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

K Gousias; A Hoyer; L A Mazurczyk; J Bartek Jr; M Bruneau; E Celtikci; N Foroglou; C Freyschlag; R Grossman; C Jungk; P Metellus; D Netuka; R Rola; P Schucht; C Senft; F Signorelli; A J P E Vincent; M Simon; EANS Surgical Neuro-oncology Expertise Survey working group

doi:10.1016/j.bas.2024.102822

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

Brain Spine. 2024 May 7:4:102822. doi: 10.1016/j.bas.2024.102822. eCollection 2024.

Authors

K Gousias^{1

2

3}, A Hoyer⁴, L A Mazurczyk², J Bartek Jr⁵, M Bruneau⁶, E Celtikci⁷, N Foroglou⁸, C Freyschlag⁹, R Grossman¹⁰, C Jungk¹¹, P Metellus¹², D Netuka¹³, R Rola¹⁴, P Schucht¹⁵, C Senft¹⁶, F Signorelli¹⁷, A J P E Vincent¹⁸, M Simon¹⁹; EANS Surgical Neuro-oncology Expertise Survey working group

Collaborators

EANS Surgical Neuro-oncology Expertise Survey working group:
Rachit Agrawal²⁰, Luigi Albano²¹, George A Alexiou²², Amanj Ali²³, Rafid Al-Mahfoudh²⁴, Michael Amoo²⁵, Christos Anagnostopoulos²⁶, Sven Bamps²⁷, Soham Bandyopadhyay^{28

29

30}, Damiano G Barone³¹, Fabio Barone³², Sami Barrit³³, Felix Behling³⁴, Alin Blaga³⁵, Alexandros Boukas³⁶, Paul Brennan³⁷, Vicki M Butenschoen³⁸, Mauro Campello³⁹, Areda Cara⁴⁰, Salvatore Chibbaro⁴¹, Robert Chrenko⁴², Pere J Cifre Serra⁴³, Hans Clusmann⁴⁴, Alba Corell^{45

46}, Jan F Cornelius⁴⁷, Marcello D'Andrea⁴⁸, Andreas K Demetriades⁴⁹, Steven De Vleeschouwer⁵⁰, Richard Drexler⁵¹, Johnny Duerinck⁵², Ruben V Fanarjyan⁵³, Alejandro Fernandez-Coello⁴³, Kostas Fountas⁵⁴, Thomas M Freiman⁵⁵, Vadim Gadzhiagaev⁵⁶, Miltiadis Georgiopoulos⁵⁷, Nathalie Gilis³³, Jagos Golubovic⁵⁸, Eric Goulin Lippi Fernandes⁵⁹, Giovanni Grasso⁶⁰, Francesco Guerrini⁶¹, Beste Gulsuna⁶², Ciaran S Hill⁶³, Julius Höhne⁶⁴, Markus Holling⁶⁵, Ievgenii Iarmoliuk⁶⁶, Florian Ioan-Alexandru⁶⁷, Tamara Ius⁶⁸, Kestutis Jacikevicius⁶⁹, Asgeir S Jakola^{45

46}, Paweł Jakubowski⁷⁰, Georgios Kalantzis⁷¹, Konstantina Karabatsou⁷², Ramez Kirollos⁷³, Ralph König⁷⁴, Danil A Kozyrev⁷⁵, Dietmar Krex⁷⁶, Barbara Ladisich⁷⁷, Ruth Lau⁷⁸, Yauhen Lizunou⁷⁹, Arnaud Lombard⁸⁰, Hu Liang Low⁸¹, José Luís Alves⁸², Yazid Maghrabi⁸³, Marco Mammi⁴⁸, Ala Marji⁸⁴, Luca Massimi⁸⁵, Ioannis Mavridis⁸⁶, Aaron Lawson McLean⁸⁷, Anna C Lawson McLean⁸⁷, Bernhard Meyer³⁸, Malte Mohme⁵¹, Pedro Moura Branco⁸⁸, Michael Müther⁶⁵, Issam Musleh²⁰, Danial Nasiri⁸⁹, Ramon Navarro⁹⁰, Ibrahim Omerhodzic⁹¹, Marvin Darkwah Oppong⁹², Nikolaos A Paidakakos⁹³, Zoi Pantera⁹⁴, Mohammed A Patel⁹⁵, Mateusz Pawlowski^{96

