated w/ one or the other, and if the treatment fails, a follow up procedure is scheduled; sometimes, tumors are embolized prior to surgical resection to decrease the vascularity).

Also, there is a large misconception that interventionalists do not manage their own complications. If there is a vessel perforation or wire embolus, it is managed endovascularly w/ balloon occlusion and snare retrieval, respectively. Only in the case of an extensive and profuse perforation causing life-threatening increase in ICP is an emergency craniotomy warranted, and is performed by the neurosurgeon.

I suppose I should rephrase my question: Do a lot of endovascular neurosurgeons also perform general neurosurgery, or do they dedicated their practices entirely to endovascular work? What are the differences in lifestyle, salary, call, etc? Don't worry about the bread and butter cases, already know them. Thanks.

 

[badasshairday]

No offense, but I'm not sure if this is accurate, and slightly confusing. Endovascular and Cerebrovascular/Skull Base fellowships remain distinct specialties. There are some combined "clip-and-coil" fellowships available, but they seem to be rarities. Though I'm sure surgeons with excellent general neurosurgery training can perform basic angiography and uncomplicated cerebrovascular/skull base cases, to perform any complicated procedure, they should be fellowship trained. Unless you are trained in endovascular AND cerebrovascular/skull base, you would NOT be able to embolize an AVM and subsequently take a patient to the OR for resection. (On a slight tangent, I think AVMs are treated w/ one or the other, and if the treatment fails, a follow up procedure is scheduled; sometimes, tumors are embolized prior to surgical resection to decrease the vascularity).

Also, there is a large misconception that interventionalists do not manage their own complications. If there is a vessel perforation or wire embolus, it is managed endovascularly w/ balloon occlusion and snare retrieval, respectively. Only in the case of an extensive and profuse perforation causing life-threatening increase in ICP is an emergency craniotomy warranted, and is performed by the neurosurgeon.

I suppose I should rephrase my question: Do a lot of endovascular neurosurgeons also perform general neurosurgery, or do they dedicated their practices entirely to endovascular work? What are the differences in lifestyle, salary, call, etc? Don't worry about the bread and butter cases, already know them. Thanks.

They do both. Not enough volume for them to do 100% endovascular. Not enough volume for anyone really. Surgeons will operate, radiologists will read diagnostics, and neurologists will keep a headache/general neurology clinic.

 

[mmmcdowe]

At major academic centers it is possible. Most choose not to though.

 

[neusu]

Most tend to do both. Their focus is on vascular (e.g. endo and open vascular), however to pay the bills, they do whatever comes in.

 

[SurgeDO]

Guys in my area who are trying to make a name for themselves in the vascular world are clipping and coiling and paying the bills with fusions.