However, the term interventional neurology in the last two decades is more focused and limited to the procedures that are recognized as part of the training requirements of the “Endovascular Surgical Neuroradiology” fellowship according to Accreditation Council for Graduate Medical Education (ACGME). According to ACGME, endovascular surgical neuroradiology is a subspecialty that uses minimally invasive catheter-based technology, radiologic imaging, and clinical expertise to diagnose and treat diseases of the central nervous system, head, neck, and spine (www.agme.com).
Historically, interventional neurology has a long journey
before arriving at this point. Actually,
neurologists have already had a
long history of involvement in the cerebral angiography. However, the roots of
neurologist involvement in therapeutic endovascular procedures have not been
previously documented. The cerebral
angiography was done first time by Egas Moniz from Portugal. He is a Professor
of Medicine and subsequent Chair of Neurology
at University of Lisbon in Portugal. Dr. Egas Moniz performed cerebral
angiography since 1927 through direct carotid puncture and publish his
paper at the First International
Neurology congress in Bern in 1931. The role of neurologists in diagnostic imaging
was further enhanced by Karl Theodore Dussik who was a neurologist at
Allgemeine Poliklinik (General Polyclinic) and University of Vienna Medical
School. He was the first to propose the use of ultrasound as a diagnostic device in a
paper he wrote in 1941 (Qureshi AI, 2011).
In the
next two decades afterward, there is an ongoing transition in the approach ; from
the direct carotid puncture to femoral approach. The changing patterns also
resulted in a great change where neurologists are excluded from performing these
procedures. By the early 1970s, cerebral angiography through direct carotid
puncture by neurologists was an obsolete practice.
In
United State of America, the first procedure done by Dr. Gomez, an interventional
neurologist, is in 1993 at the cardiac cathlab. However, on June 2000, the
ACGME had officially approved the Guidelines for Training in endovascular
surgical neuroradiology. Subsequently, the program requirements for neurology
were approved by the ACGME in May 2003 (Qureshi AI, 2011).
Interestingly,
Dr. Shakir Husain, who joined the fellowship in Interventional Neuroradiology
at the Institute of Neuroradiology, University Hospital Zurich, Switzerland, has completed his
fellowship in 1999. His fellowship is under the supervision
of Prof. Valavanis. This shows us that Dr. Shakir, a neurologist, has completed
the interventional neuroradiology program one year before the ACGME in the USA
had officially approved neurology to enter the field (www.acgme.org). Since then, he
has designed a fellowship program in Stroke & Interventional Neurology and started it in the
year 2004 at Sir Ganga Ram Hospital, New Delhi. He has now joined Max Super
Specialty Hospital, Saket, New Delhi and has taken the Fellowship program with
him (www.delhicorse.com).
In
Indonesia, interventional neurology evolved after dr. Fritz Sumantri Usman completed
his fellowship in 2008 from Sir Ganga
Ram Hospital New Delhi, India. The Director of the program is Dr. Shakir Husain. After dr Fritz begun his
journey in neurointerventional procedures, many Indonesian neurologists are
interested in that area. In almost every year, there are several Indonesian
neurologists join that fellowship program. Currently, there are twenty one
Indonesian interventional neurologist have completed the program. They are
spread in several cities in Indonesia, mostly in Java. There are three of them
in Surabaya (Tabel 1).
Table 1. The spread of Interventional
Neurologist in Indonesia (May, 2014)
City
|
Province
|
Number
of Interventional Neurologist
|
Jakarta
|
DKI
Jakarta
|
4
|
Tangerang
|
Banten
|
2
|
Bogor
|
West
java
|
1
|
Bandung
|
West
Java
|
1
|
Solo
|
Central
java
|
1
|
Surabaya
|
East
Java
|
3
|
Makasar
|
South
Sulawesi
|
1
|
Bukit
Tinggi
|
West
Sumatra
|
1
|
Medan
|
North Sumatra
|
2
|
Lokshumawe
|
Aceh
|
1
|
Denpasar
|
Bali
|
1
|
Pekan Baru
|
Riau
|
1
|
Semarang
|
Middle Java
|
1
|
Jayapura
|
Papua
|
1
|
Total
|
21
|
Just like in other
countries, there are some political issues in Indonesia regarding the
development of neurointervention, the relatively new subspecialty of neurology,
in Indonesia. The Issue is centered at the intriguing question whether
neurologist have the competence to perform neurointerventional procedure.
Fortunately, in 2006, the Indonesian collegiums of neurology stated clearly
that neurologist have the competence to
perform in this field. Meanwhile, the first neurologist start studying this
subspecialty started his program in 2007, exactly after the collegiums
approved.
Recent development of
neurointervention in Indonesia shows that there are a considerable number of neurointerventional
procedures performed by neurologist. In fact, the neurointerventional
procedures performed by neurologist is proved to be safe and show a very low complication
(Usman FS et.al, 2012). Almost all the interventional procedures have been
performed including carotid and
vertebral artery stenting, coiling aneurysm, tumor embolization, embolization
of the dural and carotid fistula and brain arteriovenous malformation. This is
undeniably a promising development in the area of neurointervention in
Indonesia.
To sum
up, the title of Dr. Kori’s article : "Interventional Neurology, a subspecialty whose time has come"
very fits to illustrate the situation in
Indonesia. Furthermore, it is also very
relevant to quote Edgell RC et. al., to describe the potential of
neurointervention in the future Indonesia, as they said that “currently,
Interventional neurology is subspecialty
that is here to stay and thrive. “ (Kori SH, 1993; Edgell RC et.al., 2012).
