**15. Resident and fellowship training**

The expansion of endovascular techniques has led to a need to train neurosurgical residents in the application of endovascular therapies, just as they would learn newer techniques in spine or tumor neurosurgery. The Neurosurgery Residency Review Committee and American Board of Neurological Surgeons (ABNS) have correctly made regular adjustments in the area of endovascular case minimums for neurosurgery residents not only to include cerebral angiography, but now also to include more complex intervention experience, such as aneurysm coiling [90].

The future of endovascular neurosurgery would be inseparable from the future of neurosurgery. Residents interested in the vascular disease processes that affect the central nervous system must understand the application of neuroendovascular techniques and if they want to treat these pathologies must be adequately trained in their implementation. In Japan and China, most endovascular surgery is carried out by neurosurgeons who carry out cerebral and spinal cord angiography and interpret the images obtained. This experience not only increases their knowledge of vascular anatomy, but also improves their surgical acumen.

We do not believe that the vascular neurosurgeon of the future must carry out both surgical and endovascular treatments. Precisely in order to reach the required excellence, there must be two figures, a vascular neurosurgeon who deals with the traditional surgical management knows the strengths and weaknesses of endovascular treatment, and an endovascular neurosurgeon knows the strengths and weaknesses of surgical treatment. To remain at the forefront of evaluating, caring for, and treating patients with cerebrovascular disease, vascular neurosurgery must evolve toward a specialty, mastering the knife as well as the catheter. We think it is time for neurosurgeons to start training residents in endovascular neurosurgery in the same way we train neurosurgeons in every other neurosurgical discipline.
