It is true that neurosurgeons have fellowships in InterventionalNeuro. But there are already lots of intracranial procedures which neurosurgeons do. This includes stereotactic surgery, radiosurgery, epilepsy surgeries , endoscopy and minimally invasive neurosurg to name a few. Then there are many skull base procedures and spinalcord surgeries which will remain a neurosurgeons domain. So only a proportion of ns go into this fellowship. I mean to say that there are lots of invasive things. Having been a neurosurg resident for a few years in my country , i know for sure that no neurosurgeon can claim to be an expert at all procedures or even do them for that matter , simply because of the overwhelming number of procedures. Whereas the only intervention in neurology could be endovascular management if it continues to evolve. This is also one way of making neurology more glamorous for american med students to pursue as a career.
If we see the way modern cardiology has evolved from purely medical management to a dynamic procedure based field , neurology is moving along the same lines , although it is a few decades behind cardio . A patient coming to a cardiologist in early days would be admitted , recorded ecg and enzymes and started on medication and monitored. Now depending on indication cardiologist will proceed to cardiac cath , angioplasty if needed. In early days after angiogram it used to be the cardiac surgeons job after referral from cardiologist or internist . THE IMPORTANT THING IS THAT THE PATIENT COMES TO PHYSICIAN and if needed goes to surgeon. Modern medicine is moving in a direction when surgical fields are becoming less invasive and medical fields become more invasive.
Similarly certain congenital anomalies (ASD , VSDs) are being treated by ped cardiologists using intervention procedures.
A patient with acute stroke goes to ER and if admitted , certainly goes to a neurologist. Similarly many patients of cerebral hemorrhage who need intensive care are managed by neurologists. The mentality behind starting these fellowships is that if neurologists have to manage these cases , let them train to start intervention too. The inspiration for intervention in neurology seems to have come from the way various medical subspecialities as cardio , gastro have evolved , even anesthesia.
I was speaking to a neurology resident at UCLA . One of his senior was accepted for a stroke fellowship with intervention. This fellowship is at least 3 yrs with one year in stroke and critical care (including transcranial doppler) and 2 yrs in intervention. The duration of endovascular training is same as int.neurorad. with an added advantage of clinical exposure in cerebrovasc disease.
Within a few yrs such fellowships have also come up in UMDNJ , Wayne state univ and other places. I was told that American acad of neur is developing a fellowship core curriculum for certification to dev a career in this field. But this is the beginning.
All i am saying that neurosurgery has a vast procedural domain and if there is anything which needs a craniotomy procedure , it will certainly go to the surgeon.
Similarly cardiothoracic surgeons still do a CABG for triple vessel or L. main cor art dis and cardiologists do PTCA for other cases. So i guess the treatment modalities will depend on indication.
PLUS cardiac transplantation and the recently developing field of artificial heart implantation will always be the cardiothoracic surgeons realm.
Regarding carotid stents , it is even done by cardiologists apart from neuro , ns ,nr . But i doubt any intervention on intracranial vasculature will be attempted by cardiologists.
The scope for intervention in neuro is huge. Just an example , the treatment of vasospasm after SAH was hypertension, hemodilution and hydro(IV fluids) also called triple h therapy apart from nimodipine . There are people who have started doing stenting of MCA and intracranial angioplasty.
I think this is just a start , the real change will be felt after 5 to 10 yrs.
