More work to be done

This has been another successful year for the Journal of NeuroInterventional Surgery (JNIS). At the time of this writing, we are approaching a record number of total submissions as well as more submissions from international authors than in any year of the journal’s history. At the outset, I would like to thank the outgoing editorial board for its commitment to the JNIS. The journal’s success is predicated on the dedication and imagination of its editorial board. While several members of the previous board will remain, we have added new editors from the three subspecialties that constitute our field. In 2022, the journal published important research pertaining to issues that critically impact neurointerventionalists. These include the persistent effects of the COVID19 pandemic, the use of mechanical thrombectomy (MT) in the treatment of medium vessel and basilar occlusions, the role of intravenous thrombolytics in MT procedures, the utility of artificial intelligence and robotics in the treatment of stroke and cerebral aneurysms, and novel devices and techniques such as the transvenous management of cerebrospinal fluid fistulas. Importantly, JNIS has also served as a forum for a discussion of diversity within our field. In this issue, the Society of NeuroInterventional Surgery (SNIS) published a position statement on pregnancy and parental leave for practicing neurointerventionalists. This statement was produced through the efforts of the society’s Women in Neurointervention Committee, Standards and Guidelines Committee, and Board of Directors. This document underscores several issues that directly impact the number of women pursuing neurointerventional careers. Specific concerns include radiation exposure to the practicing neurointerventionalist, schedule flexibility in the era of increased performance of MT, extent of parental leave after childbirth, lack of senior female neurointerventional mentors, and protected environments for breastfeeding. These issues contribute to the low number of women entering neurointervention despite higher rates of women than men matriculating into medicine. In a 2020 JNIS publication, Chen and Brunet specifically evaluated radiation exposure of a neurointerventional fellow before and during pregnancy. The study revealed no difference in exposure to the fellow during these periods. Importantly, fetal radiation exposure was 0 mrem throughout the entire study. While concern over radiation exposure probably deters more women than men from entering our field, this study elucidated that when employing optimal protective measures, the risks of maternal and fetal harm were very low. Other impediments to women entering neurointervention are more difficult to evaluate than the objective barometer of radiation exposure. Individual practice characteristics such as burdensome call requirements and chauvinistic barriers to academic advancement are other deterring factors. Recently, Javed and coauthors evaluated the issue of academic scholarship by studying the contributions of women to JNIS manuscripts from 2016 to 2020. Their analysis revealed growing percentages of female first and senior authors over the study period. In an illuminating editorial column published in the JNIS in 2021, Dorothea Althschul articulated the struggles encountered by female neurointerventionalists. These challenges include the lack of female mentorship, sexual harassment, and inequities in pay. All are factors that potentially contribute to a greater risk of burnout and job dissatisfaction among women interventionalists. Importantly, these are issues that many male neurointerventionalists are ignorant of or tolerate at improper levels. As we move into 2023, I wish all our authors, reviewers, and editors a happy new year. What is clear is that the JNIS is a healthy and vibrant forum for the presentation of groundbreaking research and the discussion of the challenges that we face in this fascinating yet stressful field. We look forward to leading the way for all practitioners within our three subspecialties. There is certainly more work to be done!