97}, Athanasios Petridis⁴⁷, Adrian J Praeger^{98

99}, Stephen Price³¹, Franz Ricklefs⁵¹, Luigi Rigante¹⁰⁰, Florian Ringel¹⁰¹, Pierre A Robe¹⁰², Karl Rössler¹⁰³, Eduarda Sá-Marta¹⁰⁴, Jose L Sanmillan⁴³, Alba Scerrati^{105

106}, Matthias Schneider⁷⁹, Henry Ws Schroeder¹⁰⁷, Michael Schwake⁶⁵, Mohamed Shoaib¹⁰⁸, Octavian Mihai Sirbu¹⁰⁹, Iñigo L Sistiaga¹¹⁰, Tomasz J Skajster¹¹¹, Albertas Sliauzys¹¹², Vitaly Sokotukhin¹¹³, Jehuda Soleman¹¹⁴, Veit M Stoecklein¹¹⁵, Eric Suero Molina⁶⁵, Wojciech Świątnicki¹¹⁶, Νikolaos Syrmos¹¹⁷, Graziano Taddei¹¹⁸, Avin Taher¹¹⁹, Martin Tamarit¹²⁰, Mark Ter Laan¹²¹, Theocharis Theocharous²⁰, Dieter Thijs¹²², Leonidas Trakolis¹²³, Monica Truffelli¹²⁴, Miriam Weiss¹²⁵, Eberhard Uhl^{126

127}, Laura Grazia Valentini¹²⁸, Dimitri Vanhauwaert¹²⁹, Bassel Zebian¹³⁰, Bojana Zivkovic¹³¹, Matteo Zoli^{132

