Vascular Interventional Neuroradiology in a Country with a Small and Scattered Population Twenty Years' Experience in Norway

Abstract

<jats:p> Experience with neuroradiological endovascular therapy in a small country is presented. Five Norwegian university hospitals are currently performing coiling of cerebral aneurysms and three are embolizing cerebral arteriovenous malformations. The small number of procedures in most of these institutions may threaten the quality of treatment, education of neuroinradiologists, research and scientific work in this field. An even greater concern might arise in the field of neurosurgery after the reduction in surgical procedures following the increasing takeover by endovascular procedures. The safety during transportation of patients with subarachnoid hemorrhage has been debated and is considered by some as a problem, but earlier experience from Nordic countries does not support this concern. </jats:p><jats:p> Reducing the number of centres performing these procedures seems necessary to obtain adequate patient safety and an ethical practice. </jats:p>

The changing landscape of cerebral revascularization surgery: A United Kingdom experience

“…In pediatric neuro-oncology surgery, it has become accepted that centralization to increase the numbers treated in each center improves results ( 20 , 21 ). This movement to centralization has been adopted in neurovascular services in Norway ( 22 ) and has been previously suggested in the United Kingdom for cerebral revascularization surgery ( 23 ). Although not formalized, neurovascular surgery in the United States has in effect become centralized with aneurysm surgery being concentrated in fewer centers ( 24 ) and a reversion to the era of Charles Drake where vertebrobasilar aneurysms were transferred to specialist centers ( 25 ).…”