Like those who focus on other areas within neurosurgery, many of the members of the Cerebrovascular section find it difficult to keep up within our hectic practice environments. It is trite to note that “patients matter” but there are days when focusing on patients and their outcomes is difficult in the face of demands from hospital staff, hospital organizations, payors, medical device representatives and the crowd of others that are a part of modern American health care. Early in our careers, we are taught that being “available” is a key part of building our careers. However, that availability makes us vulnerable to demands that border on abuse, distracting us from the most important aspects of our work and life. Yes, we must multitask, but the necessity to do so has become almost comical. This is why we believe that this year’s American Association of Neurological Surgeons Annual Scientific Meeting theme really does matter: Perspective and focus have become critical. From time to time, we must take a breath and consider what to push back against in order the preserve our ability to be effective.
Patient outcomes matter. Recent work confirms that stroke looms over us to a degree that eclipses any other health care problem. Members of the Cerebrovascular Section must focus on patients who are having hemorrhagic and ischemic stroke and those who are at risk of having these strokes. Our members and our leadership are engaged in a war to get these patients the timely, resource-intensive care that they require. This requires fundamental changes to our systems of care that start with EMS and go all the way through to decisions on futility of care, long-term care and hospice. While most of us got into this line of work because we love the cases, we must remain engaged in changing these aspects of care to better meet the needs of this patient population.
Technology matters, and it is a double-edged sword. For better or worse, it is clear that medical technology offers the possibility of dramatically improving the balance of efficacy and safety that we can offer to patients. It is equally clear that the benefits of new technology can be oversold, sometimes resulting in worse outcomes for patients. Artificial intelligence, brain-computer interface, improvements in endovascular interventions and new ways to intervene through the vascular system will all change what cerebrovascular neurosurgeons can offer to their patients. We must strive to achieve a judicious balance between “early adopter” and “lagging Luddite.”
Finally, the future of cerebrovascular neurosurgery matters. We have to ensure that those entering this field gain an education that better equips them to withstand the challenges ahead. This necessitates a deep understanding of anatomy and keen insights into how to shepherd patients through illness with minimal risk. We must maintain focus on research that provides them with better tools. We have to both support and challenge those willing to provide good evidence for new therapies. What we do matters and preparing the way for others to do this work matters most of all.
Dr. Arthur is currently a professor in the University of Tennessee Department of Neurosurgery and director of Cerebrovascular and Endovascular Neurosurgery. He has a strong interest in managing neurovascular disease in both healthy and very sick patients. He is actively engaged in several areas of research to improve the treatment of patients with cerebrovascular diseases, such as aneurysms and acute stroke. He leads a multidisciplinary team that is devoted to improving patient outcomes for these illnesses.
Stavropoula I. Tjoumakaris, MD, FAANS, is a dual appointed professor in neurological surgery and radiology at Thomas Jefferson University Hospital. She also serves as the chair of Thomas Jefferson University Faculty Affairs, director of the Open Cerebrovascular and Endovascular Neurosurgery Fellowship and director for the Neurosurgery Clerkship. Dr. Tjoumakaris holds the distinction of being the first female dual trained cerebrovascular and endovascular neurosurgeon in the United States.
