The Mission of the Vanderbilt University Medical Center Fellowship in Neuro-Endovascular Surgery is to train fellows to develop technical competence in Neuro-Endovascular Surgery. Fellows will be trained to identify patients who will benefit from neuro-endovascular surgical techniques and teach them to safely and effectively provide those techniques. We educate fellows to perform high quality research. The vision for the fellowship is to educate the best providers of the highest quality of Endovascular Surgical Neuroradiology care.
The Program provides an environment that is intentionally inclusive, promotes diverse perspectives, and trains graduates to become advocates for their patients and communities.
The fellow will be exposed to a large number of challenging cerebrovascular pathologies that includes training in endovascular coiling of cerebral aneurysms, trans-arterial liquid polymer embolization of cerebral and spinal arteriovenous malformations and arteriovenous fistulas, embolization of intracranial, spinal, and head and neck tumors, and epistaxis, carotid artery angioplasty and stenting, cerebral artery angioplasty and stenting, intracranial thrombolysis and thrombectomy for acute stroke treatment, and related procedures. Additionally, Fellows will obtain experience in outpatient neurovascular clinic, as well as learning basic tenets of neuro-ICU neurovascular patient management. There are ample opportunities for fellows to engage in research and teaching.
The Vanderbilt Neuroendovascular Surgical Fellowship provides structured advanced training for endovascular procedures, variously called neuroendovascular surgery, interventional neuroradiology, endovascular neurosurgery, surgical neuroangiography and endovascular surgical neuroradiology.
Training requirements will depend on the clinical backgrounds of the applicants in accordance with current CAST requirements. Neurosurgeons may perform their first year of fellowship during their ACGME approved neurosurgery residency, along with completion of 200 diagnostic and/or interventional procedures as a primary operator. However, their second year must come after completion of their residency program including a chief residency year. If a neurosurgery applicant has no experience with endovascular training during residency, then the fellowship will be two years. Neurology applicants will have completed an ACGME approved neurology residency as well as either a dedicated stroke or critical care fellowship. Again, if the neurology applicant has completed 200 procedures (diagnostic or interventional) prior to matriculation at Vanderbilt their fellowship may be 1 year only. Radiology applicants must have completed an ACGME approved radiology residency as well as a dedicated neuro-radiology fellowship with at least 6 months of dedicated clinical time. It is further required that all applicants have demonstrated competency in catheter techniques and achieved Level 1-4 Milestones for cerebrovascular diseases and neuroendovascular surgery and that this is attested in writing by their respective Program Directors as well as the Neurendovascular Program Directors.
The final year of advanced endovascular training occurs over 12 continuous months and focuses on minimally invasive catheter-based technology, open vascular neurosurgery, neurocritical care, stroke neurology, neuroradiology, neuroimaging, and a development of clinical expertise to diagnose and treat vascular diseases of the central nervous system, as well as disorders of the head, neck and spine and their vascular supply. The curriculum includes all required elements of training as noted in the CAST Matrix for completion of the program. The fellow will complete a minimum of 250 interventional procedures as a primary operator. If the fellow is unable to complete the required procedures he/she must extend their training or seek training at other institutions to accomplish this requirement.
The 250 procedures should include:
- 40 aneurysm treatments (including 10 ruptured aneurysms)
- 20 intracranial embolizations (AVM. AVF, Tumor)
- 25 intracranial or extracranial stent placements (at least 5 in each category to include stents or flow divertors for aneurysms)
- 30 acute ischemic stroke treatments
- 10 intracranial infusions (e.g. vasospasm, chemotherapy, stroke)
- 5 extracranial embolizations
- 5 spinal angiograms and/or embolizations