Neurosurgical Onclogy v.s Vascular Neurosurgery

[TheNeuroGod]

I want to invoke a conversation on these two sub-specialties of 'Neurosurgery'.

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[slants]

Neurosurgical Oncology - love to use gamma knife
Vascular neurosurgery - love to be in endovascular suite

There's the start of a conversation. A more pointed question (or in this case comment) may help get you the answers you seek.

 

[Bombrainiac]

A lot of cerebrovascular neurosurgeons do plenty of tumor work, because most of them are trained and very comfortable with skull base surgery and they are the most comfortable with microsurgical technique. Any cerebrovascular neurosurgeon who does not do endovascular work is either over the age of 50 or has made a grave mistake in planning their training in my opinion.

Tumor surgeons end up being involved in genetic and molecular biology research, or tumor vaccine trials, and they end up focusing a lot of their energy on GBMs. Fun surgeries, plenty busy. Oncology can be depressing and equally rewarding. You'll get to work with oncologists and you'll get to know a lot of community physicians. About 1 in 4 to 1 in 5 cancers are diagnosed, because they met to the CNS and cause symptoms…just some food for thought.

 

[el_pistolero]

A lot of cerebrovascular neurosurgeons do plenty of tumor work, because most of them are trained and very comfortable with skull base surgery and they are the most comfortable with microsurgical technique. Any cerebrovascular neurosurgeon who does not do endovascular work is either over the age of 50 or has made a grave mistake in planning their training in my opinion.

Tumor surgeons end up being involved in genetic and molecular biology research, or tumor vaccine trials, and they end up focusing a lot of their energy on GBMs. Fun surgeries, plenty busy. Oncology can be depressing and equally rewarding. You'll get to work with oncologists and you'll get to know a lot of community physicians. About 1 in 4 to 1 in 5 cancers are diagnosed, because they met to the CNS and cause symptoms…just some food for thought.

I get the impression that cerebrovascular and skull-base neurosurgery is going towards minimally invasive approaches. Though practically every surgery is getting less and less invasive, the transition seems to be faster in this particular field of (neuro)surgery than, say, CT surgery. Things like endovascular neurointerventions, stereotactic radiosurgery, and endoscopic neurosurgery will ultimately need to be added into a skull-base neurosurgeon's 'armamentarium' in order to 'protect' the field from 'encroachment' by other specialties (i.e., interventional neurology and radiology, radiation oncology). (IMHO, though, neurosurgeons are very well-prepared and well-positioned in this area)

That being said, with all those new minimally-invasive techs, the rates of open skull-base surgery and microsurgery are declining, and skull-base and cerebrovascular neurosurgeons do less open and microsurgical cases than they used to in the past. So how do skull-base neurosurgeons stay 'in-shape' for open skull-base surgery and microsurgery? Considering there are very few skull-base cases to begin with (I've always thought neurosurgery deals with rare diseases, apart from trauma and degenerative spine pathologies), the technicality and high learning curve for skull-base surgeries, and the fact that the cases that needed open approaches nowadays are the most difficult ones..
Is the current cerebrovascular neurosurgery situation more or less similar to vascular surgery as a field?