This is the fourth edition of the year. Next on the international calendar is the Interim meeting of the World Federation of Neurosurgical Societies at which the matter of the SBNS bid to hold the congress in 2017 will be decided. Win or lose the whole society has fully committed to the bid and has put substantial effort into this project, and the result is the bid proposal which will be put before the World Federation and of which British Neurosurgery can feel proud; it is clear to me that the World Federation could feel completely confident that the proposed meeting would undoubtedly be a great success on all fronts – most importantly scientifically, but also socially, in promoting the education, training, and scientific agenda to all areas of the globe, whatever their resources, but particularly helping those who resources may not be so plentiful, and finally and importantly for any meeting of this size that it be financially sound. I hope that all readers appreciate this – I especially hope that readers who happen also to be members of the WFNS also note these points and – whilst not in any way wishing to denigrate any other bids – find ours to be of such quality that they find it necessary to support our bid!!!
The rest of the issue includes the usual spectrum of articles spread across the sub-specialist areas of neurosurgery. One aim of the journal is to provide items that all, whatever their sub-specialty, will find of some interest, though clearly those with a special interest in specific areas will have a more dedicated focus on certain articles. One aspect of neurosurgery – or for that matter any medical sub-specialty – is how restricted should an interest become; and how much general medical education and specialist education is needed to inform the sub-specialty, by way of background. We may all agree that all neurosurgeons should start with a basic medical qualification but when and how to sub-specialise from that point. The argument can be reduced to the absurd; no-one now could expect to be a “doctor” empowered to treat any disease whatsoever, nor would it be sensible to consider being an expert on a ridiculously restricted topic such as for example – disease of the left fifth toenail!!! Then by what methodology – preferably quantifiable – should we decide where the rational balance between these two obviously absurd extremes should lie? At the moment it seems to be determined by a mixture of previous history, serendipity and natural development of sub-specialists in various groups of conditions. It is possible to see tensions arising where different criteria are used to determine groupings – disease considerations produce groupings such as oncology, or vascular; technology groupings such as radiosurgery and age produces paediatrics. Sadly these positions are confounded in some instances by lobbying around the self-interest of the affected parties. Of course there are natural overlaps between the criteria, and each position has some strengths and some weaknesses, some of which have been debated elsewhere in the journal, and perhaps more in the future. Perhaps the answer lies in multidisciplinary working also sometimes referred to in another guise as networking, though neither of these concepts seems to be easily defined, and certainly not in any useful quantifiable form that all can agree upon. Is a condition rare? Again, depends upon the demoninator, and if this is restricted then a condition can become rarer – for example when criteria are combined; for example vascular conditions – frequent in adults – maybe quite rare in children.
Underlying the answer to this must lie measurement of outcomes, and if this is done then sooner or later the evidence will answer these questions, though the analysis may not be completely simple, and as above – beware the demoninator!
I hope you enjoy the edition!