When the 74th AANS Annual Meeting officially opened on Monday, April 24, Annual Meeting Chair James T. Rutka, MD, announced the expectation that the event would be “the most successful annual meeting in the history of the AANS.”
The final numbers bear out Dr. Rutka’s optimism. With medical attendees totaling 3,172, the San Francisco meeting proved to be the most successful ever by this measure, and the grand total of 6,887 attendees puts the meeting in contention for top honors with the year 2000 meeting. The meeting’s success sets the bar high in keeping with great expectations for the AANS 75th anniversary, a celebration that began with the 2006 meeting, continues throughout the year, and culminates in the 75th Annual Meeting: Celebrating AANS’ Diamond Jubilee, to be held in Washington, D.C., April 14–19, 2007.
Of course, stellar attendance is but one indicator of success. This meeting’s singular mix of science, social events, and the city’s hospitality coalesced in a particularly memorable occasion.
The meeting owes its success in large part to Dr. Rutka and to the entire planning team, including Mitchel S. Berger, MD, scientific program chair, and Timothy B. Mapstone, MD, scientific posters chair; Russell J. Andrews, MD, Nicholas M. Barbaro, MD, Sue Ellen Barbaro, Deborah L. Benzil, MD, Lawrence S. Chin, MD, E. Sander Connolly Jr., MD, Anthony L. D’Ambrosio, MD, Joseph A. Hlavin, PA-C, David F. Jimenez, MD, Eric A. Potts, MD, Andrea Strayer, CNRN, Vincent C. Traynelis, MD, and Eve C. Tsai, MD.
This meeting’s 38 practical clinics, 19 general scientific sessions, 77 breakfast seminars, 135 oral abstract presentations, more than 500 poster presentations, and 234 companies exhibiting the latest neurosurgical technology and products were introduced to a broader audience through media outreach. The AANS not only promoted the meeting and the association itself, it also employed a peer-review process to select scientific topics from all accepted annual meeting oral abstracts for release to the media.
This year’s 13 annual meeting scientific press releases reflected a wide range of neurosurgical topics, covering, for example, spinal fusion and artificial discs, the use of cortical language mapping before glioma surgery, skull protection offered to children by bicycle helmets, and deep brain stimulation. The scientific releases as well as the public interest releases associated with Neurosurgery Awareness Week, held concurrently with the AANS Annual Meeting, generated considerable media attention, with print and broadcast media reaching an estimated worldwide audience of 636 million and counting. Notable online publications covering the meeting included Yahoo! News, USA Today, Reuters, HealthScout, HealthDay, HealthCentral, Excite and Forbes. Major newspapers and magazines included The Wall Street Journal, The Cleveland Plain Dealer, Star Tribune, Indianapolis Star, and Business Week.
CME: A Main Attraction
A major attraction of the meeting is the opportunity to earn continuing medical education credit. Meeting registrants could earn 20.75 category 1 CME credits, and those attending ticketed educational programs such as breakfast seminars, practical clinics, the Pain Section Satellite Symposium and the Japanese American Friendship Symposium, additionally could earn up to 35 category 1 CME credits.
While the meeting has concluded, the opportunity to learn continues. Audio recordings on compact disc cover the plenary, scientific, subspecialty section, and socioeconomic sessions. Titles of the individual programs recorded are listed on the order form available in the AANS Online Marketplace at www.AANS.org. In addition, DVD recordings of three programs—Cerebral Trauma State-of-the-Art Treatment, Head Trauma: Current Treatments and Controversies, and Minimally Invasive Microendoscopic Discectomy—offer CME credit and also are available in the Online Marketplace.
Memorable Moments
Following two days of intensive, hands-on practical clinics, the Sunday evening opening reception marked the ceremonial start of the 74th AANS Annual Meeting in an event that offered 3,000 guests the opportunity to stroll through the streets of San Francisco without ever leaving the friendly confines of the AANS headquarters hotel. Fisherman’s Wharf, Chinatown, and the Giants’ stadium were among the attractions. The “sweet spot” and a popular destination was Ghirardelli Square, appropriately located on Rich Street (named, as were all these “San Francisco” streets, for an AANS president, in this case 1996–1997 President J. Charles Rich).
