Research in Neurological Surgery.

Neurosurgical research is a fundamental driver of understanding and continues to improve care across the biomedical sciences. Neurosurgeons from around the world have the distinct opportunity to obtain physiologic data, access normal/diseased neural tissues, make direct clinical-operative correlations, develop/apply new therapeutic technologies, and lead multidisciplinary research teams across neurologic disorders. Neurosurgeon-led research has propelled discoveries that have extended life expectancy, improved function, enhanced neurologic health, minimized therapeutic morbidity, and reduced disease-associated mortality. Similar to other medical and nonmedical fields, discovery and innovation are at the foundation of success of the specialty and remain inextricably linked to vitality. Consequently, continued and evolving efforts to develop and diversify the next generation of neurosurgeon-scientists is existential to future success. Now more than ever, neurosurgical research and innovation are critical to public health and well-being. In 2017, it was estimated that more than 200 million people in the United States (more than 60% of the population) alone suffered from a neurological disorder. Neurological disease burden continues to increase as the population ages.1 The most debilitating disorders, as defined by disability-adjusted life-years, include stroke, Alzheimer disease/other dementia, and migraine. Historically, neurological disorders initially not amenable to surgical treatment, including some of the most burdensome neurologic disorders, are now surgically managed due to neurosurgeon innovations (eg, ischemic stroke, Parkinson disease, psychiatric disorders, pain syndromes). Recent discoveries make it conceivable that additional neurodegenerative diseases, psychiatric disorders, and metabolic disorders will become neurosurgical disorders soon through neuromodulation, gene therapy, and/or other modalities. To maintain specialty growth and relevance, it is essential to optimize the development of the next generation of international neurosurgeon-scientists. Specifically, it will require departments to be truly committed to support (financial and time) trainees/early career faculty (within first 5 years of terminal training), intentional dialogue/collaboration with federal funding agencies/foundations/industry to support research areas with highest impact, defined mentoring programs locally/nationally that build communities of neurosurgeon-scientists, and recognition/acknowledgement that different subspecialties can have different pathways to research support and definitions of success. Trainees and early career neurosurgeons will need to find areas and types of research they are passionate about to be successful in the long term. These individuals also need to be flexible and adapt to opportunities (scientific, geographic, mentor, and institutional) to maximize success over a career. Recently, training and mentoring programs, including the National Institute of Neurologic Disorders and Stroke R25 (residents and fellows), National Institute of Neurologic Disorders and Stroke K12 (early career), and the American Academy of Neurological Surgery Emerging Investigators, have driven exponential expansion in federal research funding to neurosurgeon-scientists leading to unmatched funding growth in neurosurgery compared with other medical and surgical specialties over the past few decades.2,3 These programs bring together resident/early career surgeon-scientists, senior mentors across all neurosurgical subspecialties, and department Chairs from around the country. These programs were developed to build national communities of neurosurgeon-scientists at the resident/early career stages. Not only do these programs build communities of developing neurosurgeon-researchers but they also provide them with defined mentoring, advice, and encouragement. Similarly, international programs for resident and early career surgeon-scientist research training have been deployed around the world that are government, institutional, and/or neurosurgical society driven. These programs use a variety of tactics to enhance research training, including training courses, collaborative group meetings, in-person/virtual symposia, and scheduled mentoring sessions across neurosurgical subspecialties. Owing to the globalization of biomedical research and discoveries, it will be essential to further define opportunities to expand collaboration through global partnerships at the individual, institutional, and society levels. These types of collaborations can be fueled and extended by virtual research meetings and symposia across diverse groups around the world. Specifically, because early exposure to research is desirable in developing a career as a neurosurgeon-scientist, it will be critical to provide opportunities for research training to a diverse group of students. Gephart and colleagues4,5 provide 2 critical “roadmaps,” including 1 for individuals interested in a career in research and 1 for mentors/programs interested in training the next generation of surgeon-scientists worldwide. Like all successful development paradigms, research training requires intentional decision-making by the trainee. Gephart and colleagues provide a detailed roadmap for trainees to have a successful neurosurgical research career, and several points bear emphasis. For the medical student/resident trainee with aspirations to be a leading neurosurgeon-scientist, it is critical to seek out training in residency programs that value research, to write/secure grant funding during residency, to train with rigor (like clinical training), and to find mentors that guide in an intentional manner. Finally, early career neurosurgeon-scientists should receive department support and take advantage of the defined national specialty-specific training and mentoring opportunities described above. Similarly, Gephart and colleagues4,5 provide detailed recommendations for increasing diversity in the neurosurgery research workforce and how to build a program that will support development of in-training and early career neurosurgeon-scientists that was endorsed by the One Neurosurgery Summit member organizations. As they describe, a diverse research workforce will be the most successful. They provide detailed recommendations and metrics to track progress. They emphasize that institutional initiatives are not enough to diversify the workforce, but rather the drive for diversity will need to come at the department and faculty level. They also describe programmatic recommendations that will lead to trainee success in research, including building infrastructure (didactic, financial, time) that support research growth, development of research training tracks, support of mentors committed to intentional development of trainees, and defined/potent oversight of research training. Through research and innovation, neurosurgery will continue to expand in scope and impact worldwide. New discoveries, insights, and technologies from international neurosurgeon-scientists will propel the influence of the field. Core to driving future neurosurgery-related investigations and innovation will be the development of the next generation of diverse neurosurgeon-scientists. Advanced and evolving training paradigms, as well as roadmaps for expanding diversity in the neurosurgery research workforce, will ensure success. Russell R. Lonser, MD Associate Editor, Neurosurgery Publications Department of Neurological Surgery, Ohio State University Wexner Medical Center, Ohio State University, Columbus, Ohio, USA