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Winter 2005 Issue
From the Chair... Mark R. McLaughlin, MD
From the Editor "The Endless Pile" ... Tanvir Choudhri, MD
YNC Update
YNC Members, YNC Related Committees, YNC Liaisons, YNC Meetings/Minutes, YNC Announcements
YNC Careers
"How I Did it…" Robert Spetzler, MD
Call for submissions
YNC Outlook
"A Master-full evening…" Mark McLaughlin, MD
Record-setting 2004 Silent Auction
YNC Clinical
Test yourself… 79-year-old with H/A and posterior fossa ICH…Gavin Britz, MD
YNC Review
Book review: Color Atlas of Microneurosurgery of Acoustic Neuromas. Wolfgang T. Koos, et al. New York: Thieme, 2002, 326 pp. Price: $199.00
YNC Feedback
Medical Liability Questionnaire
From the Chair...
Mark R. McLaughlin, MD
Greetings from the Young Neurosurgeons' Chair! As chair, I would like to invite anyone interested in getting involved with our organization to please attend our upcoming meeting in New Orleans. The meeting is slated for Monday, April 18, 2005. We have a lot of work to discuss at this meeting, and certainly welcome anyone interested in helping out. Tanvir Choudhri, MD has put together another outstanding publication that highlights many of our activities. I would like to focus on our most important task at hand: professional liability reform.
| "It's never too late to do the right thing." | |
| B. Gregory Thompson, MD | |
| Words imparted to me as an intern on the neurosurgery service at the University of Pittsburgh |
Let's face it — the medical liability crisis is the most dangerous and threatening problem for medicine today. It is not going to go away. It will not be solved by our current legal system. It will not be solved to our satisfaction if we let the politicians try to remedy the situation. It will only be solved by our fierce determination and resolve to reshape the medico-legal climate in the United States.
This needs to be a grass roots effort aimed at the public, not the politicians, designed to change attitudes and perceptions about medical liability. To accomplish our mission of reforming the tort system, it will take time and money, with a significant amount of each coming from you. Instead of facing yearly increases in your malpractice insurance premiums, which have already ranged from $10,000 to upwards of $200,000, why not invest a fraction of that money in a campaign to reform the broken system? It's never too late to do the right thing. If you haven't donated to Neurosurgeons to Preserve Health Care Access (NPHCA), do it today!
Fortunately these leaders have provided us with a vehicle to accomplish our goal. Stewart Dunsker, MD and others have begun a valiant effort to get the ball rolling in spearheading professional liability reform by creating NPHCA. Many of these senior leaders don't have as much at stake as we do, as young physicians. They have taken up this fight because it is the right thing to do. It is the right thing for us to do, but more importantly, it is the right thing to do for our patients who ultimately suffer the most from this problem.
You ask, "How can I help? I am busy with my patients and have little time." The answer is to get involved, and spread the message. Be available and volunteer for opportunities to interact with the lay public. It does little good to grumble and complain to your fellow doctors at the hospital or medical association meetings, as this is preaching to the choir. For example, I recently did a local television interview for the lay public and one of the questions asked was: "What's the most frustrating part of medicine?" This was my reply:
"The liability insurance crisis that exists in the United States is clearly the most frustrating part of practicing medicine in this day and age. It is counterproductive to caring for patients. Medical professional liability is a very complex problem, and one I don't want to pretend to have all the answers for. But I can comment with certainty on how the liability crisis badly affects the doctor-patient relationship, as well as medicine and the public. One indisputable fact that we all agree on is that malpractice insurance for many physicians in the United States has become either unavailable or prohibitively expensive."
"Some say it's because of frivolous lawsuits and runaway jury verdicts. Others malign the insurance companies for raising their rates to make up for losses in the stock market by passing this on to the doctors. What I can say is that clearly, no responsible doctor wants to see medicine practiced poorly. Any reasonable person would agree that a person who has suffered as a result of a true medical error deserves to be compensated for their damages. The problem is how to go about compensating that person who has suffered as a result of a true medical error."
