Jason Sheehan, MD, PhD, FAANS— L. Dade Lunsford, MD, FAANS, is the Lars Leksell Professor and Distinguished Professor at the Department of Neurological Surgery at the University of Pittsburgh. He also is director of the Center for Image-Guided Neurosurgery at the University of Pittsburgh Medical Center, and an internationally recognized authority on stereotactic surgery and minimally invasive surgery. Jason Sheehan, MD, PhD, FAANS, recently interviewed him for AANS Neurosurgeon.
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Editorial License
Use It or Lose It
Michael Schulder, MD, FAANS—In this issue’s editor’s column, Dr. Michael Schulder discusses the development of stereotactic radiosurgery (SRS), its importance within the neurosurgical specialty and why it’s critical for neurosurgeons to take the opportunity to confirm their roles as practitioners of SRS.
When did neurosurgery begin? Some say it started when Harvey Cushing defined “the special field of neurological surgery” in 1905. Of course, surgery of the central nervous system was being done by others at that time and long before that, as well. Stereotactic radiosurgery (SRS), on the other hand, has an undeniable point of origin. The concept and, indeed the very term, were coined by Dr. Lars Leksell in 1951. (For those who may not know, Leksell was the Swedish neurosurgeon who also devised your double-action rongeurs.) So it is clear that SRS is not at all a brand-new technology. In fact, 60 years after its birth, SRS is at least half as old as neurosurgery. It is equally clear that SRS was invented by a neurosurgeon.
Leksell conceived of SRS primarily as a tool for minimally invasive surgery for the relief of pain and movement disorders. (Indeed, it is ironic that after decades of SRS aimed at treating tumors and arteriovenous malformations (AVMs), attention again is being paid to its use in functional neurosurgery).
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Financial Forethought
Is the Financial Sky Falling?
Bob Keating, MD, FAANS—Where do we go from here? Undoubtedly, by the time this pecuniary masterpiece gets to you, our financial landscape will likely be radically different (hopefully not approaching Dan Simmons’ latest vision portrayed in “Flashback”). Nonetheless, current questions raised about the fiscal health of our country, never mind your portfolios, warrant an in-depth review of where one should place his or her assets in these unsettling times and avoid kissing their assets goodbye.
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Bookshelf
A Look into the Abyss: Staring at America’s Potential Self-destruction
Gary D. VanderArk, MD, FAANS—“After America: Get Ready for Armageddon,” Mark Steyn, 2011, Regnery Publishing, Washington, D.C., 349 pp. No, this book is not about neurosurgery. It’s not even primarily about health care. But if we’re interested in the survival of the world, as we know it, we probably should not ignore the socioeconomic message of this book. Mark Steyn keeps writing best-selling books about the future. His previous book, “America Alone: The End of the World as We Know It,” was about the impending collapse of all the Western world except America. In “After America,” which was released just as disastrous U.S. budget news was distressing our ears, he reports that America “has decided to sign up the program but supersized.” The author thinks the U.S. is caught up in the great rush to self-destruction. If he’s right, it will even affect neurosurgeons. The national debt has reached alarming levels. While Steyn gives the current administration credit for doubling-down on deficit spending, he is appropriately bipartisan in assigning responsibility for the decade-long run-up to the current crisis. The…
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Coding Clarity
Stereotactic Radiosurgery Coding: A Brief Overview of Current Professional Codes for Neurosurgeons
Joseph Cheng, MD, MS, FAANS; Jason Sheehan, MD, PhD, FAANS—Over the years, stereotactic radiosurgery (SRS) coding has changed significantly. Prior to 2009, CPT 61793 was used with the appropriate modifiers and associated 77xxx series of codes. Code 61793 was deleted on Dec. 31, 2008. In 2009, new neurosurgical codes were introduced for SRS. These new codes reflected the growth in SRS to treat spinal lesions and also the use of SRS to treat more than one lesion at a time, principally in brain metastasis patients. For intracranial radiosurgery, the following codes are used: 61793- Stereotactic radiosurgery (deleted 12/31/2008) 61796- Simple lesion (1 unit) 61797- Additional simple lesions up to a maximum 4 units 61798- Complex lesion (1 unit) 61799- Additional complex lesions up to a maximum 4 units 61800- Stereotactic frame application 20665- Stereotactic frame removal A simple lesion is defined as a target with a dimension of less than 3.5 cm and more than 5 mm away from the optic apparatus or brainstem. A complex lesion is one that has a dimension of 3.5 cm or greater, or is adjacent (5 mm or…
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