Handbook> Selectives > Surgery > Neurosurgery

Surgery Subspecialties

Neurosurgery

Number: (Oasis - S50b) 1803

Rotation Supervisor: Dr. Ashok Asthagiri

Available: Rotations 1 - 12

Duration: 2 weeks

Report to: 6 West Neurosurgery Conference Room

Time to Report: 6:00 am

Place to Report: 6 West Neurosurgery Conference Room

Typical day: 6:00 am - 6:00 pm

Number of students per rotation: 4

Course Description: This rotation is designed to provide the student with a fundamental knowledge of and in depth practical experience with Neurosurgery that will be useful to all participating physicians regardless of future discipline chosen. Under the mentorship of a world renowned faculty as well as its resident staff, students will be exposed to a busy clinical service caring for a patient population harboring the entire spectrum of neurosurgical diseases of the central and peripheral nervous system. Any interested student is welcome and general learning objectives will be met during this rotation. However, the experience can be tailored to an individual's goals whether it be targeted by someone with career aspirations in Neurosurgery or focused for a particular future specialty (such as Pediatric Neursurgery for those interested in a career in Pediatrics or Spine Surgery for those interested in a career in Orthopaedic Surgery).

Students will participate in both the outpatient and inpatient care of neurosurgical patients. The complete spectrum of adult and pediatric neurosurgery is available to the rotating student. There are a variety of outpatient clinics available each day of the week including complex spine, general neurosurgery, neuro-endocrine, pediatric neurosurgery, neuro-oncology, functional/epilepsy, and neuro-vascular. Students are encouraged to participate in two clinics per week of their choosing. The Neurosurgical Service maintains a busy operative schedule and students have the opportunity to scrub in on any operation that interests them. Students are also encouraged to take in-house call one in four nights and participate in consults and emergent operative cases. Students are given appropriate graduated responsibilities commensurate with their interests and level of expertise.

There are four teaching conferences per week, 2 on Wednesdays and 2 on Saturdays. Students are encouraged to participate in these sessions and they are designed to stimulate thought and discussion. An optional journal club meets every Sunday. Additionally, the faculty and chief residents will work with each medical student to ensure the learning objectives are met through formal didactic teaching sessions and through informal teaching during rounds, clinic or in the operating room.

Learning objectives:

General Skills Topics:

  • The Neurological Examination:
    • perform a complete neurological examination including evaluation of mental status, speech, cranial nerve function, sensory and motor function, reflexes, cerebellar function and gait.
  • Fundamentals of Neuroimaging
    • distinguish between blood, air, CSF and bone on computed tomographic (CT) scans
    • recognize characteristics of basic magnetic resonance imaging sequences including T1- adnd T2-weighted sequences
    • recognize spine fractures and dislocations
    • recognize specific disease entities listed below such as epidural, subdural and intracerebral hematomas, subarachnoid hemorrhage, brain tumors and hydrocephalus
  • Intracranial hypertension
    • understand the pathophysiology of raised intracranial pressure, cerebral perfusion pressure and the influence of blood pressure, blood gases, and fluid and electrolyte balance
    • recognize the clinical manifestations of acute brain herniation including the Cushing reflex, midbrain effects and vital signs.
    • appreciate the impact of focal mass lesions, structural shifts and their consequences.