On Monday, two luminaries from different walks of life, Volker K.H. Sonntag, MD, and George Will, offered tales from their respective experience. As the Rhoton Family Lecturer, Dr. Sonntag discussed the “Journey of Spinal Neurosurgery in the United States,” a journey that began in 1905 when Cushing removed an “inoperable” spinal lesion. He said that neurosurgical treatment of the entire spinal column began to be emphasized in the 1980s, and tension that arose between neurosurgery and orthopedics in 1989 with the approval of spine fellowship training in orthopedics was not resolved until the specialties together faced the pedicle screw challenge in the 1990s. Observing that the Journal of Neurosurgery: Spine now is published monthly and that the Decade of the Spine spans 2001 to 2010, he teasingly concluded that “vascular neurosurgery is out and spinal neurosurgery is in,” to general amusement and applause.
Cushing Orator George F. Will delivered an entertaining amalgam of economics, politics, American wit and wisdom, and baseball. “This is a country in which the American people have decided that the government has a role in assuaging two ancient fears: illness and old age,” he said. He discussed entitlements, “promises we have made to ourselves,” such as Social Security. “Fixing Social Security is easy: Raise the retirement age,” he said. Noting that “medicine is another matter,” he discussed the growth of medicine from 6 percent of the U.S. gross domestic product in 1960 to the point at which medical centers now often are the largest employers in cities like Cleveland and Houston.
“Prosperity produced by a dynamic economy creates economic hypochondria,” he said, a concept which he described as Americans driving “Lincoln Navigators, barely making it from one gas station to another, sipping designer water that costs more than a gallon of gasoline, and talking on their cell phones discussing how arduous life in America has become.”
The business meeting of the AANS and the American Association of Neurosurgeons concluded the day with the election of 2006–2007 AANS leadership: Executive Committee members are Donald O. Quest, MD, president, Jon H. Robertson, MD, president-elect, Arthur L. Day, MD, vice-president; James T. Rutka, MD, PhD, secretary; James R. Bean, MD, treasurer; and Fremont P. Wirth, MD, past president.
Rounding out the Board of Directors are directors at large William T. Couldwell, MD, PhD, Robert E. Harbaugh, MD, Christopher M. Loftus, MD, Warren R. Selman, MD, Troy M. Tippett, MD; regional directors Jeffrey W. Cozzens, MD, R. Patrick Jacob, MD, Stephen T. Onesti, MD, and Edie E. Zusman, MD; historian Eugene S. Flamm, MD; ex-officio members Rick Abbott, MD, P. David Adelson, MD, Charles L. Branch Jr., MD, Lawrence S. Chin, MD, Fernando G. Diaz, MD, PhD, Andres M. Lozano, MD, Richard K. Osenbach, MD, Setti S. Rengachary, MD, B. Gregory Thompson Jr., MD, and Ronald E. Warnick, MD; and liaisons Richard G. Ellenbogen, MD, H. Derek Fewer, MD, and Isabelle M. Germano, MD.
The scientific papers presented Tuesday morning were punctuated with presentations by A. John Popp, MD, and Martin W. Weiss, MD. Representing Doctors for Medical Liability Reform, Dr. Popp related the recent progress of medical liability reform in Congress. “When I talk to neurosurgeons about this, I sense their frustration,” he said. He discussed the establishment of AANSPAC, neurosurgery’s new political action committee that is funding the campaign for federal tort reform, and he stressed the importance of each neurosurgeon’s commitment to this effort. Pointing to his jacket, he said, “This lapel cost a thousand dollars because I’m wearing an AASNPAC founders’ pin, and I hope that as I walk though the hall today I will see many more.”
Representing the Neurosurgery Research and Education Foundation, Dr. Weiss described the NREF’s impressive 25-year track record of finding ways to fund the research projects of neurosurgeons through donations and through corporate partnerships. “Research and development, corporate or scientific, is the foundation of the future,” he said. Noting that participation in just the Young Neurosurgeons Committee’s Silent Auction, held in the exhibit hall during the meeting, funds one NREF award, he encouraged broader, enthusiastic support of the NREF.
Presidential Address
Fremont P. Wirth, MD, identified five main issues with which neurosurgery today must contend: (1) education; (2) defining the boundaries of neurosurgical practice (3) responding to changing demands of society (4) influencing increase in reimbursement; and (5) medical liability reform. He called education the fundamental issue for neurosurgery as well as a primary mission of the AANS, which is bent upon providing “modern, efficient, responsive educational programs for neurosurgeons.”
