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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

Neurosurgery , Volume Advance Article – Apr 27, 2018

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Publisher
Oxford University Press
Copyright
Copyright © 2018 by the Congress of Neurological Surgeons
ISSN
0148-396X
eISSN
1524-4040
DOI
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

References