133}

Affiliations

¹ Department of Neurosurgery, Athens Medical Center, Athens, Greece.
² University of Nicosia Medical School, Nicosia, Cyprus.
³ University of Münster Medical School, Germany.
⁴ Biostatistics and Medical Biometry, Medical School OWL, Bielefeld University, Bielefeld, Germany.
⁵ Department of Neurosurgery, Karolinska University Hospital, Stockholm, Sweden.
⁶ Department of Neurosurgery, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
⁷ Department of Neurosurgery, Gazi University Faculty of Medicine, Ankara, Turkey.
⁸ Department of Neurosurgery, AHEPA University Hospital, Aristotle University, Thessaloniki, Greece.
⁹ Universitätsklinik für Neurochirurgie, Medizinische Universität Innsbruck, Innsbruck, Austria.
¹⁰ Department of Neurosurgery, Brain tumor center, Rambam Health Care Campus, Rappaport Faculty of Medicine, Haifa, Israel.
¹¹ Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany.
¹² Department of Neurosurgery, Clairval Private Hospital, Marseille, France.
¹³ Department of Neurosurgery, Central Military Hospital Prague, Prague, Czech Republic.
¹⁴ Department of Neurosurgery and Paediatric Neurosurgery, Medical University of Lublin, Lublin, Poland.
¹⁵ Department of Neurosurgery, University Hospital of Bern, Bern, Switzerland.
¹⁶ Department of Neurosurgery, Jena University Hospital, Jena, Germany.
¹⁷ Department of Neurosurgery, Azienda Ospedaliero-Universitaria Consorziale Policlinico, University "Aldo Moro" of Bari, Bari, Italy.
¹⁸ Department of Neurosurgery, ErasmusMC /Brain Tumor Center, Rotterdam, the Netherlands.
¹⁹ Department of Neurosurgery, Bethel Clinic, University of Bielefeld Medical School OWL, Bielefeld, Germany.
²⁰ Department of Neurosurgery, St. Marien Hospital Lünen, Lünen, Germany.
²¹ Neurosurgery and Gamma Knife Radiosurgery Unit, IRCCS Ospedale San Raffaele, Milan, Italy.
²² Department of Neurosurgery, University of Ioannina, Ioannina, Greece.
²³ Department of Neurosurgery, Faruk Medical City, Sulaymaniyah, Iraq.
²⁴ Department of Neurosurgery, University Hospitals Sussex NHS Trust, UK.
²⁵ Department of Neurosurgery, Cork University Hospital, Cork, UK.
²⁶ Department of Neurosurgery, Korgialenio Benakio Hellenic Red Cross Hospital Athens, Greece.
²⁷ Department of Neurosurgery, Jessa Hospital Hasselt Belgium, Belgium.
²⁸ Clinical Neurosciences, Clinical & Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, Hampshire, UK.
²⁹ Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
³⁰ Oxford University Global Surgery Group, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
³¹ Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK.
³² Department of Neurosurgery, Cannizzaro General Hospital, Catania, Italy.
³³ Department of Neurosurgery, Erasmus Hospital, Université Libre de Bruxelles, Brussels, Belgium.
³⁴ Department of Neurosurgery and Neurotechnology, Eberhard Karls University Tübingen, University Hospital Tübingen, Germany.
³⁵ Department of Neurosurgery, SCJU Oradea, Romania.
³⁶ Department of Neurosurgery, Oxford University Hospitals, Oxford, UK.
³⁷ Center for Clinical Brain Sciences, Cancer Research UK Edinburgh Center, Edinburgh Neuro- Oncology, Edinburgh, UK.
³⁸ Department of Neurosurgery, School of Medicine, Klinikum Rechts der Isar, Technical University Munich, Munich, Germany.
³⁹ Department of Neurosurgery, University "UniCal" and Great Metropolitan Hospital, Reggio Calabria, Italy.
⁴⁰ Department of Neurosurgery, Mother Tereza Hospital, Tirane, Albania.
⁴¹ Department of Neurosurgery, Strasbourg University Hospital, Strasbourg, France.
⁴² Department of Pediatric Surgery, National Institute of Children's Diseases, Bratislava, Slovak Republic.
⁴³ Department of Neurosurgery, Bellvitge University Hospital, Barcelona, Spain.
⁴⁴ Department of Neurosurgery, RWTH Aachen University Hospital, Aachen, Germany.
⁴⁵ Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg, Sweden.