Dr. Wirth defined the most recent challenge to the scope of neurosurgical practice as the possible encroachment of proposed specialists in acute care surgery. He explained that these specialists would be expected to perform among their duties emergency neurosurgical procedures, contrary to the idea that “patients are safest when neurosurgeons provide neurosurgical care.” He discussed the results of the AANS 2006 Workforce Survey, which demonstrated that most neurosurgeons are providing on-call services. Acknowledging that there may be a better system for providing neurosurgical emergency care, he said that ideas for improving the delivery of such care were being explored.
Dr. Wirth also described organized neurosurgery’s efforts for medical liability reform and other issues on the national agenda as moving forward in cooperation with colleagues in other specialties. He warned that advocacy efforts such as these can be protracted and that apathy toward continuing involvement in these matters is a worthy opponent. “We must step up to the plate,” he said. “It’s going to take time, effort and money. Individual neurosurgeons can have an impact.”
On Wednesday, communication, science and politics were the focus of two lecturers. Mark Bernstein, MD, the Theodore Kurze lecturer, honored the raconteur in Dr. Kurze by discussing the importance of neurosurgeons making their voices heard more widely through publication in nonbiomedical venues. Dr. Bernstein noted that Harvey Cushing, a Pulitzer Prize winner, could serve as inspiration. “Narrative stories reach people,” he said. “It’s never too late to try.” Hunt-Wilson Lecturer Arnold Kriegstein, MD, reviewed the science and politics currently affecting neural stem cell research. He said that current stem cell research in the United States is moving forward at the state level, led by New Jersey, Illinois, Maryland, Connecticut, and California, and that the University of California, San Francisco has planned a stem cell training program.
The Thursday socioeconomic session was highlighted by pointed discussion of and audience commentary on the Centers for Medicare and Medicaid Services’ pay-for-performance project. Jeffrey Flick, the CMS administrator for region IX, presented rationale for the program and said that the 262 hospitals already participating in CMS P4P have demonstrated that “just measuring and publishing improves quality.” He said that the CMS is “looking for your help to make sure we have this right” and encouraged physicians to participate in the CMS’ P4P demonstration program. “I believe that physicians are likely to be paid just for reporting as early as next year,” he said.
Robert E. Harbaugh, MD, chair of the Quality Improvement Workgroup of the AANS/CNS Washington Committee, expressed neurosurgery’s concerns involving establishment of appropriate P4P measurements. “All measures are focused on management of chronic disease, so application to surgical patients is a concern,” he said. Acknowledging that there is “widespread, bipartisan support in all of Washington” for P4P and that the CMS is very committed to the program as a way to save money, Dr. Harbaugh suggested that neurosurgery should participate but should develop its own quality measures based on prospectively collected outcomes data.
Presentations by master neurosurgeons Kevin T. Foley, MD, spine; Patrick J. Kelley, MD, tumor; Michael T. Lawton, MD, vascular; Johannes Schramm, MD, epilepsy;
Manda J. Seaver is staff editor of the AANS Bulletin.
Awards and Honors
Cushing Medal–David G. Kline, MD
Dr. Kline received the Cushing Medal, the highest honor that is bestowed by
the AANS. “Few have given so generously of themselves over time to the
field of neurosurgery,” said Dr. Wirth in his introduction, in which
he recognized Dr. Kline for launching a peripheral nerves clinic. Dr. Kline,
recounted his experience “rendering care without electricity, air conditioning
or elevators” during the evacuation of intensive care unit patients during
the harrowing period during and after Hurricane Katrina.
Distinguished Service Award–Lyal G. Leibrock, MD
“This afternoon I am honored and sad because the AANS is recognizing
a neurosurgeon posthumously after his protracted battle with colon cancer,” said
Dr. Wirth. He noted Dr. Leibrock’s many years of service and his initiation
of the Neurosurgical Leadership Development Conference. Judi Leibrock, accepting
the award on behalf of her husband, discussed his love of neurosurgery and
said, “This is wonderful, thank you.”
Humanitarian Award–Gene E. Bolles, MD
Dr. Bolles was honored in recognition of his many professional accomplishments
to the development of neurosurgery and for his extensive efforts in Mexico,
Beliz and Albania. “I am surprised, honored and humbled to receive this
award,” he said. He described his volunteer work as educational and extremely
rewarding and encouraged “each and every one of you to become involved
in this kind of work.” He said that he and his family were leaving the
following week to volunteer in Iraq. “It’s important to express
to the rest of the world the humanness of Americans,” he said.
