ACCESS S:VIN August 2026

So in terms of workflow, actually, so you asked about the problem.

The problem, of course, is common.

There's a common problem that will probably be the most common cranial surgical disease in a few years.

To Vincent's point, it's a growing problem.

I'm curious to hear about your shop too.

In our shop, the workflow still, as of today, and historically has been through neurosurgery.

These patients come through neurosurgery, by large, through the ER.

Our workflow is that the things that we have evidence on, like adjunct embolization, we just do those.

Typically, we do surgery first and then embolization, like Vincent said.

I think the other patient, like for some primary embolization, we try to enroll them in the studies.

People who I think has good evidence for adjunct embolization, we follow that.

The people who can follow and do a study, we try to enroll them.

And in terms of patients, probably two patients a week is what we're seeing.

But as awareness grows for this disease, that we're seeing more and more of them.

I really appreciate the perspective.

I mean, I want to be honest that neurosurgeons tend to be protective of their territory and classically subdurals were the domain of a neurosurgeon.

I'm not saying that that's necessarily true anymore, but I have heard plenty of stories where it does create some animosity among groups about who controls the workflow of those patients.

I don't know if anybody does it any better than anyone else, but I just want to sort of throw it out there and empathize with those who might find that Sometimes neurosurgeons may operate up front without considering the referring for an embolization.

And how about in those circumstances, how can we engage our surgical brothers and sisters and make sure that they remain up to date with the literature and open-minded about this treatment pathway?

Well, I think to your point, you know, I think, of course, what we do is a multi-specialty group.

I think when it comes to embolization, I mean, absolutely, you know, if I'm a radiologist, I'm a neurosurgeon, and I have neurology partners, all specialties are involved in doing this, you know, but I think outside of this, right, there are other surgical positions, and I think that's why in the North Shore it comes through, because there are other people, for example, all the trials exclude the people who need emergent surgery, like there are people who have severe neurologic deficit in surgery right away, and then there are people People perhaps have very small subdurals that don't need anything done.

So I do think that as of now, like there are surgery considerations, they're outside, well, outside group patients that we're discussing, you know, but the patient is going to get embolized, like the indications are expanding as we speak.

So I think that workflow certainly can be reassessed, you know, but I think as of now, you know, I mean, there are still people that need emergent surgery.

I just want to kind of put that in perspective.

I mean, of course, I mean, we collaborate, we like to work together with our radiology and neurology colleagues.