Greater awareness of neurosurgical issues needed

Andre Grotenhuis

Coming off the back of a successful annual meeting (17–21 October, Madrid, Spain), the new president of the European Association of Neurosurgical Societies (EANS), Andre Grotenhuis (Radboud University Nijmegen, Nijmegen, Netherlands) speaks to NeuroNews about his goals for the future of the association, the questions still left unanswered in the field of neurosurgery and gives a brief overview of what delegates can expect at the 2016 annual meeting (4–8 September 2016, Athens, Greece).

What were the highlights of the 2015 annual meeting?

The positive mood among all participants stood out above all, and the Spanish hosts did a remarkable job in creating such a great atmosphere, allowing for high-level scientific exchange as well as time for renewing old friendships and making new ones during the social gatherings. The level of presentations was excellent, also well balanced between plenary sessions with review-like lectures and parallel sessions on technical advances in all fields of neurosurgery. Personally, I very much liked the new type of interactive seminar with a small group of participants that was offered free of charge, this is something we will continue to offer during the congresses.

As the new president of EANS, what goals do you hope to achieve during your tenure?

In my two-year term I would like to work on creating more awareness among the public in general, but also among policy makers in particular, on neurosurgical disorders, particularly the treatment possibilities and the disease burden that these entail, not only at the individual level but also macro-economically.

I also want to work on the further growth of our organisation according to our mission statement: as being the primary advocate for neurosurgery, neurosurgeons and their patients in Europe and beyond, and to strengthen the bond between EANS and the national societies, as well as the ever increasing number of individual members.

What are the three most pressing questions in neurosurgery still left unanswered?

In each subspecialty within neurosurgery there are many unanswered questions and it is thus difficult to name only three as being the most pressing. I would rather see it as current challenges and dilemmas, eg. why do all interventions after severe traumatic brain injury (TBI) fail, despite the fact that we know so much more on the pathophysiology and have drugs that could counteract most of the secondary insults after the TBI? Or, should we treat, and how should we treat, incidentally found intracranial aneurysms? Or, are there ways to prevent them bleeding at any time? Is surgery warranted or useful in the ageing spine? If so, what kind of surgery is best? What is the best treatment modality for hydrocephalus in the very young, or for normal pressure hydrocephalus—shunt or ETV? Should deep brain stimulation be an early treatment for Parkinson’s disease or should it be the last tier?

The common denominator in all these unanswered questions is the fact that the volume of patients with most neurosurgical diseases is rather small and this makes research projects both lengthy and costly. In neurosurgery there are relatively few randomised controlled trials (RCTs), and they are difficult to fund and often unsuccessful. In my own experience, patients often refuse randomisation, and crossovers between treatment groups are common. One possibility is to use comparative effectiveness research (CER). Neurosurgery is an almost ideal field for CER but as a field, neurosurgery has been slow to respond, in part because of a paucity of available funding, although within the clinical research in traumatic brain injury there has been a reorientation towards the use of CER. However, the rigors of a structured literature search and the complex mathematical modelling and statistics needed for more comprehensive comparative effectiveness studies may dissuade some neurosurgeons otherwise interested in clinical research. But if neurosurgeons do not participate in CER, or at least understand it, we will not be in a position to challenge reports from outside our specialty that may endanger our freedom to choose the best treatment options for our neurosurgical patients.

What is EANS doing to help solve these questions?

First of all, as already mentioned in the description of the goals I want to achieve, we will need to create more awareness. Globally we can see that neurosurgical issues are not prevalent when it comes to grants and funding in healthcare. For example, in the USA, of the more than 200 topics advanced by the National Institutes of Health for challenge grants, not a single one was primarily neurosurgical. And the same is true at the European level. Professor Westphal represents the EANS within the European Brain Council and he has already done a remarkable job in increasing the neurosurgical focus within neuroscience on a European level, but there is still a lot of work to be done.

We have recently restructured the Board of Officers and now every board member is assigned to a specific task and through this we will strengthen and broaden our Research Committee in such a way that, after an initial survey on what research is taking place at this time in Europe, it would become a central point for bringing together neurosurgical projects and researchers within our 40 national societies, and also assist them in applying for European funding.

What does EANS have in store for neurosurgeons in terms of courses over the coming year?

We will, of course, continue our well known Training Courses, and from 2016 the structure has been altered by the EANS Training Committee under the inspired leadership of Professor Schaller to make them more interactive. We are committed to making these heavily oversubscribed courses available to as many trainee neurosurgeons as possible and are actively considering the introduction of a third course cycle in 2017. We furthermore offer an increasing number of subspecialty courses and hands-on workshops, organised by the different sections. And we participate more and more with special CME events, such as a one-day or half-day special EANS event during national neurosurgical congresses. And I would also like to mention the Young Neurosurgeons Meeting to be held in April 2016.

What is the theme of the 2016 annual meeting and why should neurosurgeons attend?

The selected theme is “Neurosurgery: from the Classics to the future”. Exploring the past, present and future of neurosurgery, the 2016 European Congress will take an in-depth look at how far we have come, where we are now, and what may lie ahead.

There are at least two very good reasons to attend. First, the Scientific Programme will cover the whole neurosurgical spectrum so that at the end participants will have a complete overview of state-of-the-art neurosurgery but will also know the future path of our specialty. Second, the Congress is being held in the city of Athens, the cradle of modern civilisation, and there is simply no better place for our chosen theme. Besides the many attractions of the city of Athens itself, the MEGARON (Athens International Conference Centre) is an ideal venue, in the centre of Athens, with many hotels, restaurants and museums in walking distance.

EANS2016 will provide an ideal opportunity to reconnect and share knowledge with colleagues and friends, whilst enhancing your skill set, helping your practice, and improving patient care.