Robert Florin Award–Douglas Kondziolka, MD
Dr. Kondziolka received the Florin Award for his paper “Improving the
Informed Consent Process for Surgery.” The paper demonstrated that a
patient’s recall of informed consent information can be improved when a surgeon
goes through the form with the patient followed later by a staff member asking
the same questions of the patient. “Patients can be well informed, informed
consent can be documented in an efficient manner, and efforts to improve the
informed consent process are valued by patients,” he said.
Cone Pevehouse Award–Ming-Yuan Tseng, MD
Dr. Tseng received the Pevehouse Award for his paper “Survival Analysis
for 540 Patients With Primary Spinal Intramedullary Gliomas in England and
Wales: A Population-Based Study.” The study identified old age, nonependymoma,
and high grade tumors as negative prognostic factors for these patients’ survival.
Dr. Tseng and colleagues concluded that results from this population-based
study are very helpful for comparison with other hospital-based studies and
for public health purposes.
Developing Science
Poster Chair Timothy Mapstone, MD, and the Scientific Program Committee selected more than 500 abstract submissions for poster presentation at the 74th AANS Annual Meeting. The top three posters in each of the following categories were• Cerebrovascular Shaye I. Moskowitz, MD, “Statin Use Increases the Risk of Vasospasm Following Aneurysmal Subarachnoid Hemorrhage”
• General Interest Pankaj A. Gore, MD, “Normobaric Oxygen Therapy Strategies in the Treatment of Postcraniotomy Pneumocephalus”
• History William C. Bergman, MD, “Walter Dandy and His Approaches to the Third Ventricle Circa 1933”
• Pain Aneela Darbar, MD, “Efficacy of Gamma Knife Radiosurgery For Trigeminal Neuralgia Associated With Multiple Sclerosis”
• Pediatrics Richard J. Edwards, MD, “The Development of a Telemetric Intracranial Pressure Sensor for Long-term Monitoring of Intracranial Pressure”
• Spine and Peripheral Nerves Denis J. DiAngelo, PhD, “Biomechanical Comparison of the Charite and Prodisc-L Lumbar Disc Prostheses”
• Stereotactic and Functional Abbas F. Sadikot, MD, “Probabilistic Maps of Subthalamic Electrodes in an MRI-Atlas Integrated Reference Space Correlated with Clinical Outcome”
• Trauma and Critical Care Lori Shutter, MD, “Unhelmeted Motorcyclists—Higher Mortality, Morbidity and Costs”
• Tumor Hidenobu Ochiai, MD, “Targeted Therapy for Glioblastoma Multiforme Neoplastic Meningitis With Intrathecal Delivery of an Oncolytic Recombinant Poliovirus”
2006 International Awardees
During the AANS Annual Meeting in San Francisco, the following 2006 International Award recipients were announced.
The International Abstract Award was presented to Ming-Yuan Tseng, MD, of the United Kingdom, for “Biological Effects of Acute Pravastatin Therapy On Cerebral Vasospasm, Delayed Ischemic Deficits, and Outcome in Patients Following Aneurysmal Subarachnoid Hemorrhage: A Randomized Controlled Trial.”
The International Travel Scholarship recipient was Emad K. Hammood, BSN, of Iraq for “Surgical Management of Brain Hydatid Cyst in the North of Iraq.”
The association also announced the first two recipients of the first AANS International Visiting Surgeons Fellowships. They are Mirsad Hodzic, MD, of Bosnia and Herzegovina, and Rene Fernando Paz, MD, of Honduras.
Dr. Hodzic, whose fellowship will be at the University of New York at Buffalo, is specifically interested in developing new knowledge in minimally invasive neurosurgery in children.
Dr. Paz will complete his fellowship at the University of Colorado Health Sciences Center. His research study will involve the effects of spinal decompression and stabilization, and time of surgical treatment on patient outcomes.
Additionally, the recipient of the FIENS/Integra Fellowship was announced at the AANS Annual Meeting. He is Sushil Shilpakur, MBBS, of Nepal, who is studying neuroendoscopy during his fellowship at the CURE Children’s Hospital of Uganda.
With the exception of the FIENS/Integra Fellowship, these awards are managed by the AANS International Outreach Committee. All awards will be offered again in 2007.