• Vance L Fredrickson, Ben A Strickland, Kristine Ravina, Robert C Rennert, Daniel A Donoho, Ian A Buchanan, Jonathan J Russin, William J Mack, and Steven L Giannotta.
• Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, USA. Electronic address: vance.fredrickson@gmail.com.
• World Neurosurg. 2019 Feb 1; 122: e553-e560.

BackgroundThe evolution of minimally invasive endovascular approaches and training paradigms has reduced open neurovascular case exposure for neurosurgical residents. There are no published estimates of open neurovascular case volumes during residency or Committee on Advanced Subspecialty Training (CAST) accredited fellowships.MethodsCase volumes from residency programs submitting data for CAST accredited fellowship applications were collected and analyzed. The study period covered the academic years of 2013-2016. Case index volumes were calculated to provide an estimate of total volume of cases each trainee participated in a given year. The case index volume was defined as the total volume of cases per year divided by the total training complement.ResultsOver the study period, institutional data from 46 programs were available. Of those programs, 9 programs had CAST accredited open cerebrovascular fellowships. Across all 46 programs, the median number of vascular cases was 246 (interquartile range [IQR]: 148-340), whereas the median number of open vascular cases was 105 (IQR: 67-152). The median number of open aneurysm cases among programs with CAST cerebrovascular fellowships was 80 (IQR: 54-103) and among programs without CAST cerebrovascular fellowships was 34 (IQR: 24-63). The median open aneurysm case index volume for trainees at programs with and without CAST cerebrovascular fellowships was 23 (IQR: 14-29) and 19 (IQR: 11-24).ConclusionsStrong neurovascular training can be obtained through dedication and planning. Completion of a CAST accredited cerebrovascular fellowship will often more than double aneurysm case exposure of trainees.Copyright © 2018 Elsevier Inc. All rights reserved.

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