Letter: Results of Surgery for Low-Grade Brain Arteriovenous Malformation Resection by Early Career Neurosurgeons: An Observational Study

Letter: Results of Surgery for Low-Grade Brain Arteriovenous Malformation Resection by Early... CORRESPONDENCE slightly lower, and more likely to be ruptured (lower Lawton– Letter: Results of Surgery for Low-Grade Brain Young supplementary grades). This study also demonstrates that Arteriovenous Malformation Resection by ECCN are low-volume AVM surgeons. Our previous publication Early Career Neurosurgeons: An Observational demonstrated improved outcomes for patients undergoing AVM Study resection at high-volume centers with only modest differences for patients being treated by high-volume surgeons. Therefore, To the Editor: We read with interest the manuscript entitled “Results young neurosurgeons appear to benefit from practicing in high- volume centers where they have support from senior neurosur- of Surgery for Low-Grade Brain Arteriovenous Malformation Resection by Early Career Neurosurgeons: An Observational geons and from established AVM teams. The benefits of these factors may offset the lower surgical volume of younger neuro- Study.” The authors present a novel review of 110 low-grade (Spetzler–Ponce Class A [SPC A]) brain arteriovenous malfor- surgeons and should be a consideration when young neurosur- geons decide on the first job after fellowship. We congratulate the mations (AVMs) treated surgically by 6 young neurosurgeons, or early career cerebrovascular neurosurgeons (ECCNs), who authors on this excellent study. recently completed fellowship. The purpose of the study was to determine whether ECCNs can perform SPC A AVM resection Disclosure safely. The average number of years in practice was 5.5. The The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. AVM obliteration rate in the ECCN cohort was 95% and the adverse outcome rate was 1.8%. There was no statistical difference in any outcome measure compared to the experi- Justin R. Mascitelli, MD enced senior author, who was also the fellowship director for Michael T. Lawton, MD each surgeon being evaluated. The authors also performed a Department of Neurosurgery cumulative summation (Cusum) plot with the highest acceptable Barrow Neurological Institute level of adverse outcomes set to 3.3% and derived from the upper Phoenix, Arizona 9% confidence interval of the senior author’s own series. At no point did the ECCN cohort reach this threshold. REFERENCES This is an important study that should encourage young neuro- 1. Patel NJ, Bervini D, Ektekhar B, et al. Results of surgery for low-grade brain surgeons as they embark on their AVM careers after fellowship. It arteriovenous malformation resection by early career neurosurgeons: an observa- suggests that our existing fellowship system succeeds in training tional study. Neurosurgery. 2018. doi: 10.1093/neuros/nyy088 [published online ahead of print ]. vascular neurosurgeons to perform this difficult operation safely, 2. Davies JM, Lawton MT. Improved outcomes for patients with cerebrovascular and that fellowship graduates can proceed with confidence malformations at high-volume centers: the impact of surgeon and hospital volume in building this piece of their practice. While results were in the United States, 2000–2009. JNeurosurg. 2017;127(1):69-80. compared with SPC A AVMs, the data suggest that these young neurosurgeons were careful with their patient selection, with 10.1093/neuros/nyy165 AVMs being slightly smaller, overall Spetzler–Martin grades being NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/neurosurgery/advance-article-abstract/doi/10.1093/neuros/nyy165/4989154 by Ed 'DeepDyve' Gillespie user on 07 June 2018 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Neurosurgery Oxford University Press

Letter: Results of Surgery for Low-Grade Brain Arteriovenous Malformation Resection by Early Career Neurosurgeons: An Observational Study

Free
1 page

Loading next page...
1 Page
 
/lp/ou_press/letter-results-of-surgery-for-low-grade-brain-arteriovenous-bCQzD2jEko
Publisher
Oxford University Press
Copyright
Copyright © 2018 by the Congress of Neurological Surgeons
ISSN
0148-396X
eISSN
1524-4040
D.O.I.
10.1093/neuros/nyy165
Publisher site
See Article on Publisher Site

Abstract

CORRESPONDENCE slightly lower, and more likely to be ruptured (lower Lawton– Letter: Results of Surgery for Low-Grade Brain Young supplementary grades). This study also demonstrates that Arteriovenous Malformation Resection by ECCN are low-volume AVM surgeons. Our previous publication Early Career Neurosurgeons: An Observational demonstrated improved outcomes for patients undergoing AVM Study resection at high-volume centers with only modest differences for patients being treated by high-volume surgeons. Therefore, To the Editor: We read with interest the manuscript entitled “Results young neurosurgeons appear to benefit from practicing in high- volume centers where they have support from senior neurosur- of Surgery for Low-Grade Brain Arteriovenous Malformation Resection by Early Career Neurosurgeons: An Observational geons and from established AVM teams. The benefits of these factors may offset the lower surgical volume of younger neuro- Study.” The authors present a novel review of 110 low-grade (Spetzler–Ponce Class A [SPC A]) brain arteriovenous malfor- surgeons and should be a consideration when young neurosur- geons decide on the first job after fellowship. We congratulate the mations (AVMs) treated surgically by 6 young neurosurgeons, or early career cerebrovascular neurosurgeons (ECCNs), who authors on this excellent study. recently completed fellowship. The purpose of the study was to determine whether ECCNs can perform SPC A AVM resection Disclosure safely. The average number of years in practice was 5.5. The The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. AVM obliteration rate in the ECCN cohort was 95% and the adverse outcome rate was 1.8%. There was no statistical difference in any outcome measure compared to the experi- Justin R. Mascitelli, MD enced senior author, who was also the fellowship director for Michael T. Lawton, MD each surgeon being evaluated. The authors also performed a Department of Neurosurgery cumulative summation (Cusum) plot with the highest acceptable Barrow Neurological Institute level of adverse outcomes set to 3.3% and derived from the upper Phoenix, Arizona 9% confidence interval of the senior author’s own series. At no point did the ECCN cohort reach this threshold. REFERENCES This is an important study that should encourage young neuro- 1. Patel NJ, Bervini D, Ektekhar B, et al. Results of surgery for low-grade brain surgeons as they embark on their AVM careers after fellowship. It arteriovenous malformation resection by early career neurosurgeons: an observa- suggests that our existing fellowship system succeeds in training tional study. Neurosurgery. 2018. doi: 10.1093/neuros/nyy088 [published online ahead of print ]. vascular neurosurgeons to perform this difficult operation safely, 2. Davies JM, Lawton MT. Improved outcomes for patients with cerebrovascular and that fellowship graduates can proceed with confidence malformations at high-volume centers: the impact of surgeon and hospital volume in building this piece of their practice. While results were in the United States, 2000–2009. JNeurosurg. 2017;127(1):69-80. compared with SPC A AVMs, the data suggest that these young neurosurgeons were careful with their patient selection, with 10.1093/neuros/nyy165 AVMs being slightly smaller, overall Spetzler–Martin grades being NEUROSURGERY VOLUME 0 | NUMBER 0 | 2018 | 1 Downloaded from https://academic.oup.com/neurosurgery/advance-article-abstract/doi/10.1093/neuros/nyy165/4989154 by Ed 'DeepDyve' Gillespie user on 07 June 2018

Journal

NeurosurgeryOxford University Press

Published: Apr 27, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off