• 2018 Joint Cerebrovascular Section Update

    Author: Clemens Schirmer

    The AANS/CNS Joint Section on Cerebrovascular Surgery is closing out 2018 with ongoing vitality, continuing to lead in the field of cerebrovascular surgery with engagement from its members. During the past year, the Section has represented the neurosurgical community, not only within the AANS and CNS. Representation to other bodies and collaboration with other stakeholders and societies in the neurovascular space continue to be a focal point: Along with representatives from SNIS and SVIN a number of members of the Section worked on a model for a stroke delivery that was used to respond to a request for applications from the Center for Medicare and Medicaid Innovation (CMMI).

    When the FDA recently called for a meeting of Neurological Devices Advisory Panel on Intracranial Aneurysm Treatment, the entire leadership of the section offered to represent our members and patients on this important matter, submitting a request to present and discuss alternatives to prospective randomized controlled trials such as use of registry data and post-market approval data collection efforts that would continue to allow of devices and therapies to benefit patients sooner. In addition, the presentation addressed surgical treatment options for unruptured, smaller (under 7mm) aneurysms, for appropriately selected higher-risk patients, including but not limited to younger patients with strong family histories of ruptured aneurysms. This will again highlight the importance of participating in the Quality Outcomes Database cerebrovascular module as a critical tool in the evaluation of tracking and improving outcomes and quality. We now have around 3,000 patients enrolled, across multiple centers, with more centers joining every month.

    The section is open to and remains a vibrant resource across the entire lifecycle of cerebrovascular specialist, and we seek to offer value to all members, ranging from trainees who will benefit from the fellows' course during the upcoming meeting, to the now known CAST training selected patients to receive the benefit an expanded treatment time window up to 24 hours after onset of symptoms. Along with that comes the perhaps not surprising realization that cerebrovascular surgery as a whole has entered an era where treatment plans and practices are founded on solid evidence and risk and benefit can be better than ever defined when discussing potentially life-altering surgery or intervention with our patients. We saw new high-level evidence spanning the field from coiling to stenting and are looking forward to results in the treatment of intracerebral hemorrhage.

    At the same time, new and exciting opportunities lie ahead. The section continues to represent us as the only group of practitioners able to provide comprehensive care, bringing expertise ranging from radiosurgery to clipping of aneurysms to the table. If nothing else, we know that detractors pointing out any of these modalities are niches, bound to disappear and likely proven wrong within a short while.

    Dr. Ralph Dacey receiving the inaugural eponymous medal for cerebrovascular research at the 2018 annual meeting of the Cerebrovascular Section in Los Angeles, CA, pictured here with Past-Chair of the Section Dr. Greg Zipfel.

    Our next meeting in collaboration with SNIS will be in Honolulu, HI and the onus is on us to show and exchange ideas with colleagues from all over the world, especially with our colleagues from Japan who will hopefully take the opportunity to meet us in the middle of the Pacific Ocean.

    On the other end of the spectrum, the section created a newly named research medal for a body of collaborative cerebrovascular research. Dr. Ralph Dacey, the inaugural recipient, was presented with the medal at the annual meeting in 2018 and will lend the medal its name going forward.

    We also want to also highlight on a culture of giving in our section, having created an easy pathway that allows anyone to give money towards CV section activities using the charitable donation process through the CNS foundation or NREF foundation-either way earmarked and reserved for CV section activities. Robust giving will allow us to create the funds for more research and training activities for tomorrow which will directly influence the future of our profession and specialty.

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