"The other major problem is that some plaintiffs and attorneys seek to benefit from medical episodes that do not constitute malpractice, but are merely unfortunate patients that have bad outcomes. This is particularly true in neurosurgery, where we are performing extremely high-risk procedures and often the odds are against us for a good outcome. As a result, many doctors who perform high-risk medicine are unable to obtain, or can not afford, malpractice insurance and are leaving their home state to go to more liability friendly states."
"But the problem runs even deeper than that. The ripple effects of the liability insurance crisis are causing veteran, seasoned physicians and surgeons to retire early. Do you know what this means? When an experienced doctor retires early it is like a giant library burning down to the ground! Nobody benefits from that doctor's years of experience, which is so critical to being a great doctor. Each year of experience lost is like a textbook of knowledge lost forever. I am trained to perform state-of-the-art techniques in brain and spine surgery, but you know what? There isn't a week that goes by that I don't ask one of my senior associates their advice on a difficult case. They each have 26 years of experience — that's like 52 volumes of an encyclopedia. All the training in the world doesn't match up to that. We are losing doctors like these to early retirement. Another frightening, and little discussed consequence of the malpractice crisis, is the reluctance of some doctors, many of them highly trained, to perform certain surgeries which carry a high risk."
The comments I got back from my patients were astonishing! "Doc, we never knew this is what's happening." "Doc, that library example really brings this thing home to me." "Are experienced doctors really retiring early?"
Take this message to the public! You have got to get out there and educate your patients. Use simple analogies, concrete examples, and common experiences that exemplify the absurdity of the current system. You must remain calm when discussing these issues with your patients or with the media. Once you become impassioned or emotional, you may lose your credibility. You have got to become an ambassador of medicine to the public. I find it amazing that the vast majority of the public still admires or even reveres their doctor, but has no inclination at all to vote in favor of tort reform. There is a public image misconception and we need to remedy that.
Need help honing your public relations and media skills? Check out the AANS Public Relations and Media Training opportunities during the AANS Annual Meeting. The Communications Department at the AANS has organized several major activities to increase your exposure and to train you on how to work with the media and the public. Get involved with the Hometown Radio Interview program. Additional information is available about these Public Relations and Media Opportunities and we encourage you to learn more. For additional information or to sign up for this training, contact Betsy van Die, AANS communications director at bvd@aans.org.
We, as young neurosurgeons, have the most at stake in this battle. There is a mechanism in place to begin this fight. You need to be committed for the long run, both financially and mentally. Don't waste any time on this. Donate now. It's never too late to do the right thing.
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AANS-Sponsored Hometown Radio Interviews AANS 2005 Neurosurgical Media Awards Program AANS Annual Meeting Media Training Work with a seasoned media trainer on how to effectively deal with the media. Topics touched upon include educating the public on the role of the neurosurgeon in treating a wide variety of medical conditions, as well as learning to speak about policy issues, such as medical liability reform. The two-hour interactive breakfast seminar is scheduled for Tuesday, April 19 from 7:30 — 9:30 a.m. |
From the Editor…
Tanvir Choudhri, MD
"The Endless Pile…"
The adage goes, "If you want to get something done, give it to a busy person…" Well, I can tell you from personal experience that this may be true in many walks of life, but the adage does not necessarily hold up well in neurosurgery, particularly for young neurosurgeons who are building their careers and families. Almost all of us face the same problem… the seemingly endless "pile" of things that we need and/or want to do for our work and home lives.
At work, the potential commitments to our patients, paperwork, professional reading, and other tasks could (and sometimes do!) take up every hour of the day and night. In our attempts to meet all our obligations, the "system" continually asks more from us in terms of documentation, forms, etc. (and frequently gives less). We are often asked to write separate letters of necessity, as if our prescriptions and office dictations are meaningless. Admittedly, the payers of the world struggle with their own challenges of a troubled health care system, but they are often unfairly shifting their burdens onto physicians and patients. Other systemic changes, often with good intentions (eg. resident work hour reforms) have also created new challenges for young neurosurgeons.
