Interventional Neuroradiology

[AlbertConstable]

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[Docxter]

What's the standard (and alternate) paths to becoming an Interventional Neuroradiologist?

Also, what are some thoughts on this subspecialty? I will try and get my feet wet with someone in the field within a few months but in the meantime, comments would be appreciated.

Standard: Radiology residency + neuroradiology fellowship+ one year INR fellowship (a few two years)
Alternate: Neurosurgery + some neuroradiology training + two years INR (some places will take neurology residents too)

The field has recently undergone ACGME accreditation (under the auspices of radiology, neurosurgery, and neurology major organizations) and many programs are undergoing ACGME accreditation under the name "Endovascular surgical neuroradiology". The requirements are here:

http://www.acgme.org/acWebsite/downloads/RRC_progReq/422pr403.pdf

Many programs are changing their requirements to fulfill these new ACGME requirements. Though the ACGME requirement is one year, many programs still want the fellow to do two years.

 

[Tenesma]

i have a few neurosurgery friends who did one year fellowships in INR and have incorporated it into their practice... one of them does exclusively INR (however since he is still credentialed as a neurosurgeon he has taken a few back to the OR for ie: carotid dissection, temporal lobectomy/hemicrani)

 

[entropy]

Are there any direct or integrated NIR programs similair to the ones that exist for VIR?
If so where are they and how have they been recieved (filling or not)?

 

[Docxter]

Are there any direct or integrated NIR programs similair to the ones that exist for VIR?
If so where are they and how have they been recieved (filling or not)?

None like the integrated VIR pathway. There are three active combined programs in radiology/neurology/neuroradiology. They started out about 6-7 years ago, but two have since closed due to lack of enthusiasm and that a majority of their residents ended up wanting to do radiology only. Hopkins recently added a new one. They don't have a full INR curriculum, but you'll end up doing some INR depending on the program.

 

[Docxter]

i have a few neurosurgery friends who did one year fellowships in INR and have incorporated it into their practice... one of them does exclusively INR (however since he is still credentialed as a neurosurgeon he has taken a few back to the OR for ie: carotid dissection, temporal lobectomy/hemicrani)

This field requires a lot of initial and on-going experience to be good. Unless your friends are god's gift to humanity (which I doubt they are), with only one year of training and only part-time INR practice, their technical skills will be mediocre at best. I seriously doubt that they will be the best person for the very complex cases, maybe just for IA thrombolysis and coiling of a straight forward narrow-neck aneurysm. But then again, many neurosurgeons have a high tolerance for poor outcome. I am not saying that neurosurgeons aren't able to do it or do it very well, but in my own experience and INR people I know (having done some INR and having gone to the conferences and case discussion clubs), the ones with minimal training and part-time INR practice are not technically good at all, leading to a uncomfortably high complication rate. And complications in INR are usually disastrous complications for the patient.

 

[Bonobo]

As I understand it there are three paths to INR:

1. Radiology to Neuroradiology to INR
2. Neurosurgery to INR
3. Neurology to vascular neurology to INR

These are specified explicitly in the ACGME guidelines for endovascular surgical neuroradiology (i.e. INR), and all require 3+ months training in neurological examination, neuroradiology, and neurosurgery. The third path is difficult in the sense that there are only half a dozen programs that regularly take neurologists and another half a dozen that take them rarely. The first two paths are commonplace now.

Regarding which path is better: it depends partly on where you would like to practice. If you want to practice at a very large academic institution, option 1 will almost clearly train you best in the procedures themselves and allow you to have the support of other clinical specialties. If you want to practice INR privately, or at a much smaller institution, you will probably be best off with option 2 so that you can deal with the complications (unless you can find a neurosurgeon on call to take care of them for you... good luck!). I should note that path 3 is really designed for those who want to specialize in basic stroke INR procedures like IA thrombolysis and stenting so that complete stroke care can be delivered by a single physician. Path 3 INR folks are more akin to interventional cardiologist than interventional radiologists in the scope of their work.

In other words, if you want to be a maverick interventionalist at an academic institution and are sure about it, take option 1. If you want to work privately or are not sure about INR, take option 2 so that you can take the patient back if you need to or fall-back yourself on a different profession. If you want to be an 'interventional neurologist' for stroke patients, take option 3.

B

 

[Docxter]

Didn't the Hopkins neurosurgeon Ben Carson incorporate INR to 3-D map the conjoined twins' brains and successfully separate them? Or was that some sort of advanced imaging technique?

If I wanted to take Docxter's "Alternate" path, how long would it take after med school? 'Bout 7 years?

The world's most famous and accomplished interventional neuroradiologist, Pierre Lasjaunias from France, was involved in their care in Singapore and did the cerebral angios. Also, Ben Carson was an assistant surgeon in the operation. Keith Goh from Singapore was the primary surgeon. The mapping was some sort of advanced imaging by CT and MR, the details of which I don't know.