The state of cerebrovascular training in the United Kingdom.

Abstract

Background: Cerebrovascular training for neurosurgical residents has been impacted by the decrease in open surgery for aneurysms, the rise of endovascular treatments, and a decline in interventions for arteriovenous malformations (AVMs). Our aim was to explore the open vascular and endovascular experience recorded by residents in the United Kingdom (UK) over a 12-year period (2011-2022, inclusive).

Methods: A retrospective database review of 12 open vascular and endovascular procedures logged by UK residents over a 12-year period was conducted. The number of operations recorded as performed by the resident was evaluated.

Results: A total of 324neurosurgical residents' operative logbooks were included and 14,427 procedures were recorded during the study period. Clipping of anterior circulation aneurysms were the commonest operations recorded. Fewer trainees accounted for more of the recorded clipping cases as the study period progressed unlike AVM excisions, where a similar proportion of residents recorded performing them across the study. Endovascular procedures were recorded by a limited number of residents.

Conclusions: A large proportion of cerebrovascular procedures are performed by a select few trainees which may reflect centralisation of services, variations in treatment patterns, or trainee subspecialty interest. Implications for future service delivery are crucial as trainees' operative experience appears limited.