At home we struggle to spend quality time with our families. Our profession's heavy training requirements leave us in debt to our families. After training, the hopes for an improved life are often dashed, as the realities of being a young neurosurgeon set in. In addition to the direct spillover of our clinical practices to our home life, we carry with us the burdens of professional reading, board preparation, and unfortunately, sometimes medical lawsuits.
What can be done? Clearly there is no single, simple answer. The system will not easily adjust to facilitate our needs. Most of our lives will always be busy. It is difficult to become more efficient; although we all try, and with experience, some of us succeed. Physician extenders can only do so much. It is difficult to practice neurosurgery part-time. On top of all this, there are real concerns caused by a neurosurgical workforce shortage. Our families already sacrifice way too much… we should not expect them to give more. Some neurosurgeons do, and their families suffer. There are some things which would, in my opinion, help improve our lives and those of our patients and families:
(1) Meaningful liability reform should bring tremendous direct and indirect cost and time savings. All those close to the issue believe that now is the moment to make this happen. We need the public, our patients, and more directly, our legislators to realize the importance of the issue to their health care. See Dr. McLaughlin's comments in this issue on ways to get involved.
(2) Improved office infrastructure with better software, databases, voice recognition, and secure wireless electronic medical records is sorely needed. These developments are limited by technology and cost.
(3) Restoration of the physician/patient autonomy in medical decision-making. The era of physician autonomy has, for mostly positive reasons, long since transformed to shared physician/patient decision-making. Unfortunately, this model has been compromised by the significant role of payor "decisions" regarding what is medically necessary. These decisions are made by and large by people who have never, and likely, will never, see the patient and who frequently do not have medical degrees. The basic tenets of health care and the patient-physician relationship have been altered and we must work to reestablish them. Our patients deserve it and our profession will depend on it. How to do it is obviously the difficult part.
For these goals to be achieved, we must have more awareness and involvement. When trying to juggle full office hours and operating rooms, frequent emergencies, family events, and occasionally personal pursuits, these less tangible, frequently frustrating, and sometimes hopeless issues of "system reform" can easily slip to the bottom of the endless pile. Yet it is our patients, profession, and personal lives that are being threatened. The problems are not going to disappear until we make a concerted effort to deal with them. Please get involved and stay involved.
In this and upcoming issues of the YNC newsletter, we will address issues relevant to young neurosurgeons. In this issue, we are pleased that Dr. Robert Spetzler agreed to participate in a "How I did it…" feature. We also present the new YNC Clinical section with "Test Yourself…" by Dr. Gavin Britz. Finally, there are features on the 2004 "Master's Dinner," the 2004 Silent Auction, and a book review. We hope you enjoy the issue and look forward to your feedback!
2004-2005 AANS Young Neurosurgeons Committee Members
Newsletter (Fall 2003- Fall 2005)
| Editor | Tanvir Choudhri, MD | tanvir.choudhri@mountsinai.org |
| Associate Editor | Gavin Britz, MD | gbritz@u.washington.edu |
| Associate Editor | Jonathan Friedman, MD | jonathan.a.friedman@hitchcock.org |
| YNC Chair | Mark McLaughlin, MD | mclaughlin@spineuniverse.com |
| YNC Vice-Chair | Lawrence Chin, MD | lchin@smail.umaryland.edu |
| YNC Secretary | Brian Subach, MD | bsubach@spinemd.com |
| Assistant Editor | Aaron Afshin Cohen-Gadol , MD | cohengadol.aaron@mayo.edu |
| Assistant Editor | Michael Y. Oh, MD | ohm@health.missouri.edu |
| Assistant Editor | G. Edward Vates, MD PhD | edward_vates@urmc.rochester.edu |
| Assistant Editor | Brian J. Snyder, MD | brianjeffreysnyder@yahoo.com |
Silent Auction Committee (2004-05)
| Chair | Eve Tsai, MD |
Marshall's Subcommittee (2004-05)
| Chair | Carlos David, MD | Vice Chair | Eve Tsai, MD |
Date in parentheses indicates end of term.
