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Tumor vs Functional
#21
The notion that DBS is burr holes only is funny. I've done >20 revision surgeries on community and academic surgeons who viewed the procedure that way. Their patients suffered immensely for it. Yeah, technically it's an easy case. But in actual practice, a lot of people scrimp on the planning, MER, and clinical testing. I'd wager that non-fellowship trained practitioners throwing in leads have an accuracy worse than 2mm which is atrocious in 2020. I've seen more than enough scans to base this on.

Flip side, there are good people in private practice that do a great job on these cases. If you know what you're doing and use a Mazor, the case can take 2h. It pays >60 RVUs total. Certainly not a lumbar fusion, but the same as a crani for aneurysm clipping.

Some people find functional cases boring. Others hate watching glioma get sucked up. Care less about what other people like to do and find what you care about.
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#22
(04-22-2020, 04:02 PM)Guest Wrote: The notion that DBS is burr holes only is funny. I've done >20 revision surgeries on community and academic surgeons who viewed the procedure that way. Their patients suffered immensely for it. Yeah, technically it's an easy case. But in actual practice, a lot of people scrimp on the planning, MER, and clinical testing. I'd wager that non-fellowship trained practitioners throwing in leads have an accuracy worse than 2mm which is atrocious in 2020. I've seen more than enough scans to base this on.

Flip side, there are good people in private practice that do a great job on these cases. If you know what you're doing and use a Mazor, the case can take 2h. It pays >60 RVUs total. Certainly not a lumbar fusion, but the same as a crani for aneurysm clipping.

Some people find functional cases boring. Others hate watching glioma get sucked up. Care less about what other people like to do and find what you care about.

Oh no question. I have a healthy respect for functional peeps and completely acknowledge that the patient selection, planning, follow-up/neurology coordination is really complicated and time-consuming. I was just saying that from a pure technical standpoint, functional cases are boring for a lot of residents. Having seen so many cycles of trainees jump from cranial to spine in residency, I really think that apart from the lifestyle/reimbursement a lot of people switch to spine because the technical parts of the cases and variety are really gratifying and just more fun to do. The one guy in my class who chose functional did so because of his deep research background that complemented well with it.

You can absolutely make a living doing high-volume DBS. Also there's a ton of device development/industry you can collaborate with.
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#23
The thing most trainees do not realize is that ~25 cases during residency does not qualify you to put in DBS leads. You think 25 cases of lumbar pedical screws is enough? Why would DBS leads be any different? It's paradoxically worse because the complication of misplacing a lead in the brain is hemiparesis from a microhemorrhage in the internal capsule. People get over confident and reliant on the technology, then something goes wrong.

You don't do fellowship to learn the mechanics of DBS. You do the fellowship to learn what to do when things do not go exactly according to plan (which happens 10% of the time in the best of circumstances).
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#24
(04-22-2020, 05:18 PM)Guest Wrote: The thing most trainees do not realize is that ~25 cases during residency does not qualify you to put in DBS leads. You think 25 cases of lumbar pedical screws is enough? Why would DBS leads be any different? It's paradoxically worse because the complication of misplacing a lead in the brain is hemiparesis from a microhemorrhage in the internal capsule. People get over confident and reliant on the technology, then something goes wrong.

You don't do fellowship to learn the mechanics of DBS. You do the fellowship to learn what to do when things do not go exactly according to plan (which happens 10% of the time in the best of circumstances)

so what you're saying is that fellowship is designed to spend a year learning how to tactfully apologize to families?
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#25
he/she's saying it is a year of learning how to decrease the amount you'll have to tactfully apologize to families, because you were able to fix frequent complications.
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#26
Is it harder to do functional research than tumor research
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