This is the last report that I will prepare as President of The American Association of Neurological Surgeons (AANS). We have had an eventful year and I hope that the membership is reassured about the strength and direction of the AANS.
Task Force on Fellowships
The Fellowship Task Force has successfully addressed the important issue of subspecialty fellowships in neurosurgery and all of their implications for training and for clinical practice. A firm stance has been taken to review the quality of fellowships and not to provide any certification associated with various fellowship programs. A detailed article on the work and recommendations of the Task Force can be found elsewhere in this issue of the Bulletin.
Cerebrovascular/Endovascular
The Cerebrovascular/Endovascular Task Force is still working on methods of improving the role of neurosurgeons in endovascular procedures. We are optimistic that continued collaboration with our colleagues in neuroradiology will result in real advances in this new and growing field of collaborative endeavor.
Cost Containment Task Force
In the area of reimbursement, The Cost Containment Task Force has been working hard to achieve its dual goals of decreasing the cost of neurosurgical care to our patients and in increasing the efficacy and cost effectiveness of neurosurgical practices in general.
In recognition of the fact that reimbursement is so closely tied to CPT coding, the Joint Officers of the AANS and Congress of Neurological Surgeons (CNS) have just created a new task force centered on the various aspects of CPT coding. This will include the correctness and appropriateness of codes, the development of new codes for new procedures, the teaching of proper coding practices, and the proper valuation of various neurosurgical procedures for reimbursement. Richard Roski, MD, has been appointed the Chair of this task force, and we expect that it will remain in the center of reimbursement activities for the near future.
How Neurosurgery has Evolved
As I reflect on the practice of neurosurgery and how it has evolved, it becomes clear to me that there is a tremendous vitality within our field and I think there is room for significant optimism on almost every front. As I look back on my own clinical activities over the past five years, it is extraordinary how many new procedures have been incorporated into my own day-to-day practice.
Endoscopic approaches have become routine for carpal tunnel surgery; for performing third ventriculostomy and operating on third ventricular tumors; for assisting in transsphenoidal surgery; for adjunctive use in craniotomies with operations around and about the optic chiasm; and lamina terminalis. I have been using computer-guided surgery incorporating laser guides, pointers and stereotactic microscopes for many different types of intracranial surgery and have recently incorporated the functional MRI into the actual interactive computer guided techniques.
Three-dimensional computerized image planing has been used for stereotactic pallidotomy and thalamotomy with great effect. We have now moved to using the same techniques for deep brain stimulation for the relief of essential tremor and tremor of parkinsonism.
We have used selective dorsal rhizotomy with a minimal exposure for the treatment of children with spastic cerebral palsy, and intercostal neurotization for brachial plexus injuries. We have been using BCNU wafers in the adjunctive management of glioblastomas. We have used lateral mass plates for the correction of cervical spine fracture dislocations and have used proximal intraoperative balloon occlusion for clipping of a basilar tip aneurysm along with an intraoperative angiography.
These are just a few of the procedures that a single neurosurgeon has adopted over a reelatively short period of time and after more than 25 years of neurosurgical practice. I hope this example is as encouraging to others as it has been to me with regard to the future of neurosurgery and that of clinical neuroscience in general.
Edward R. Laws, Jr., MD, FACS President