Expertise in surgical neuro-oncology. Results of a survey by the EANS neuro-oncology section

Abstract

Introduction: Technical advances and the increasing role of interdisciplinary decision-making may warrant formal definitions of expertise in surgical neuro-oncology.

Research question: The EANS Neuro-oncology Section felt that a survey detailing the European neurosurgical perspective on the concept of expertise in surgical neuro-oncology might be helpful.

Material and methods: The EANS Neuro-oncology Section panel developed an online survey asking questions regarding criteria for expertise in neuro-oncological surgery and sent it to all individual EANS members.

Results: Our questionnaire was completed by 251 respondents (consultants: 80.1%) from 42 countries. 67.7% would accept a lifetime caseload of >200 cases and 86.7% an annual caseload of >50 as evidence of neuro-oncological surgical expertise. A majority felt that surgeons who do not treat children (56.2%), do not have experience with spinal fusion (78.1%) or peripheral nerve tumors (71.7%) may still be considered experts. Majorities believed that expertise requires the use of skull-base approaches (85.8%), intraoperative monitoring (83.4%), awake craniotomies (77.3%), and neuro-endoscopy (75.5%) as well as continuing education of at least 1/year (100.0%), a research background (80.0%) and teaching activities (78.7%), and formal interdisciplinary collaborations (e.g., tumor board: 93.0%). Academic vs. non-academic affiliation, career position, years of neurosurgical experience, country of practice, and primary clinical interest had a minor influence on the respondents' opinions.

Discussion and conclusion: Opinions among neurosurgeons regarding the characteristics and features of expertise in neuro-oncology vary surprisingly little. Large majorities favoring certain thresholds and qualitative criteria suggest a consensus definition might be possible.

Keywords: CNS tumors; EANS; Expertise; Surgical neuro-oncology.

Graphical abstract

Fig. 1

A) overall and B) annual caseload required to be considered an expert in surgical neuro-oncology.

Fig. 2

A) Glioma and meningioma caseloads are considered good indicators of surgical neuro-oncology expertise by more respondents than brain metastases caseload. B) Specific lifetime caseloads for intrinsic tumors, meningiomas, and brain metastases are needed to characterize an expert. 20.2% and 28.3% vs. 44.6% of our participants feel that surgical neuro-oncology expertise requires an overall caseload of 51–100 intrinsic tumors and meningiomas vs. brain metastases.

Fig. 3

The use of certain surgical adjuncts and techniques is considered by large majorities as a feature of neurosurgical oncology expertise. IONM, intraoperative neuromonitoring.

Fig. 4

Surgical neuro-oncology expertise & spinal and peripheral nerve tumor (Per.nerve tum.) surgery. Mastering intra- and extramedullary tumors is considered an important qualification of a neurosurgical oncology expert, whereas experience with spinal fusion (Spin.fusion) and peripheral nerve tumor surgery is not.

Fig. 5

Non-operative skills and qualifications of an expert in neurooncological surgery. Opinions on A) social competence, B) academic activities, and C) related medical knowledge. Med. ethics, medical ethics; Radiother/surg, radiotherapy/radiosurgery; Med.oncolog, medical oncology.

Fig. 6

Institutional and workplace characteristics believed to be required for expert neurosurgical oncology services. Interpr.NO, interprofessional neuro-oncology team; ICU, specialized intensive care unit; OR team, specialized operating room team; Nursing, specialized nursing.