⁴⁶ Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴⁷ Neurosurgical Department, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
⁴⁸ Department of Neurosurgery, M.Bufalini"Hospital, AUSL Romagna, Cesena, Italy.
⁴⁹ Department of Neurosurgery, Royal Infirmary Edinburgh, UK.
⁵⁰ Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium.
⁵¹ Department of Neurosurgery, University Medical Center Hamburg Eppendorf, Hamburg, Germany.
⁵² Department of Neurosurgery, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
⁵³ University Clinic of Neurosurgery and Comprehensive Stroke Center of YSMU, Armenia.
⁵⁴ Department of Neurosurgery, Faculty of Medicine, University of Thessaly, Larissa, Greece.
⁵⁵ Department of Neurosurgery, University Medical Center Rostock, Rostock, Germany.
⁵⁶ Department of Neurosurgery, Moscow Regional Research Clinical Institute "M.F. Vladimirsky" (MRRCI), Moscow, Russia.
⁵⁷ Spinal Surgery, Swansea Bay University Health Board, Swansea, UK.
⁵⁸ Department of Neurosurgery, Faculty of Medicine, University of Novi Sad, Clinical Centre of Vojvodina, Novi Sad, Serbia.
⁵⁹ Department of Neurosurgery, University Hospital OWL, Campus Bielefeld Bethel, Bielefeld, Germany.
⁶⁰ Department of Neurosurgery, University of Palermo, Palermo, Italy.
⁶¹ Unit of Neurosurgery, Department of Head and Neck Surgery, Fondazione Policlinico IRCCS San Matteo, Pavia, Italy.
⁶² Department of Neurological Surgery, University of California San Francisco, CA, USA.
⁶³ Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
⁶⁴ Department of Neurosurgery, Klinikum Nürnberg Paracelsus Medical University, Germany.
⁶⁵ Department of Neurosurgery, University Hospital Münster, Münster, Germany.
⁶⁶ Department of Neurosurgery, Schwarzwald-Baar-Klinikum Villingen-Schwenningen, Villingen-Schwenningen, Germany.
⁶⁷ Department of Neurosciences, UMF Cluj, "Iuliu Hatieganu" University of Medicine and Pharmacy, Faculty of Medicine, Romania.
⁶⁸ Neurosurgery Unit, Head-Neck and NeuroScience Department University Hospital of Udine, Udine, Italy.
⁶⁹ Department of Neurosurgery, Klaipeda University Hospital, Klaipeda, Lithuania.
⁷⁰ Department of Neurosurgery and Neurotraumatology, Samodzielny Publiczny Wojewódzki Szpital Zespolony, Szczecin, Poland.
⁷¹ Neurosurgery Department, General University Hospital of Patras, Patra, Greece.
⁷² Department of Neurosurgery, Salford Royal Hospital, Greater Manchester, UK.
⁷³ Department of Neurosurgery, National Neuroscience Institute, Singapore.
⁷⁴ Department of Neurosurgery, University Hospital Ulm, BKH Günzburg, Günzburg, Germany.
⁷⁵ Children's City Hospital, St. Petersburg, Russia.
⁷⁶ Department of Neurosurgery, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
⁷⁷ Department of Neurosurgery, University Hospital St. Pölten, Karl Landsteiner University of Health Sciences, St. Pölten, Austria.
⁷⁸ Department of Neurosurgery, Joan XXIII University Hospital, Tarragona, Spain.
⁷⁹ Department of Neurosurgery, University Hospital Bonn, Bonn, Germany.
⁸⁰ Department of Neurosurgery, GIGA-Neuroscience, Laboratory of Nervous System Disorders and Therapy, University of Liège, CHR Citadelle, Liège, Belgium.
⁸¹ Department of Neurosurgery, Queens Hospital, London, Barking, Havering and Redbridge University NHS Trust, London, UK.
⁸² Department of Neurosurgery, Centro Hospitalar e Universitário de Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal.
⁸³ Department of Neurosurgery, King Faisal Specalist Hospital and Research Center-Jeddah, Saudi Arabia.
⁸⁴ Department of Neurosurgery, King Hussein Cancer Center, Amman, Jordan.
⁸⁵ Department of Neuroscience, Catholic University Medical School, Rome, Italy.
⁸⁶ Department of Neurosurgery, School of Medicine, Democritus University of Thrace, University General Hospital of Alexandroupolis, Alexandroupolis, Greece.
⁸⁷ Department of Neurosurgery, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany.
