Vascular Neurosurgery

By Elijah Powell

From Unsplash

Intro

Vascular neurosurgery is a subspecialty of neurosurgery that deals with conditions affecting blood vessels, typically those that prevent or obstruct blood flow throughout the central nervous system. A vascular neurosurgeon can treat numerous conditions, including vascular brain tumors, strokes, aneurysms, and arteriovenous malformations (AVMs), to name a few. The goal of this paper is to provide an overview of the specialty and compare it to similar ones, with the aim of sparking interest in neurological studies and related surgical interventions.

Keywords: Aneurysms; Arteriovenous Malformations; Subspeciality; Skull Base; Endovascular.

The Hyper-Competitiveness of Neurosurgery

Vascular neurosurgery is a competitive subspecialty of neurosurgery with a match rate of 75.80%, which is selective relative to similar subspecialties, such as vascular neurology, with a match rate of 97%. For the average high schooler, this 75.80% match rate might still seem high, but admission into fellowship is no easy feat—you are competing against some of the most accomplished neurosurgeons from across the globe.

Neurosurgery has become the second-most competitive specialty, up from its previous fifth-place ranking, and the only “notable difference to neurosurgery was match rate” - Dr. Jubbal. According to neurosurgical match rates from 2022-2024, they’ve decreased from 74.3% to 68.7%. This newfound competitiveness raises the question: what are the alternative routes that allow students to reach their goals without being subjected to the increased burnout rates that are bound to arise from the hyper-competitiveness of neurosurgery?

Programs in Vascular Neurosurgery

There are different fellowship opportunities to pursue, but it might be worth enduring the increased competitiveness. These fellowships include the normal one-year fellowship, a two-year fellowship that offers more comprehensive training for vascular and endovascular procedures and additional research opportunities, and a combined fellowship that allows you to subspecialize in both vascular and related subspecialties, such as skull base surgery.

Vascular Neurology

If you want to perform neurosurgical procedures, the opportunities in vascular neurology are very limited. However, vascular neurology is an attractive alternative. You have the opportunity to study neurology, be involved with limited vascular and endovascular procedures, and maintain a better quality of life. Emergency cases in neurology are few and far between because the specialty is mainly diagnostic. This means a neurologist who takes calls is still able to have reasonable work hours. Neurology requires a 4-year residency and a 1-year fellowship for those who want to subspecialize in vascular neurology. Attending neurologists in this specialty work, on average, 50 hours per week and earn an average salary of $300,981 USD per year. Neurology is a non-surgical specialty, so vascular surgery is the ideal alternative for those still interested in performing procedures. Vascular surgery, ranked 8th in competitiveness for 2024, trailing behind general surgery, does not have a neurology-related subspecialty.

Vascular Surgery

Vascular surgery requires a 5-year residency, and as of October 2021, it does not have “defined” subspecialties. The average salary for this specialty is $333,802 USD.

Conclusion

The hypercompetitive nature of some medical specialties, like neurosurgery, forces some students to search for alternatives. Between salaries, quality of life, residency durations, and burnout rates, it is vital to determine the best choice for you before you match into a program. This guide is not meant to be comprehensive; the goal is to get premedical students thinking about this as early as possible! No matter how far away residency seems, thinking about your desired specialty early on can lead to engaging shadowing opportunities with physicians during undergrad and an overall better experience during medical school clerkships.

Citations:

Scullen, T., Milburn, J., Mathkour, M., Larrota, A., Aduloju, O., Dumont, A., Nerva, J., Amenta, P., & Wang, A. (2024). Training Cerebrovascular and Neuroendovascular Surgery Residents: A Systematic Literature Review and Recommendations. Ochsner journal, 24(1), 36–46. https://doi.org/10.31486/toj.23.0118