Report from Japan; Spring 2018

Fumio Yamaguchi, MD, PhD, FJCNS, IFAANS

Japan Neurosurgical Database（JND）has been launched from January 2018. Since 2014, Japan Neurosurgical society (JNS) had been using NCD (National Clinical Database) that is mainly led by general surgery. NCD has the problem for retrieving data from this database. Therefore, JNS had decided to set up its own database. All neurosurgical patients who admitted to any neurosurgical units are subject to the registration, while NCD included only patients who underwent surgery. Many studies are expected by using new big data in the future.

The Japan Society for Neuro-Oncology (JSNO) published Brain Tumor Guideline and now it is available online in Japanese.

This version covers 1. Adult Glioblastoma, 2. Adult Metastatic Brain Tumor, 3. Primary Central Nervous System Lymphoma (PCNSL).  This guideline has been approved by The Japan Neurosurgical Society and Japan Society of Clinical Oncology.  Brain Tumor Guideline committee is now preparing the guidelines for Pediatric Brain Tumors and Low Grade Gliomas.

EANS 2016: Athens

Going to Athens was always one of my dreams. Being one of the centers of the classic world and the birthplace of much of critical thinking and dialogue would set a great stage for a modern professional meeting under the topic “From the classics to the future”. This motto would aspire to bridge the very beginnings and foundations of our field (such as gross anatomy in perfect dissections as seen with the naked eye) and the most recent technical advances to address pathological anatomy with state of the art imaging (e.g. 3D anatomy, sophisticated radiology sequences for white matter segmentation, automated Raman spectroscopy analysis, or high end endoscopy) allowing us to approach old problems with new avenues or from new angles.

The meeting was located in the Megaron Athens International Conference Center,  a state of the art conference facility about a 10 min cab ride from downtown - and it was exquisitely well set up and prepared. The conference staff was on top of all possible issues, was friendly and very well informed. The venue was well chosen and was neither oversized nor too tight for the scientific events or the exhibits, which were spread out along the corridors and in a central lobby that could accommodate any size booth and demo-equipment.

The great feature off EANS is its surprisingly informal character and “family feeling” . Despite its good size (about 1000 neurosurgical attendees), the groups divided readily into subspecialty presentation halls and many small lobbies where it was easy to meet colleagues and staff from the companies you wish to talk to. Amongst all these places to talk science or technology, participants were spoilt by great food and beverage services which were well scattered throughout the conference center and of excellent quality.

The science of the meeting was top notch and well selected from the Organizing Committee. A number of tumor sessions were offered over the course of the conference, and their timing was meticulous as to not compete for the same audience with parallel sessions.  Outstanding presentation were given by both renown faculty (the usual suspects were all there:  M. Westphal giving an impressive talk on his institutions’ large experience with pineal region tumor, and so did U Ture from Turkey, V Benes from Prague and Al Mefty from Boston. An excellent selection of surgical talks were centered around gliomas, meningiomas, anterior and posterior skull base lesions amongst others.  Focused science talks addressed hot topics such as “pulsed ultrasound for disruption of the blood brain barrier” (Fountain/Paris) and the latest advances in intraoperative Raman spectroscopy for the analysis of unstained primary tumor tissue (Livermore/Oxford) which now allows the identification for mutation subtypes in glioma. Many other less well known areas of neurosurgery were also well covered including the author delivering a talk that drew attention on tumor surgery during pregnancy to name but a few. The full program can still be accessed here.

The organizers had set up a most wonderful reception during one of the conference evenings, where attendees and their spouses could mingle in small groups over a delicious traditional greek dinner and enjoy some quality time discussing life - as well as plan some future projects.

Overall, I was once again really impressed that the EANS has created a platform of intense exchange and debate in a very collegial environment, and has thus contributed greatly to our mission to advance science and mutual understanding. I very much encourage our US colleagues to join in for one of the upcoming meetings (EANS 2017: Venice, October 4-8^th) and to take advantage of the joint membership that is being offered to us CNS members (50$ annual cost is almost nothing for what you get in return!;  check out www.eans.org).

Meeting Updates

International Advanced Endoscopy Cadaver Course

Aesculap Academy Tuttlingen, Germany; January, 2017

This is a practical hands on course that is offered by the medical device manufacturer Aesculap to adequately train advanced providers in the indications and applications of endoscopic surgical techniques. The 3-day course is comprised of a set of focused lectures that are geared towards a particular neurosurgical problem/area – which is then immediately afterwards explored in the lab.

