Living for the Weekend: Real World Practice of On Call Dual Trained Neuroendovascular Neurosurgeons

Introduction: Dual trained (DT) neuroendovascular and open vascular neurosurgeons have increased in demand; however, the real world practice of the DT neurointerventionalist is poorly characterized. At the author’s institution, DT neurosurgeons on call for the weekend are responsible for covering both neuroendovascular and general neurosurgery cases. The objective of this study is to characterize the case volume and distribution of DT neuroendovascular neurosurgeons during weekend call.

Methods: The weekend cases of 5 DT neurosurgeons at a single level 1 trauma center and comprehensive stroke center from August 2021-August 2023 were reviewed. Cases were categorized as either cranial trauma, spine trauma, general neuroendovascular (vasospasm, and nonspecific diagnostic angiogram), tumor resection, tumor embolization, endovascular mechanical thrombectomy, subarachnoid hemorrhage (SAH) diagnostic angiogram, aneurysm treatment, middle meningeal artery (MMA) embolization for subdural hematoma (SDH), epistaxis embolization, or other. The number of cases was recorded. Concomitant procedures requiring the “back up call” neurosurgeon were documented.

Results: A total of 296 cases were performed by 5 DT neurosurgeons during weekend call. Categorization of cases showed: Cranial trauma: 81 cases (27.36%), spine trauma: 23 (7.77%) general neuroendovascular: 36 (12.16%), tumor resection: 1, (0.34%), tumor embolization: 2 (0.68%), endovascular mechanical thrombectomy: 70 (23.65%), SAH diagnostic angiogram: 17 (5.74%), aneurysm treatment: 25 (8.45%), MMA embolization: 36 (12.16%), epistaxis embolization: 1 (0.34%), other: 4 (1.35%). Over the 104 weekends reviewed, the neurosurgeon on “backup call” performed 23 cases (7.77%) due to the frequency of neurosurgical emergencies.

Conclusion : This study emphasizes the volume and scope of treatment provided by DT neurosurgeons at combined level one trauma and comprehensive stroke centers, and highlights the incidence of concurrent neuroendovascular and surgical emergencies. Furthermore, this retrospective review adds to the sparse current literature surrounding the real-world practice of DT neurosurgeons.