Advancing Neurologist Directed Endovascular Surgical Neuroradiology

Department of Neurology, Medical College of Wisconsin, Milwaukee, WI.
Annals of Neurology (Impact Factor: 9.98). 10/2008; 64(4):474-5. DOI: 10.1002/ana.21353
Source: PubMed
18 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Advancements in heterogeneous and pervasive computing introduce many dynamic features that require applications to be adaptive. To become adaptive, an application first needs to be aware of its computing environment characteristics (awareness) as well as its peer's awareness. The paper presents flexible awareness measurement and management architectures for adaptive applications in a pervasive computing environment. We investigate how our system can be beneficial to adaptive applications by providing an integrated interface (adding, deleting, and querying) to different types of awareness, measurement extensibility, and application controlled measurement behaviors. To manage awareness efficiently, we then discuss a pull/pull method, and flexible consistency management. A hybrid architecture is used to distribute awareness efficiently for both wired and wireless networks.
    Preview · Conference Paper · Jan 2009
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cerebral angiography (CA) is increasingly used in clinical practice with advances in neurointerventional therapy. We present our CA experience performed by neurologists at an academic institution. CA performed between July 2005 and March 2008 was reviewed. Major neurological outcome was defined as a new neurological deficit lasting >24 hours or worsening of pre-existing neurological deficit by 4 points on the National Institutes of Health Stroke Scale. Major non-neurological outcomes were defined as any death within 24 hours of the procedure, vascular injury requiring surgery, arteriovenous fistula, or pseudo-aneurysm formation and access site hematoma >5 cm, and/or requiring blood transfusion. In total 661 angiograms were performed over 30 months. CA indications were ischemic stroke in 210/661 (31.7%), hemorrhagic stroke in 321/661 (48.6%), trauma for 16/661 (2.4%), presurgical epilepsy workup 95/661 (14.3%), and other conditions 19/661 (2.9%). Mean age of the group was 49 +/- 18 years. Permanent neurological deficit occurred in .2% (1 patient) and reversible neurological deficits occurred in .2% (1/661). Major non-neurological complications occurred in .9% (6/661). All these rates were less than established guidelines. The safety and efficacy of CA performed by interventional neurologists is acceptable by current guidelines.
    No preview · Article · Mar 2009 · Journal of neuroimaging: official journal of the American Society of Neuroimaging
  • [Show abstract] [Hide abstract]
    ABSTRACT: During the past few years, the field of endovascular surgical neuroradiology has been expanding. Neurosurgeons, radiologists, and neurologists are currently being trained. We analyzed data from a national survey of endovascular training programs to assess the current training status and future projections. Survey participation requests were sent out to program directors and members of the Society of Endovascular Neurosurgery, the Society of Neurointerventional Surgery, and the Society of Vascular and Interventional Neurology. The format was an on-line survey designed by the authors, and completed through the website. Forty-three programs were identified and invited to participate. We achieved a response rate of 81% (n = 35). Twenty-seven (79%) of the 35 respondents listed their training program as academic, and 7 (20%) listed it as a mixture of academic with private practice. The training program faculty consisted of 57 radiologists, 39 neurosurgeons, and 10 neurologists. Length of fellowship offered was the same for all specialties in 43%, and differed based on clinical experience/background in 51%. Of the programs, 86% offered a 2-year fellowship, 49% had a mandatory resident rotation, 17% offered an infolded complete fellowship for residents, and 34% offered an infolded partial fellowship. Only 9% reported no resident exposure at all. There were 12% of respondents who reported to have knowledge of vascular surgeons or cardiologists performing intracranial procedures. At the time of the survey, there were 68 fellows in training, and most entered training immediately after residency (38%), whereas 26% entered after a fellowship and another 26% trained while in residency. There will be a 14% increase of graduates within the next 5 years. Comparing the past 5 years (2003-2007) with future 5-year projections (2008-2012), the number of radiologists is declining by 37% (73 vs. 46), whereas the number of neurosurgeons (74 vs. 106) and neurologists (20 vs. 37) is increasing by 42.5% and 112%, respectively. This survey suggests that there is a strong interest in endovascular surgical neuroradiology. The overall number of graduates is increasing, particularly in neurosurgery and neurology. Although the majority of current faculty is still comprised of neuroradiologists, the number of graduates in radiology will be decreasing during the next 5 years, reflecting a trend toward greater subspecialization within the fields of neurosurgery and neurology. Peer-Review Article.
    No preview · Article · Jul 2010 · World Neurosurgery