Editorial to The State of Neurovascular Surgery in 2024: a pioneering era of precision and innovation

Two decades ago, the landmark International Subarachnoid Aneurysm Trial (ISAT) study transformed how we treat ruptured aneurysms by proving that it was safer to coil them than to clip ligate. This led to an increase in the number of endovascular surgeons being trained to accommodate the increased demand. In North America, neurosurgeons were dual trained in microsurgical and endovascular surgery, whereas in Australia, Europe and the United Kingdom, interventional neuroradiologists (INRs) were trained to meet this increase in the demand for endovascular operators. This latter approach has meant a significant reduction of neurovascularly trained neurosurgeons in Europe. By contrast, there has been significant advancements in the endovascular technologies and their safety profile and the repertoire of neurovascular disorders that can be treated endovascularly; endovascular thrombectomy has been shown to be more effective in reducing disability than medical therapy alone in selected patients with ischaemic stroke due to a large cerebral vessel occlusion and there is emerging evidence that endovascular embolization of the middle meningeal artery reduces recurrence of chronic subdural haematomas. This increase in the need for endovascularly trained surgeons to meet demand has triggered a debate about European training following the North American model of dual accreditation and what credentialling models might be used to achieve this.

This special series invites experts on both sides of the Atlantic and the Pacific to share their views on how neurovascular disorders are managed across the world and to provide their insights on the future of neurovascular surgery and how technological advances and research evidence have advanced the treatment of cerebrovascular disorders.

Acknowledgments

None.

Footnote

Provenance and Peer Review: This article was commissioned by the editorial office, AME Surgical Journal for the series “State of Neurovascular Surgery. The Way Forward”. The article did not undergo external peer review.

Funding: None.

Conflicts of Interest: Both authors have completed the ICMJE uniform disclosure form (available at https://asj.amegroups.com/article/view/10.21037/asj-2025-1-84/coif). The series “State of Neurovascular Surgery. The Way Forward” was commissioned by the editorial office without any funding or sponsorship. C.M.T. served as the unpaid guest editor of the series. The authors have no other conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

John A. Emelifeonwu

Christos M. Tolias