Editorial

Readers will have noted that this is the 25^th volume, and therefore the 25^th year of the journal. Being the second issue of the year it contains the abstracts and the list of proceedings of the spring meeting of the SBNS which on this occasion is hosted by the Bristol unit. As the journal notes its 25^th volume it is completely appropriate that this meeting is held by the host unit of its founder Huw Griffith without whose efforts – no journal!!! Nothing much is new in neurosurgery – amongst the abstracts can be found items referring to the benefits and appropriateness of day case surgery. Certainly day case surgery is the current craze, though one suspects at times more for health economic reasons than any other motivation. Its also perhaps worth considering – now GP commissioning is in the news, that the economic benefits referred to have all been around the costs to hospital trusts, and not looked at possible increases in primary care costs – community based services should not be assumed to be cheap! However the authors of these abstracts may not have noticed that in the first edition, and the first issue, of the journal Huw Griffith's own paper on this very subject appears – their more modern contributions are of course valuable but they clearly cannot claim precedent¹! There were many other instances in other areas of neurosurgery of innovations to some degree or other inspired, encouraged, or contributed to by Huw Griffith, including of course his own contribution to neurosurgery in Bristol. Two that I remember are “telemedicine”, and image guided surgery. It is hard now to imagine a practice of neurosurgery in which these facilities were absent, or to remember the strength of the contemporaneous arguments produced against their introduction!

Those that have previously written to the journal with views on the subject of the European Working Time Directive will be glad to see this has now entered the House of Commons as a bill – hard to be optimistic given the usual fate of ten minute back bench bills, but maybe this one will gain some support.

The biggest challenges ahead now seem to lie with commissioning, and therein the importance of both sides understanding outcome measures. The SBNS is currently – correctly in my view – emphasizing the importance of outcome measures for all that we do. It is not going to be good enough not to have data on this subject. Its interpretation is of course another equally important issue, but the lack of a clear methodology for interpretation will not excuse us from not collecting the data. There is a worrying trend at present for a number of neurosurgical procedures that we may regard as obviously necessary and as constituting a routine part of practice that are judged as being of limited value by some associated with commissioning of services.² Perhaps the most alarming of these is steterotactic radiotherapy for cerebral metastases. It seems that now engaging with the population to indicate the necessary medical services is part of the neurosurgeon's job description – perhaps this has always been the case, and perhaps it should be the case, and not just for neurosurgery but for medicine as a whole. However it is now very necessary for us to argue our own corner in defence of patient care and our own speciality – and there follows of necessity a statement of self-interest, in that our employment depends on their being a demand for our services. By example consider how few aneurysms that are now surgically clipped compared to pre-ISAT. Clearly we will not be able to make any constructive or honest arguments without proper outcome data.

This edition contains a variety of articles though no particular theme – I've tried however to make it an edition worthy of simply a browse through regardless of speciality, though I hope each sub-speciality will find something of interest. I hope its still the case that those practising one sub-specialty area are still interested in those of colleagues. I am aware of disquiet over extremes of neurosurgical sub-specialisation in many areas, and this is from the perspective of one who completely accepts the benefits that sub-specialisation brings. How much ``general'' neurosurgery – but in training and experience should a neurosurgeon do before embarking on a sub-specialist route? How much does ``general'' neurosurgery contribute to a sub-specialist practice once entered into? Opinions on this topic will be welcomed by the journal – either as letter or as a commentary. Is neurosurgery becoming too fragmented?