⁸⁸ Department of Neurosurgery, S. José Hospital, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
⁸⁹ Department of Neurosurgery, Inselspital Bern, Bern, Switzerland.
⁹⁰ Neurosurgery Unit, Townsville University Hospital, Townsville, QLD, Australia.
⁹¹ Department of Neurosurgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina.
⁹² Department of Neurosurgery and Spine Surgery, University Hospital Essen, Essen, Germany.
⁹³ Department of Neurosurgery, Athens General Hospital 'G. Gennimatas', Athens, Greece.
⁹⁴ Department of Neurosurgery, Private Hospital IASO Thessalias, Larissa, Greece.
⁹⁵ Department of Neurosurgery, Sheffield Teaching Hospitals NHS Foundation Trust, UK.
⁹⁶ Department of Neurosurgery, Vital Medic Hospital, Kluczbork, Poland.
⁹⁷ Department of Neurosurgery, St. Hedwig's Regional Specialist Hospital, Opole, Poland.
⁹⁸ Department of Neurosurgery, Monash Health, Clayton, Victoria, Australia.
⁹⁹ Department of Surgery, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia.
¹⁰⁰ Department of Neurosurgery, Klinikum Bremen Mitte, Bremen, Germany.
¹⁰¹ Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany.
¹⁰² Department of Neurology and Neurosurgery, UMC Utrecht Brain Center, University Medical Center of Utrecht, Utrecht, the Netherlands.
¹⁰³ Department of Neurosurgery, Comprehensive Center for Clinical Neurosciences & Mental Health, Medical University of Vienna, Vienna, Austria.
¹⁰⁴ Department of Neurosurgery, Hospital de Braga, Braga, Portugal.
¹⁰⁵ Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
¹⁰⁶ Department of Neurosurgery, University Hospital Sant'Anna of Ferrara, Ferrara, Italy.
¹⁰⁷ Department of Neurosurgery, University Medicine Greifswald, Germany.
¹⁰⁸ Advanced Neurosurgery Brain and Spine Center, Jabalpur, India.
¹⁰⁹ Department of Neurosurgery, Emergency University Central Military Hospital "dr Carol Davila", Bucharest, Romania.
¹¹⁰ Department of Neurosurgery, University Hospital Cruces, Bilbao, Basque Country, Spain.
¹¹¹ Department of Neurosurgery, Vivantes Klinikum im Friedrichshain, Berlin, Germany.
¹¹² Department of Neurosurgery, Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania.
¹¹³ Department of Neurosurgery, Hospital Barmherzige Brüder, Regensburg, Germany.
¹¹⁴ Department of Neurosurgery and Division for Pediatric Neurosurgery, University Hospital and Children's Hospital Basel, Switzerland.
¹¹⁵ Department of Neurosurgery, LMU University Hospital, LMU Munich, Germany.
¹¹⁶ Department of Neurosurgery, Maria Skłodowska-Curie Regional Specialist Hospital, Zgierz, Poland.
¹¹⁷ Department of Neurosurgery, Aristotle University of Thessaloniki, Greece.
¹¹⁸ Department of Neurosurgery, Santa Maria Goretti Hospital, Latina, Italy.
¹¹⁹ Department of Neurosurgery, Erbil Teaching Hospital, Erbil, Iraq.
¹²⁰ Servicio de Neurocirurgía, Hospital Universitario de Getafe, Madrid, Spain.
¹²¹ Department of Neurosurgery, Radboud UMC, Nijmegen, the Netherlands.
¹²² Department of Neurosurgery, Antwerp University Hospital, Belgium.
¹²³ Department of Neurosurgery, Agios Loukas Clinic Thessaloniki, Thessaloniki, Greece.
¹²⁴ IRCCS Ospedale Policlinico San Martino, Division of Neurosurgery, Genoa, Italy.
¹²⁵ Department of Neurosurgery, Cantonal Hospital Aarau, Aarau, Switzerland.
¹²⁶ Department of Neurosurgery, Justus-Liebig-University Giessen, Giessen, Germany.
¹²⁷ Children's Hospital Basel, Switzerland.
¹²⁸ Pediatric Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
¹²⁹ Department of Neurosurgery, AZ Delta Roeselare, Roeselare, Belgium.
¹³⁰ King's College Hospital NHS Foundation Trust, London, UK.
¹³¹ Neurosurgical Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
¹³² IRCCS Istituto delle Scienze Neurologiche di Bologna, Programma Neurochirurgia Ipofisi (Pituitary Unit), Bologna, Italy.
¹³³ Department of Bio-medical and Neuromotor Sciences, University of Bologna, Italy.

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.