Background: The rise of minimally invasive techniques in various surgical fields has led to increased
interest in endovascular surgical neuroradiology (ESN) for treating cerebrovascular
diseases. While traditionally led by neuroradiologists, recent trends suggest a shift
toward involvement from neurosurgeons and neurologists. However, the factors influencing
neurosurgery residents' decisions to pursue endovascular neurosurgery remain unclear.
There is a significant risk that neurosurgeons who do not choose the endovascular
path may lose patients with cerebrovascular conditions to other specialists trained
in these techniques, including neuroradiologists, peripheral interventionists, cardiologists,
vascular surgeons, and neurologists.
Methods: In this study, we investigated the effect that residency program size related factors
like procedures scrubbed into, vascular procedural volume encountered, and procedures
personally done, could have an impact in shaping the decision-making process for neurosurgery
residents to become future neuroendovascular surgeons. We conducted a survey-based
study among chief residents of Accreditation Council for Graduate Medical Education
(ACGME) recognized neurosurgery residency programs to investigate the impact of program
size on residents’ exposure to endovascular procedures and their likelihood of choosing
a career in endovascular surgery. To summarize the data, we used descriptive statistics.
We calculated a correlation matrix for key variables, including program size, the
number of anterior circulation aneurysms clipped at the institution, the number of
cases where the chief resident assisted, and the number of cases where the chief microdissected
and/or clipped the aneurysm. Additionally, we used multivariate regression models
to assess how these variables impacted the chief resident’s comfort level with clipping
anterior circulation aneurysms and their decision to pursue further training in vascular
and/or skull base surgery. We also performed a Kruskal–Wallis test to check for discrepancies
among different program sizes. If a discrepancy was found, we used the Wilcoxon rank
test to determine if the difference was statistically significant.
Results: Of the 80 neurosurgery programs surveyed, program size did not significantly influence
the exposure to interventional procedures or the likelihood of residents choosing
a career in endovascular surgery. While larger programs tended to have higher academic
productivity and board pass rates, differences in clinical exposure among program
sizes were not significant.
Conclusion: Our study showed that the differences that come with program size, including the
number of interventional procedures a resident is exposed too, number of cases scrubbed
into, and the total amount of surgeries resident perform personally, aren’t playing
a deterministic effect on influencing the attitudes of neurosurgery fellows when it
comes to ESN. Our findings suggest that factors beyond program size play a more significant
role in shaping residents' training experiences and career choices in endovascular
surgery. Initiatives aimed at promoting interest in endovascular surgery among neurosurgery
residents should focus on other factors such as dedicated training pathways, mentorship
programs, and exposure to advanced endovascular techniques. Future studies should
explore the multifaceted aspects of residency program characteristics and their impact
on training outcomes and career trajectories, with careful consideration of the potential
loss of neurosurgeons to other specialties if endovascular surgery is not embraced.