| AANS Board of Directors | Mark McLaughlin, MD (2005) |
| Scientific Program Subcommittee | Jonathan Friedman, MD (2005) |
| Outcomes Committee of the AANS/CNS | Gavin Britz, MD (2005) |
| Member Benefit Development Committee | Jonathan Friedman, MD (2004) |
| Coordinating Committee for Continuing Education | Mark McLaughlin, MD (2005) |
| Neurosurgery Research and Education Foundation | Kevin Walter, MD (2006) |
| Executive Council (NREF) | |
| Neurosurgery Research and Education Foundation | Kevin Walter, MD (2006) |
| Education and Practice Management Committee | Mark Proctor, MD (2005) |
| Publications Committee | Richard D. Fessler, MD (2005) |
| Washington Committee | Lawrence Chin, MD |
| American Neurological Surgery Political Action | Richard D. Fessler, MD (2005) |
| Committee (ANSPAC) | |
| Joint Section on Neurotrauma and Critical Care | Eve Tsai, MD (2005) |
| Joint Section on Disorders of the Spine and Peripheral Nerves | Tanvir Choudhri, MD (2005) |
| Joint Section on Tumors | Andrew Parsa, MD (2006) |
| Joint Section of Stereotactic and Functional Surgery | Joshua Rosenow, MD (2005) |
| Joint Section of Pediatric Neurological Surgery | Mark Proctor, MD (2005) |
| Joint Section on Cerebrovascular Surgery | Carlos David, MD (2005) |
| Joint Section on Pain | Julie Pilitsis, MD (2005) |
| Section on History of Neurological Surgery | Aaron Cohen-Gadol, MD (2005) |
| Council of State Neurosurgical Societies (CSNS) | Mark McLaughlin, MD (2005) |
| Women in Neurosurgery (WINS) | Denise Crute, MD (2005) |
| AMA Young Physicians | Tanvir Choudhri, MD (2006) |
The YNC meetings at the CNS and AANS are open to the general young neurosurgeon membership 40 years or younger or less than five years in practice. Although only elected YNC members will be allowed to vote or hold office, young neurosurgeons are encouraged to attend, participate in the dialogue, and get involved with projects such as the Silent Auction and AANS Marshals Committee. This meeting is an excellent way to develop the skills, knowledge base, and connections to serve on the YNC in the future. Also, please plan to attend the Annual Luncheon, which will be held this year in New Orleans on April 18, 2005, featuring guest lecturers. See additional information below for more details. This event is free for young neurosurgeons, but pre-registration is highly recommended, as seating and food must be arranged in advance.
To pre-register, visit the Annual Meeting online registration page.
Upcoming YNC meetings:
Monday, April 18, 2005
1:00 - 2:45pm
Location — To be determined
The Surgeon Scientist — Demigod or Dinosaur?
Speaker: John T. Povlishock, PhD
The Surgeon Scientist — A view from the bench
Speaker: L. Dade Lunsford, MD
The Surgeon Scientist — A view from the theater
Monday, April 18, 2004
6:00 - 8:00 p.m.
Location - To be determined
http://www.aans.org/education/educational.
Past meeting minutes:
Spring 2004 Young Neurosurgeons Committee Meeting Minutes are available online.
YNC Update
Seventh Annual Silent Auction
The 2005 Annual Meeting of the AANS will be the venue for the Seventh Annual Silent Auction to benefit the Neurosurgery Research and Education Foundation (NREF). The AANS, NREF, and YNC would like to thank the countless young neurosurgeons who have participated in the auction by providing bids, or by donating items or time. If you would like a sneak peak at upcoming auction items or would like to make a donation to the silent auction, please visit: http://www.aans.org/research/neurosurgery/nref_y.asp or contact the Development Department at (888) 566-2267.
Public Service Citation
The Young Neurosurgeons Committee Public Service Citation was established in 2001. The award recognizes and honors the extraordinary efforts of a young neurosurgeon, whom outside the traditional art and science of neurosurgery, has served the public in an exemplary fashion and thereby brings both greater benefit to mankind and honor to our specialty.