Many may not know that Aesculap has a long standing tradition to dedicate resources to unrestricted educational grants as well as providing such venues under the umbrella of an established surgical academy. Within that realm, the company offers pro bono courses in various surgical fields. Amongst the well-established and acclaimed hand- on-courses are the cadaveric neurosurgery courses for either conventional transphenoidal surgery (beginners), pediatric endoscopy and hydrocephalus (mid-level) as well as an advanced course on endoscopic management of extrasellar lesions. These courses are offered free of charge at their factory site as well as in modified format at various international venues.  Check google:  Aesculap Academy Global.

This flagship course for 15 participants was put together by an international faculty under the guidance of Charlie Teo/ Sydney and hosted in a first class laboratory on site. The lab was divided into 12 individual work stations staffed by the faculty at a ratio of 1:2 and boosted by a knowledgeable group of Aesculap researchers and lab-technicians, providing an optimal trainee to equipment ratio at each table. Each table was fully laid out as an OR set and a master central work station had been designed with camera and projection facilities so that the prosector demonstrated a particular technique prior to participants repeating the observed approach.

Organized with meticulous attention to detail, good work flow and a wealth of available precision instruments, the course was highly instructional and of great practical value for anyone who wants to expand their range of endoscopic applications.  I also recommend these courses to anyone who wants to move into endoscopic work, before they acquire their set of instruments. Check with you local instrument rep or go to the websites of AANS/CNS and www.aesculap-academie.de  or www.aesculapusa.com.                        

International Conference on Complications in Neurosurgery (ICCN)

Mumbai, India; March 3-5, 2017

This unique educational initiative (see www.iccn2017mumbai.com) was endorsed by the WFNS, ACNS, MINS, most definitely one of the academic highlights of the last few years. Conceived by Prof. Dr.Keki Turel about a year ago over a glass of beer with Dr. Vladimir Benes (past president of the EANS; Prague, CZ) and the author at a different international venue, Dr. Turel put his heart and enormous effort into this project. What came about was one of the most remarkable scientific venues we have ever attended.

In Dr.Turel’s own words: “Whiles most medical conferences deal with rather staid and conventional discussion  of diseases, common and uncommon, their superb management and results, with a slide of complications rushed in at the very end, very few have shown to … only discuss the pitfalls of management -  and usually do not contain any confession of mistakes and errors made. To truly learn and advance the field, we need to shift the rhetoric from “How I do it” to “How I would not do it” or “How I wish I had done it”.   

The first and most surprising fact was that a very large number of highly respected international faculty endorsed this event and shared the notion of a highly needed forum to discuss this side of our profession – and to do so free from any legal implications.   The Scientific Program was skillfully put together and covered all areas of neurosurgery. 14 packed sessions where each devoted to a lead topic and started off with one or two brief didactic lectures, followed by presentations by prominent invited speakers from around the globe as well as from nationally established contributors. Each subsession was moderated by a leading surgeon of the respective field who was joint as primus inter pares by 2 panelists, who were expected to comment on the presentation and to guide questions from the audience.

Each presentation was instructed to follow a particular format of 7 steps (1. Case report: What happened? 2. Why did this happen? 3. When did this happen? 4. What could have been done to prevent this problem?) Which was then followed by 3 steps of: an expert comment, background as well as by a short response by the presenter.   

Given the fact that highly visible leaders of the field did not shy away from sharing their “worst case experience” and how they decided to deal with it was hugely instructive and insightful. “Failure is only defeat, if we do not learn from it”, to quote Dr. Turel who hopes with many attendees that this will be the first of a regular series.

Inconeson

Kathmandu; March 8-11, 2017

This was a WFNS, AASNS and ACNS endorsed 5^th meeting of the Nepalese society of neurosurgery put together by Dr. Gopal Sharma, president of the NESON, and his team under the motto “Shaping the future of neurosurgery in Asia” (www.neson.org.np).  A number of hands on workshops from select WFNS faculty preceded the meeting and covered areas such as endoscopy, skull base surgery as well as anatomy.

The program was well rounded and included representatives from many of the Asian countries in the region as well as invited speakers including a good number of experts from the USA (e.g. Bill Couldwell, Ed Benzel, the author), Europe (Vladimir Benes, Henry Schoeder) and the Middle and Far East (Imad Kanaan, Basant Mishra, Yoko Kato, Kyu Sung Lee) amongst many other known experts.  

The meeting was a well attended platform for interaction that allowed us to get an insight into burning questions of an emerging health care system in the host country, but also showed many interesting aspects of neurosurgery as currently practiced in other Asian countries.  The enthusiasm which could be felt throughout the entire event, the exceptional hospitality and the great dedication to interact and to collaborate was impressive and can be seen as a clear sign to move neurosurgery into the next phase of evidence based medicine that is currently emerging in Asia. The meeting will leave us attendees with a lasting impression of an open invitation to be part of this endeavor - and the wish to return soon to participate.

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Published June, 2013