• Second Opinions Matter: Neurosurgeons to Debate Pros and Cons of Treatments in Bold New Controversy Sessions

    • Oct 01, 2013

    Redefining Best Practices in Three Key Treatment Areas at Congress of Neurological Surgeons Annual Meeting

    SCHAUMBURG, IL – Oct. 1, 2013 – The Congress of Neurological Surgeons (CNS) will offer a bold new educational format at its Annual Meeting, October 19-23, 2013, at the Moscone West Convention Center in San Francisco. For the first time, Controversy Sessions – one each on Oct. 21, 22 and 23 – will provide a forum for leading neurosurgeons to debate different treatment approaches for three of the most challenging topics facing the field today.

    “This type of dialogue is critical for continuing education in our field,” said Ali R. Rezai, MD, President of CNS. “Objective examination of different approaches to the treatment of neurosurgical disease will challenge us to open our minds to new perspectives, embrace the best of what past experience and the latest technology provide, and encourage us to push the envelope on what is possible.”

    Spinal Cord Injuries and the Debate Related to Steroid Use
    Monday, Oct. 21, 8:00 a.m.
    R. John Hurlbert vs. Michael G. Fehlings
    Moderator: James S. Harrop

    In March of this year, the Joint Section on Disorders of the Spine and Peripheral Nerves of the CNS and the American Association of Neurological Surgeons issued a recommendation against the use of steroids in acute spinal cord injury in the first 24 to 48 hours after an injury is sustained. This represented a change from the Section’s previously issued guidelines in 2002. The new recommendation states, “Administration of methylprednisolone (MP) for the treatment of acute SCI is not recommended.” The standard was revised based on lack of medical evidence supporting benefits of these drugs’ use in the clinical setting.

    Despite this change in approach, opinions remain divided. During this Controversy Session, R. John Hurlbert, MD, will present the case against steroid use, agreeing with the new Guidelines that the risks of MP use outweigh any potential benefits.

    “Many physicians continue to prescribe steroids for acute spinal cord injury even today,” said Dr. Hurlbert. “However, a study showed that 70 percent do so because of the perception that everyone else does, or out of fear of litigation. Only 17 percent prescribe steroids because they believe them to be efficacious.”

    On the other side of the issue, Michael G. Fehlings, MD, will present a case for the careful use of MP in certain circumstances. “Judicious use of high-dose steroids in acute SCI … continues to be an option for initial treatment [and] can reduce associated complications,” said Dr. Fehlings.

    Open Craniotomy vs. Minimally Invasive Endoscopic Approach to Tumors
    Tuesday, Oct. 22, 7:57 a.m.
    Open: Laligam N. Sekhar
    Endoscopic: Theodore H. Schwartz
    Moderator: William T. Couldwell

    This session will address the advantages and limitations of open craniotomy procedures vs. minimally invasive endoscopic approaches for tumor removal. Both preeminent neurosurgeons in their respective fields, Drs. Sekhar and Schwartz will present a vigorous debate on the various glioma removal techniques available today.

    Dr. Sekhar treats some of the most difficult conditions, including tumors other neurosurgeons have diagnosed as inoperable. He will present the case for open procedures. “I see a lot of difficult brain tumors, such as massive tumors or those in the middle of the brain,” said Dr. Sekhar. He has pioneered several techniques, including bypass procedures for both tumors and aneurysms, and skull base surgery to deal with meningiomas, acoustic neuromas, pituitary tumors and chordomas.

    Arguing for the other side, Dr. Schwartz is known as a pioneer in the development of endoscopic neurosurgical techniques, and leads workshops around the world on the topic. “These endoscopic procedures are not just the future of skull base surgery, they are the present,” he said. “Every patient deserves access to the most effective, least invasive procedures available.”

    Open Microsurgical Repair vs. Endovascular Approach to Aneurysms
    Wednesday, Oct. 23, 8:22 a.m.
    Open: Robert F. Spetzler
    Endovascular: Robert H. Rosenwasser
    Moderator: H. Hunt Batjer

    This session will present two sides to the debate on aneurysm treatment. Dr. Spetzler will argue for traditional open procedures, emphasizing that not all lesions are amenable to endovascular treatment. “Direct microsurgical repair is the appropriate treatment for many patients, which should not be supplanted by endovascular therapy simply because of the perceived difficulties and risks associated with surgery for basilar artery aneurysms,” said Dr. Spetzler. During the Controversy Session, he will argue that especially the most complex cerebral aneurysms (basil apex aneurysms) must involve the “meticulous exercise of the basic tenets of aneurysm surgery … to optimize patient outcomes.”

    Presenting for the opposing view, Dr. Rosenwasser will argue the benefits of the endovascular approach to aneurysms in appropriate cases. “Continued advancements in technology and supportive clinical data will allow endovascular therapy to become a more durable mode of treatment,” he said. “Improvements in surgical equipment and techniques … have broadened the appropriate indications for coil embolization … and are likely to continue.”

    The CNS Annual Meeting is an essential destination for medical professionals and others seeking to learn about important medical advances in the field of neurosurgery. Register now at www.cns.org for the opportunity to participate in these must-attend Controversy Sessions, plus many other cutting-edge educational sessions and networking opportunities!

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