The award is presented annually to an individual actively engaged in neurosurgery training or practice. The nominee must be within seven years of finishing neurosurgery training. The award is for extraordinary or unusual public service outside of any service specific to organized neurosurgery. Suitable nominees may serve the public through various means including, but not limited to, public charities, medical or socioeconomic mission work, and governmental or legislative efforts. The 2005 Public Service Citation will be presented at the Young Neurosurgeon's Luncheon on April 18, 2005 at the AANS Annual Meeting in New Orleans, LA.
To nominate a candidate, contact Chris Ann Philips at cap@aans.org. Deadline for submission is March 18, 2005. Please include the following:
- Name, address, and telephone number of the Nominee.
- Year of completion, or anticipated completion, of neurosurgery training.
- A 250-500 word letter of nomination, detailing the nominee's recent and relevant history of public service. Descriptive articles or other relevant material also may be appended to the submission.
- Name, address and telephone number of person submitting the nomination.
Although past winners included young neurosurgeons that made contributions though international neurosurgical service, community projects and service within the United States are equally valid and the Young Neurosurgeons Committee looks forward to these nominations as well.
There are countless members who are contributing to organizations and their communities. The YNC would like to recognize those individuals. Self-nominations are entirely appropriate.
Join the AANS Neuro-KnowledgeTM Network
Neurosurgeons in the early years of their practice have an advantage that was unavailable even a few years ago: Neuro-KnowledgeTM, a joint program of the American Association of Neurological Surgeons and Outcome (formerly Outcome Sciences, Inc). This unique resource combines the expertise, prestige and clinical resources of the world's largest neurosurgical specialty society with an industry leader in Internet based clinical, experiential and opinion research. And you can be paid to participate!
Experimental Trials. Observational studies and registries. Practitioner surveys. Neuro-KnowledgeTMconducts all of these by combining a web-based data collection infrastructure with the world's largest network of neurosurgeons to establish a unique resource for conducting clinical research. Neuro-KnowledgeTM manages neurosurgical clinical trials and registries, evaluates neurosurgical practice and expense issues and gathers opinions from practicing neurosurgeons.
| " Anyone who needs data collected and analyzed — from an opinion survey to planning and conducting a multicenter clinical trial — should consider Neuro-Knowledge. The expertise of the industry leader in on-line data collection plus the prestige and resources of the world's largest neurosurgical organization is a powerful combination — Robert E. Harbaugh, MD |
The AANS is developing Neuro-KnowledgeTM panels, a network of neurosurgeons who want to participate in funded research activities. We invite you to join the AANS Neuro-KnowledgeTM Network. Your participation can range from completing occasional surveys to serving as an expert consultant or speaker to being an investigator in a clinical trial. Each time an opportunity matches your interests you will receive a notification describing the project and how much compensation you will receive for your participation. You decide whether or not to participate.
Neuro-Knowledge'sTM services are focused on three areas of data collection: clinical trials (including recruiting investigators and managing data), observational studies such as registries, and opinion research (including surveys, expert panels and speakers). Neuro-Knowledge™ will work with clinical investigators, device manufacturers, academic research centers and others interested in high quality clinical data collection and analysis relating to neurosurgical patients, procedures and opinions.
AANS is also seeking physicians who would be willing to assist us with contacting
corporations to expand our client base. If you have any questions, or if you
are an independent consultant working with a company, and would be willing
to assist us in making contact with the appropriate personnel in that company,
contact Robert E. Harbaugh, MD, at (717) 531-8807 or rharbaugh@psu.edu.
For additional information about Neuro-KnowledgeTM ,
visit: http://www.aans.org/neuro.asp.
To register as an expert consultant, visit http://www.outcomesciences.com.
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"How I did it…" is a section in the AANS Young Neurosurgeon's Committee newsletter in which prominent neurosurgeons are questioned to identify factors which they felt were essential to build their area(s) of success including their clinical practice, subspecialty focus, operative skills, academic reputation, and/or laboratory and grant efforts. In addition, questions regarding work schedule and work/home balance will be included.
Robert F. Spetzler, MD
Barrow's Neurological Institute
We are pleased to have Robert F. Spetzler, MD as our second participant. His academic and clinical accomplishments are well known. Please contact one of the section editors to suggest future participants and/or questions.
