Surgery for primary brain tumors at United States academic training centers: results from the Residency Review Committee for neurological surgery.

OBJECT Surgery for primary brain tumors has been an important index of the quality of neurosurgical training programs in the US. The scope of such cases and the proportion of surgeries performed transsphenoidally are an interesting means of tracking the effectiveness of residency education. METHODS Program Information Forms from the 94 American Council for Graduate Medical Education-approved US neurosurgical residency programs were reviewed for the period between 2000 and 2003. Particular attention was focused on an analysis of the cases requiring craniotomy for primary brain tumor and transsphenoidal surgery. The mean annual number of primary brain tumor cases per program was 195, with a range from 36 to 724 cases. The proportion of primary brain tumors accessed transsphenoidally was 20%. The mean annual number of transsphenoidal operations performed at academic training centers was 39. A wide range in the frequency of transsphenoidal cases from one program to another was also noted. Almost one third of training centers performed fewer than 20 transsphenoidal operations annually and 80% performed fewer than 50. CONCLUSIONS Most neurosurgical training programs provide residents with excellent experience in craniotomy for primary brain tumors. Practice with transsphenoidal surgery, however, is less well represented and tends to be clustered at several active centers. The implications for neurosurgical education are significant.

[1]  H. Adams,et al.  Improving the outcomes of carotid endarterectomy: results of a statewide quality improvement project. , 2000, Journal of vascular surgery.

[2]  D M Long,et al.  Competency‐based Residency Training: The Next Advance in Graduate Medical Education , 2000, Acta neurochirurgica. Supplement.

[3]  John A. Cowan,et al.  The Impact of Provider Volume on Mortality after Intracranial Tumor Resection , 2003, Neurosurgery.

[4]  E. Laws,et al.  Pituitary adenoma in Olmsted County, Minnesota, 1935--1977. A report of an increasing incidence of diagnosis in women of childbearing age. , 1978, Mayo Clinic proceedings.

[5]  G. Stranjalis,et al.  Ruptured cerebral aneurysm: Influence of specialist and trainee-performed operations on outcome , 2005, Acta Neurochirurgica.

[6]  R. Clayton,et al.  Pituitary surgery for acromegaly , 1999, BMJ.

[7]  M. Lawton.  Basilar Apex Aneurysms: Surgical Results and Perspectives from an Initial Experience , 2002, Neurosurgery.

[8]  F. Barker,et al.  In-hospital mortality rates after ventriculoperitoneal shunt procedures in the United States, 1998 to 2000: relation to hospital and surgeon volume of care. , 2004, Journal of neurosurgery.

[9]  S. Mayer,et al.  Relationship between the volume of craniotomies for cerebral aneurysm performed at New York state hospitals and in-hospital mortality. , 1996, Stroke.

[10]  J. Lynch,et al.  Outcome analysis of carotid endarterectomy in Connecticut: The impact of volume and specialty , 1996, Annals of vascular surgery.

[11]  D. Rees,et al.  Long‐term follow‐up results of transsphenoidal surgery for Cushing’s disease in a single centre using strict criteria for remission , 2002, Clinical endocrinology.

[12]  J. Birkmeyer,et al.  Hospital Volume and Surgical Mortality in the United States , 2002 .

[13]  J. Wass,et al.  The Importance of Locating a Good Pituitary Surgeon , 1999, Pituitary.

[14]  E L Hannan,et al.  Improving the outcomes of coronary artery bypass surgery in New York State. , 1994, JAMA.

[15]  M. Bernstein,et al.  Surgical teaching: how should neurosurgeons handle the conflict of duty to today's patients with the duty to tomorrow's? , 2003, British journal of neurosurgery.

[16]  P. Stewart,et al.  Outcome of surgery for acromegaly--the experience of a dedicated pituitary surgeon. , 1999, QJM : monthly journal of the Association of Physicians.

[17]  J. Hernesniemi.  Mechanisms to improve treatment standards in neurosurgery, cerebral aneurysm surgery as example. , 2001, Acta neurochirurgica. Supplement.

[18]  B. Bell,et al.  Association between surgeon seniority and outcome in intracranial aneurysm surgery , 2003, British journal of neurosurgery.

[19]  A. Klibanski,et al.  Transsphenoidal surgery for pituitary tumors in the United States, 1996-2000: mortality, morbidity, and the effects of hospital and surgeon volume. , 2003, The Journal of clinical endocrinology and metabolism.

[20]  Alain C Enthoven,et al.  Should operations be regionalized? The empirical relation between surgical volume and mortality. 1979. , 1979, Clinical orthopaedics and related research.

[21]  F. Barker.  Craniotomy for the resection of metastatic brain tumors in the U.S., 1988–2000 , 2004, Cancer.

[22]  S. Sawano,et al.  Retrospective analysis of long‐term surgical results in acromegaly: preoperative and postoperative factors predicting outcome , 1996, Clinical endocrinology.

[23]  H. Reulen,et al.  5 Years' Experience with a Structured Operative Training Programme for Neurosurgical Residents , 1998, Acta Neurochirurgica.

[24]  Edward R. Smith,et al.  Craniotomy for Resection of Pediatric Brain Tumors in the United States, 1988 to 2000: Effects of Provider Caseloads and Progressive Centralization and Specialization of Care , 2004, Neurosurgery.

[25]  E. Laws,et al.  A history of pituitary surgery , 2002 .

[26]  W. Friedman,et al.  Resident duty hours in American neurosurgery. , 2004, Neurosurgery.

[27]  D. Long.  Competency-based training in neurosurgery: the next revolution in medical education. , 2004, Surgical neurology.