Chairman's Message

By Robert E. Harbaugh, MD, MA

Robert Harbaugh, MD

Partnership Is Paramount for Endovascular Advancement

I want to devote this column to an issue that I think is of paramount importance to the specialty of cerebrovascular surgery: the relationship between the AANS/CNS Section on Cerebrovascular Surgery (CV Section) and the American Association of Therapeutic and Interventional Neuroradiology (ASITN). We recently completed a very successful joint meeting, co-chaired by Greg Thompson, MD, and Buddy Connors, MD. This meeting is emblematic of the benefit to be obtained from the CV Section and the ASITN working together. It also represents what we can hope for if interventional neuroradiology and cerebrovascular surgery collaborate with mutual respect and collegiality at each of our institutions. I am convinced that this kind of collaboration is the best option to develop the field of endovascular treatment of cerebrovascular disease.

Despite the obvious benefits of collaboration, the relationship between the CV Section and the ASITN needs constant attention if it is to flourish. Our relationship was tenuous just before the meeting in Phoenix. I believe that the ASITN came to this meeting considering the option of severing its ties with neurosurgery. Some members of the ASITN are adamantly opposed to further collaboration with neurosurgery, and their rhetoric was one factor that generated concerns about a neurosurgical "plot" to take over the endovascular treatment of cerebrovascular disease.

Another (and I think more substantial) concern involved several examples from around the country where an endovascularly trained neurosurgeon entered practice and commandeered the lion's share of cerebrovascular cases from excellent interventional neuroradiologists. In one case cited by the ASITN leadership, an endovascular neurosurgeon was trained by a superb interventional neuroradiologist, went into practice at the same institution and was immediately doing nearly all of the aneurysm work. Another case involved the recruitment of an endovascularly trained neurosurgeon without consulting a well established interventional neuroradiology group at the same institution. The interventional neuroradiologists found out about the search through the recruitment advertisements. The combination of these kinds of events with vituperative comments from some of their members led the ASITN leadership to seriously consider the possibility that organized neurosurgery was involved, on a national level, in a plan to exclude interventional neuroradiologists from the marketplace.

I spent much of our joint meeting assuring the ASITN leadership that no such plan exists. As chair of the AANS Endovascular Task Force and chair of the CV Section, I would know of such a plan if one existed, and I know of no such plan. Neurosurgery is committed to training neurosurgeons in endovascular techniques and in making endovascular exposure part of neurosurgical residency requirements, but we would much prefer to do this with our colleagues in interventional neuroradiology rather than against them.

At the end of the Phoenix meeting the Joint Council of Cerebrovascular Disease (the officers of the ASITN and CV Section) met and committed our organizations to continued collaboration. We are considering a "retreat" to generate recommendations for collaborative arrangements between interventional neuroradiologists and neurosurgeons. Dissemination of these recommendations by organized neurosurgery to neurosurgical practices around the country might help prevent some of the events that have generated the ASITN's concerns. I am also hopeful that the ASITN leadership will join the CV Section leadership in a commitment to work together on the NATURE trial, a North American randomized trial of clipping versus coiling for the treatment of intracranial aneurysms. It is clear to me that our patients, the specialty and both organizations will benefit from continued close collaboration between the CV Section and the ASITN. The CV Section leadership is committed to making this happen.