Question 1: What made you go into neurosurgery and then specifically, neurovascular and skull base surgery?
My interest in becoming a physician is surely based on the fact that I developed tetanus as a 6-year-old. Because my survival was deemed exceedingly unlikely, I was placed in a storage room full of iron lung machines. My long course in the hospital and presentation of my case at Grand Rounds made an indelible impression that unconsciously led me into the field of medicine. My interest in neurosurgery dates to early high school: In my yearbook I wrote down neurosurgery as my career goal. I cannot recall a specific incident or reason that marked the origin of the quest. During college I followed my interest in neurosurgery by being involved in research on cerebral blood flow and wrote an honor's paper on this work. My selection of Northwestern Medical School was influenced by the presence of Dr. Paul C. Bucy, who was then a giant in our field. Dr. Bucy had offered me a residency position, but suggested that I go to San Francisco instead, because he was planning to retire soon. With the fortuitous opportunity to train with Dr. Charles Wilson and being exposed to Professor Gazi Yasargil, my interest in neurovascular and then skull base surgery was sealed.
Question 2: What were the keys to building your academic career?
Under Dr. Wilson's tutelage, I had the opportunity to write a number of papers and spend a year in the laboratory. This experience formed the basis of my interest in academic medicine. This interest was further fostered at Case Western Reserve University, where we obtained an NIH RO-1 grant to develop a primate stroke model. In my opinion, the keys to building an academic career are based on subspecialization and research. It is important to become an expert in one's chosen field of interest.
Question 3: What were the keys to building your clinical practice? Specifically, how did you develop and establish your expertise in your specific area and build up the volume of your cases?
I copied the secret of building a clinical practice from Dr. Wilson who inundated every referring physician with letters and telephone calls letting them know about the neurosurgical care that their patients had received. The keys of availability, affability, and ability are still the underpinnings of a successful clinical practice whether in an academic or private setting.
Question 4: Are there any things you would do differently in building your career? If so, please expand.
My career has been such a source of gratification that I cannot think of anything that I would change. My incredible fortune of being surrounded by individuals more gifted than I, who joined together to build a strong neurosurgical department, has made this journey most gratifying. Particularly my good friend, Dr. Volker Sonntag, and the other attendings at Barrow Neurological Institute allowed us to build a program that has attracted superb residents and fellows who, in turn, elevate our own level of expertise.
Question 5: What are the most common mistakes you see in young neurosurgeons of today in terms of career development?
It is not easy to generalize about common mistakes in a neurosurgeon's early career. When a young neurosurgeon is too aggressive, we criticize; when a young neurosurgeon is too reluctant to take action, we criticize. This proclivity leads me to conclude that young neurosurgeons must follow their inner voice, which mingles the appropriate amount of bravado with self doubt to achieve their own success.
Question 6: Are there any things you would do differently with respect to life and include work/home balance? If so, please expand.
I have been enormously blessed by having Nancy as my life partner. She has wholeheartedly supported my career while providing a loving and nurturing home. Nancy, having been trained as a neuro-oncology nurse, was well aware of the time commitments that neurosurgery demands and thus shouldered the major responsibility for raising our children. However, we made it a priority to spend quality time with family and to minimize nonfamily social events. The balance of work and home for Nancy and I requires the addition of athletics, which is a very important component of our lives. Currently, our pastimes include heli-skiing, mountain biking, road biking, and preparing for our first marathon.
Question 7: Who are your role models?
Dr. Wilson for his singular dedication, Dr. Yasargil for his exceptional skills, and Dr. Drake for his humanity.
AANS is excited to introduce its newest member benefit, the AANS Online Career Center. Members can search for positions by subspecialty, geographic location, and other criteria. Full job descriptions are posted with positions updated regularly. Members can post resumes and CV's, anonymously if preferred. The Center features fellowship listings and grant opportunities as well. A unique conference tool enables job seekers to schedule meetings with potential employers during events such as the AANS Annual Meeting. Visit the AANS Online Career Center at www.AANS.org and click on the Career Center tab.
