Patients depend on their doctors to help them make sense of these matters. Doctors who strive for excellence in patient care must continually examine issues like these.
At the 2015 meeting of the American Association of Neurological Surgeons, two doctors from the Neurosurgery Department at Columbia University Medical Center led their peers in such learning and reflection. Dr. E. Sander Connolly of the Cerebrovascular Center and Dr. Michael Kaiser of the Spine Center spoke on controversies and complications in their respective areas of expertise.
Dr. Connolly spoke on the subject at two separate cerebrovascular* courses. An experienced neurosurgeon, vice chairman of neurosurgery, and director of the Cerebrovascular Research Laboratory at Columbia, Dr. Connolly is a leader in the research and treatment of cerebrovascular disease.
Treating a ruptured aneurysm is a medical emergency. Time is of the essence. A surgeon must prioritize what action to take first. There are two treatment approaches that differ in that first action. One is called “clip first,” and one “coil first.”
Both approaches can deliver excellent results, but research is ongoing about which approach is better for which cases. Since cases of ruptured aneurysms vary widely, treatment approaches must also be individualized for each situation.
Dr. Connolly’s debate session was more than just a presentation of helpful facts. It was a reminder that when situations are not black-and-white (…clip first or coil first?), physicians must know the criteria for making a treatment selection. And they must know it thoroughly enough to choose quickly for each new case.
Dr. Connolly’s second session was called “Controversies in the Management of Intracerebral Hematomas.” “Intracerebral hematomas” cause bleeding that pools in the brain and compresses brain tissue. Research about treatment for this problem is also ongoing. When new results are published, they must be evaluated and interpreted.
When differences of interpretation arise, controversy follows. In this session, Dr. Connolly and two other leading neurosurgeons detailed each side of the current controversies. They not only demonstrated the importance of ongoing learning, but also helped their peers keep abreast of the best available knowledge.
Dr. Michael Kaiser, associate director of the Spine Center at Columbia, was also busy demonstrating the importance of leadership and learning. He served as moderator on a panel of experienced spine surgeons.
The panel discussed complications from their own clinical practices, and what they learned from those situations. The goal of the seminar was for audience members to learn techniques to avoid complications in minimally invasive spine surgery, spinal fusion, spinal deformity correction, and other spine surgeries.
Dr. Kaiser moderates this seminar every year at the annual meeting of the AANS. It is an incredibly valuable seminar. It is valuable not only for the factual information delivered, but also because the faculty of this course are leading by example. They are encouraging spine surgeons to reflect rigorously on their cases, and to share the results of that reflection with their peers.
In this way, patient care improves…not just for the patients of one surgeon, but for the patients of many.
*”Cerebrovascular” means having to do with blood vessels of the brain: “cerebro” = brain; “vascular” = blood vessels.
**A brain aneurysm is a bleed in the brain caused by the bursting of a weak, bulging spot in an artery.
Top image credit: Cropped from (c) QuotesEverlasting/[Flickr].
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