Intracranial Disease Topics

  • Diagnosis and Managment of Head Trauma
    • understand and demonstrate application of the Glasgow Coma Scale
    • recognize the presentation of brain herniation syndromes in the setting of trauma
    • demonstrate the ability to initiate management of raised intracranial pressure in head trauma
    • recognize and initiate management of concussion, brain contusion and diffuse axonal injury
    • recognize and initiate management of acute epidural, subdural hematoma including surgical indications
    • recognize and initiate management of penetrating head trauma including gunshot wounds
    • understand the principles of managment of open, closed and basilar skull fractures, including cerebrospinal fluid leak, and chronic subdural hematoma (in children and adults).
  • Diagnosis and Managment of Brain Tumor and Abscess
    • understand the relative incidence and location of the major types of primary and secondary brain tumors
    • recognize the general clinical manifestations of brain tumors (focal deficit, mass effect, supratentorial versus infratentorial)
    • appreciate specific syndromes of presentation: extra-axial (cerebellopontine angle, pituitary, frontal...) and intra-axial
    • understand the diagnostic tools that are currently used for evaluation (laboratory tests, radiology, biopsy)
    • understand broad treatment strategies in the treatment of tumors (surgery, radiosurgery, radiation and chemotherapy)
    • recognize the clinical manifestations of abscess and focal infections due to local spread, hemotogenous disease associated with immune deficiency, and how they differ and mimic brain tumors
    • understand the general principles in the treatment of abscess and focal intracranial infections
  • Diagnosis and Managment of Headaches
    • understand the major causes of intracranial hemorrhage including vasculopathy in the elderly (hypertension and amyloidosis), aneurysm, vascular malformation, tumor, drugs and coagulapathy
    • recognize the signs and symptoms of subarachnoid, cerebral and cerebellar hemorrhage
    • demonstrate the appropriate application of diagnostic tools in the evaluation of acute headache (CT and MRI, role of lumbar puncture and angiography)
    • understand the natural history of and broad treatment strategies for intracranial aneurysms and vascular malformations (microsurgery, radiosurgery, endovascular therapy as well as treatment of vasospasm)
  • Diagnosis and Management of Ischemic Cerebrovascular Disease
    • discuss the symptoms and signs of anterior and posterior circulation ischemia emphasizing carotid artery disease, and contrast this with hemorrhagic stroke
    • classify the types of ischemic stroke including embolic, hemodynamic and lacunar
    • discuss factors involved in the developement of cerebral ischemic disease including atherosclerosis, cardiac disease, arterial dissection, fibromuscular dysplasia, vasculitis, venus thrombosis and hematologic disease
    • discuss the management of cerebral ischemia and their indications including medical management, risk factor modification and surgical/endovascular therapy
    • diagnose and monitor carotid occlusive disease using noninvasive methods and understand indications for angiography and carotid endoarterectomy and angioplasty/stenting.

Spinal Disease Topics

  • Diagnosis and Management of Spine Trauma and Spinal Cord Injury
    • assess patients with suspected spinal cord injury in the emergency room including the interpretation of radiologic studies of spinal trauma
    • initiate acute management of spinal cord injury including immobilization, steroids and systemic measures
    • understand the definition and subsequent management principles of the unstable spine
    • demonstrate understanding of the management principles in spinal cord injury including indications for decompressive and stabilizing surgery and treatement of medical complications associated with spinal cord injury (skin, bladder, bowel movement, respiratory)
    • diagnose and understand the natural history and managment principles of whiplash and soft tissue injury (minor but common traumatic spine injuries)
  • Diagnosis and Management of Nontraumatic Neck and Back Problems
    • discuss spinal pain and radiculopathy:
      • signs and symptoms (including cauda equine syndrome)
      • common causes, diagnosis, and management (cervical and lumbar disc herniation, osteoarthritic disease, spondylolisthesis)
      • differential diagnosis including metastic disease, primary spinal tumors, peripheral nerve pathology and their management
    • discuss myelopathy:
      • signs and symptoms (including comparision of acute and chronic injury)
      • common causes, diagnosis, and management (cervical/thoracic disc herniation, osteoarthritis)
      • differential diagnosis (including transverse myelitis, metastatic disease, primary spinal tumors, amyothrophic lateral sclerosis)

Peripheral Nerve Disease Topics

  • Diagnosis and Management of Peripheral Nerve Injury and Entrapment
    • diagnose traumatic nerve injury (laceration, stretch and compression) and understand indications and general strategies for treatment
    • recognize the signs and symptoms of common nerve entrapment (carpal tunnel syndrome, ulnar nerve entrapment) and their etiology, conservative management strategies and indications for surgical intervention.

Other Common Neurosurgical Problems

  • Diagnosis and Management of Hydorcephalus and Spinal Dysraphism
    • recognize the symptoms and signs of hydrocephalus in children
    • recognize the symptoms and signs of hydrocephalus in adults
    • discuss common etiologies of hydrocephalus in children and adults, and differentiate between communicating and obstructive hydrocephalus
    • understand the treatment strategies for hydrocephalus
    • recognize common syndromes of spinal dysraphism, their neurologic manifestations and broad principles of management
  • Diagnosis and Management of Surgically Treatable Pain Problems, Movement Disorders and Epilepsy
    • recognize the features of trigeminal and glossopharyngeal neuralgia, causalgia/complex regional pain syndrome and cancer pain, indications for surgical referral, and the spectrum of surgical therapeutic options
    • recognize movement disorders amenable to surgical intervention, including Parkinson's disease, dystonia, spasticity, and hemifacial spasm, indications for surgical referral and the spectrum of therapeutic options
    • understand the general classification of seizure disorders, definition of intractable epilepsy and the broad categories of surgical intervention for epilepsy including invasive electrodes for monitoring resective and disconnective surgery.