The YNC editors are working on a feature for upcoming issues featuring individuals that have developed substantial nontraditional components to their careers while practicing neurosurgery. Examples may include service in journalism, the business sector, fine arts, etc.
If you know of anyone fitting this description (including yourself), please contact Tanvir Choudhri, MD, at tanvir.choudhri@mountsinai.org.
"A Master-full evening…"
Mark McLaughlin, MD
"The men who have succeeded in business, social and political life, in art, science and philosophy, in power and virtue, have all been marked out by a constancy of purpose and an easy control of the mind."
| Ernest Wood in Concentration |
At the Dinner with the Masters held during the AANS Annual Meeting in Orlando, I had the privilege of spending one of the most interesting evenings of my career. It was an evening of great atmosphere, fine dining, and insightful conversation. Here I was, sitting at a table of neurosurgical giants, many of whom I idolized during my residency, and still do. I would liken it to a kind of reverse interview. Once, they had me in the proverbial hot seat when I was interviewing for a residency position in their program. But now it was my turn to interview them! As I was not sure if I would have this opportunity again, I had carefully prepared for the evening. I had many questions for them. Some of these queries were professional, some philosophical, and some were personal. How do you do it all? How can one succeed in neurosurgery and in life to the extent that you all have? What is the future of academic neurosurgery? What has been the most rewarding experience in your career? Do you have any regrets? What would you do differently if given the chance to do it all over again? These were just some of the questions I fired at them. The answers were thought provoking and some were profound.
They all had much in common: prolific writers, innovators, leaders in the field. But what I found more interesting was the other attributes they had in common. They were all in excellent health and were probably in better shape than I am (despite my being 20-30 years their junior). They were all married to the same spouse for over 30 years. They all had hobbies and outside interests and were actively pursuing expertise in these "non-neurosurgical" extracurricular activities. These were the intangibles that they all pointed to when I asked them to list the main ingredients of their recipe for success.
I left Orlando the next day, but I couldn't stop thinking about that evening. To this day, I have pondered their thoughts and insights. It would be difficult to condense in a single short essay, the central theme that seems consistent with the lives of these successful men. However, I did detect in all of their lives and in their persona an overriding concentration of purpose of thought and feeling. There was no image — it was the real thing. I could not explain this feeling that their entire lives were polarized and channeled by a constancy of purpose. I don't believe that this purpose was to achieve any single goal. There is a danger in trying to achieve only a single "goal" in life because once it is attained; there might be a temptation not to go further.
No, what these men seem to have been able to incorporate into their lives was the notion that they were as totally dedicated to their profession as well as the other attributes of their lives such as their marriages, their family, and their extracurricular activities. They seemed to have blended each of these virtues into an amalgam, which called for success in all of the subsidiary activities in their lives that were indirectly associated with their central purpose: their practice of neurosurgery.
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| Back Row (L to R): Mrs. Rhoton, Albert
Rhoton, MD, Volker Sonntag, MD, Richard G. Fessler, MD, James Ausman, MD Front Row (L to R): Mark McLaughlin, MD, Victor Rudenko, MD, PhD, Edward Benzel, MD |
If you ever have a chance to bid on or attend one of these dinners with the masters, I would highly recommend it. It may change your life.
Record-setting 2004 YNC Silent Auction
Over its first five years, the YNC Annual Silent Auction has raised more than $48,000 on behalf of the Neurosurgery Research and Education Foundation (NREF). In 2004, YNC Silent Auction Committee (see below) began its task, shortly after the 2003 AANS Annual Meeting, in the attempt to beat the records set at the 2003 Silent Auction ($16,820 with 50 total items). Through several in-person meetings and many regular telephone conference calls, the committee worked hard for a year to achieve this goal. They entered the 2004 AANS meeting with 88 items pledged — a new record. The feature item was the Second-Annual Dinner with the Masters, which included both cranial and spinal masters for the first time (see Dr. McLaughlin's article). The committee and staff worked hard through the whole process to make the Silent Auction possible and successful.
