Members’ Involvement Is Key to Managing Change

I am happy to report that the AANS/CNS Cerebrovascular Section remains vibrant in all of its activities. Our annual and joint section meetings were very well attended. We continue to work with other subspecialties to expand our role in the management in stroke, aneurysms and arteriovenous malformations. More neurosurgeons are now pursuing combined endovascular and open surgical fellowships, and residents are once again getting catheter skills training. These changes represent our group’s adaptation to the technical changes that have occurred in our field. Other groups also are interested in endovascular techniques, and neurosurgeons are working more closely with them on both the local and national levels. The greatest example of this collegiality is the carotid stenting training guidelines, which have been published recently. Their publication represents the combined activities of neurosurgery, neurology, and neuroradiology.

Membership in the CV Section continues to expand and we are now 567 strong. Through the able efforts of Frank Culicchia, MD, we have eliminated the requirements for sponsors, alleviated the 30-day notification, created an online application, and eliminated the requirements for a vote, all of which have expedited membership within the section. I ask any member interested in becoming involved in the leadership to please contact me directly as there are many tasks that the section needs to pursue.

John Wilson, MD, is to be congratulated for the hard work and many hours he has contributed to the Current Procedural Terminology coding initiatives. As our representative from the section, he has been working diligently on modifying the aneurysm coding categories. However, the membership has not been helping him with that effort. When surveys were sent out for definitions between simple and complex aneurysms, the response was less than optimal. Therefore, I would ask that all members please respond when a second survey comes out. In addition to this, Dr. Wilson has been working closely with various groups and with the Centers for Medicare and Medicaid Services for proposed coverage of carotid stenting. At this writing a decision regarding reimbursement has not been made. In addition to this, we are working together with the American Society of Interventional and Therapeutic Neuroradiology to develop codes for intracranial stents and angioplasty. This is an exciting and interesting time when obviously we are using minimally invasive techniques and need to create new billing codes for physician reimbursements. We are indebted to Dr. Wilson for his exhaustive efforts.

Dialogue continues between the Trauma Section and the Neurocritical Care Society regarding the responsibility of physicians managing patients in the intensive care unit setting. Alex Valadka, MD, chair of the AANS/CNS Section on Neurotrauma and Critical Care, and William Coplin, MD, representing the Neurocritical Care Society, were present at our last executive meeting to discuss meaningful interactions between neurosurgeons and critical care physicians. It is apparent that the American Board of Neurological Surgery will need to deal with many of the issues raised by the Neurocritical Care Society. The CV Section referred the society to the board. It is certainly the position of the CV Section to speak with one voice regarding the questions being raised by the Neurocritical Care Society.

The Brain Attack Coalition will be coming out with a publication describing the requirements for becoming an advanced stroke center. Probably the single most important aspect of an advanced stroke center over a basic one will be the availability of endovascular techniques. This once again raises the issue that neurosurgeons need to become more involved locally in the management of stroke patients and develop comfort levels and the expertise for providing endovascular skills.

It is clear that the face of cerebrovascular treatments for aneurysms, arteriovenous malformations and stroke is changing. Fellowships must now include both open and endovascular techniques in training the new generation of neurosurgeons interested in the management of cerebrovascular disease. Neurosurgery as a whole must also consider stroke one of its major disease entities. It is safe to say that if neurosurgery loses its prominence in the management of stroke, it runs the risk of being marginalized from other areas such as carotid occlusive disease, intracranial aneurysms, and intracranial angioplasty with stents.

New technology heralds exciting times. However, we must also make sure that the therapies we are offering patients are based upon sound scientific data rather than pressure from industry. There obviously are many competing forces, and the section will require strong leadership in the future to maximize our role in the appropriate management of cerebrovascular diseases, a topic about which we care deeply. Thus, once again, I ask all of you to start getting more involved in the section and its activities.