Training and Standards

It hardly needs to be stated that vascular neurosurgery has changed dramatically over the past 50 years. As neuroendovascular surgery has evolved, more cerebrovascular disease has come to be treated with these techniques. At the same time, fewer but possibly more complex aneurysms must be treated with open cerebrovascular techniques. Together, these changes present unique challenges for training programs and practice standards within vascular neurosurgery. In this chapter, we outline the historical context of training guidelines and certification in neuroendovascular and open cerebrovascular neurosurgery. We then review the current status of these efforts including the Committee on Advanced Subspecialty Training (CAST) certification and other training research and initiatives. We briefly review guidelines for specific operations, as well as hospital privileges. An additional aspect of training and standards, the maintenance of certification process, is discussed in the context of neuroendovascular surgery. We then turn our attention to open cerebrovascular neurosurgery, where fewer but perhaps more complex aneurysms present unique challenges for training the next generation of open cerebrovascular surgeons as well as maintaining standards in this area. Possible solutions to these challenges including simulation training and fellowship training in high-volume centers are discussed. We also review guidelines for competence including CAST certification in cerebrovascular neurosurgery. In conclusion, we offer a checklist of recommendations regarding training and standards in neuroendovascular and open cerebrovascular neurosurgery.