It is an honor to report that the Sixth Annual Young Neurosurgeons Silent Auction, held at the AANS Annual Meeting in Orlando, was a huge success. Proceeds, totaling nearly $28,100, from the auction will benefit the NREF's continued support of Research Fellowships and Young Clinician Investigator Awards. Thank you to everyone who participated this year, from the individuals and corporate partners who donated items, to the members and exhibitors whose bids secured these items in the final hour. We could not have done it without you!
If you would like more information on how to donate an item or would like to participate in the Silent Auction Committee, please contact Terri Bruce at tlb@aans.org or (847) 378-0535!
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| Left to Right in front of the 2004 Silent Auction Booth: Dr. Tanvir Choudhri, Terri Bruce, Michele Gregory, and Ron Engelbreit |
Eve Tsai, Silent Auction Vice-Chair
Terri Bruce, AANS Staff
Michele Gregory, AANS Staff
Mark McLaughlin, YNC Chair
Denise Crute
Aaron Cohen-Gadol
Kendall Lee
Alfredo Quinones
Daniel Suh
Nitin Tandon
Ed Vates
Michael Wang
Kevin Walter, YNC Liaison to NREF
Test Yourself
Gavin Britz, MD
A 79-year-old female presented with a sudden headache. Neurological examination only demonstrated a mild left hypoglossal palsy. A non contrast head CT scan (Image 1) was done, which demonstrated hemorrhage in the posterior fossa, lateral, third and fourth ventricle with hydrocephalus.
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Image 1 |
Q1. What would be your differential diagnosis based on the clinical history and CT findings?
Q2. What tests would be the next most appropriate ones to order?
Q3. What is your differential diagnosis based on this test?
Q4. What is the next step?
Q5. What does the angiogram show?
Q6. What would you recommend to the patient?
Q7. What is the next option and which approach would you use?
Book Review
Jonathan A. Friedman, MD
Lebanon, NH
Color Atlas of Microneurosurgery of Acoustic Neuromas. Wolfgang T. Koos, et al. New York: Thieme, 2002, 326 pp. Price: $199.00
Color Atlas of Microneurosurgery of Acoustic Neuromas is far more than an atlas. This extensive volume by Koos, Matula, and Lang is a textbook for the treatment of acoustic neuromas. Although the text is highly succinct in its wording and organized around the illustrations, it is comprehensive in its scope. The book covers anatomy, imaging, surgical approaches, techniques, and outcomes for the surgical management of acoustic neuromas. Sections on other cerebellopontine angle tumors are also included, as is a chapter on radiosurgery. The book is beautifully illustrated, using both high-quality photographs of cadaver or intraoperative dissections, and artists' renderings. In most cases, photographs are accompanied by a labeled drawing of the same view, which is highly useful and intuitive.
The first chapter, on anatomy, is a highly detailed description of the anatomy of the cerebellopontine angle and internal acoustic meatus. The level of detail is on par with the best of dedicated anatomy texts, and each subtlety is demonstrated with a high-resolution photograph of cadaveric dissection accompanied by a labeled artist's drawing of the same specimen. Specific anatomy in the setting of an acoustic neuroma is beautifully illustrated using high-resolution intraoperative photography, with relevant structures subtly highlighted using computer generated graphics. This is a unique and highly effective approach. Preoperative considerations are then discussed, including imaging, anesthesia, room setup and instrumentation.
The section on surgical management of acoustic neuromas is the backbone of the book and makes up nearly half of the content. As in the rest of the book, each case is beautifully illustrated with multiple intraoperative photographs, MR scans, and drawings.
The fundamental flaw of the book is found in this chapter — the authors clearly favor the retrosigmoid approach — with little attention to and almost no illustration provided of translabyrinthine or middle fossa approaches. This limits the utility of the book as a standalone text, and readers interested in the nuances of these other approaches will need to look elsewhere. The sections on other cerebellopontine angle tumors and radiosurgery complete the text.
This book is an absolute requirement for department libraries and for use in training. Surgeons who operate on acoustic neuromas via the retrosigmoid approach with any frequency are also likely to find this volume a worthwhile addition to their personal libraries.
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