The Real World of Surgery for Cerebral Stroke Performed by Mid-career Neurosurgeons of the Osaka University Group

Abstract

Recently, the rate of direct surgery for cerebrovascular diseases has decreased with the popularization of endovascular treatment. Therefore, improving individual skills is critical. We investigated the reality of cerebrovascular disease treated by mid-career neurosurgeons in the Osaka University group and attempted to clarify the requirement to improve individual skills. We collected data on the number of annual surgical cases in 2022 and subjective changes in surgical skills in board-certified neurosurgeons with 10 to 20 years of experience after graduation. The Improved, Flat and Declined groups were defined as those who answered that their skills improved, remained flat, or declined, respectively. Responses were received from 44 physicians and 24 hospitals (100% response rate). The annual numbers of clipping cases were as follows: 0 cases, n=17, 1-2 cases: n=12, 3-4 cases: n=6, 5-6 cases: n=7 and 7-8 cases: n=2. The mean cases of Improved, Flat and Declined groups were 3±0.9, 2.3±0.5, 1.1±0.6, respectively (p=0.1517). The annual number of cases of carotid endarterectomy was as follows: 0 cases: n=31, 1-2 cases: n=7, 3-4 cases: n=4 and 5-7 cases: n=2. The mean cases of Improved group was significantly higher than that of Flat and Decline groups (3.3±0.5, 0.7±0.3, 0.1± 0.3, respectively, p<0.0001). The annual number of cases of STA-MCA bypass was as follows: 0 cases: n=25, 1-2 cases: n=10, 3-4 cases: n=6; and 5: n=3. The mean cases of Improved group was significantly higher than that of Flat and Decline groups (3.2±0.5, 1.3±0.3, 0.3±0.3, respectively, p<0.01). The preservation rate of surgical skills of the group that included physicians who routinely performed self-bypass training was significantly higher than that of the group that included physicians who did not perform self-bypass training (100% vs. 48.7%, p=0.0156). Despite subjective data, the number of annual cases for the improvement of surgical skills has been clarified. However, these numbers are insufficient. A constant self-off from job training is considered imperative for the improvement of surgical skills.