EDITORIAL The future of vascular neurosurgery

Abstract

The practice of neurosurgery in the UK has been changing rapidly during this decade of the brain. There is heightened public awareness and expectation of the specialty, a less tolerant medicolegal climate and increasingly stringent junior surgeons’ training requirements, combined with the lowering of junior doctors’ hours. There are fewer but larger neurosurgical units each with increased consultant numbers. Sub-specialization has emerged piecemeal, to a certain extent as a result of these medicosocial changes, but also driven by the constant stream of exciting developments within the specialty itself. Examples of the latter include the new concepts and methods of spinal instrumentation; the new treatments in neuro-oncology (gene therapy, monoclonal antibodies); the introduction of sophisticated image guidance systems and computers into the operating theatre; skull base surgery; minimally invasive neurosurgery. Furthermore, within specialized areas, the team approach has become commonplace; paediatric neurosurgery, spinal neurosurgery, (neuro-orthopaedics), neuro-oncology, epilepsy surgery (where this concept has been extremely well developed) and surgery for movement disorders (currently with an upsurge of interest) are all examples. It is no longer proper or appropriate to be training neurosurgical generalists, the Jack-of-alltrades; public expectation, training schedules and the volume of neurosurgical knowledge demands sub-specialization producing neurosurgical consultants as masters of their own specialized ® eld of interest. Neurovascular surgery is one of the major neurosurgical sub-specialties; the subject matter is huge [aneurysm, arteriovenous malformation (AVM), spontaneous intracerebral haematoma, subarachnoid haemorrhage (SAH), as well as cerebroocclusive disease] 1 and there is no other ® eld within