The Neurosurgery Curriculum has been developed and refined through an educational committee specially appointed by the ACOS. The Neurosurgery Curriculum in Adobe form can be accessed by the following link. The overview also follows.
American College of Osteopathic Surgeons
Neurological Surgery: Neurosciences
Development of professional collaboration is an important component of surgical training. When
considering the broad realm of patient care, both within and outside the operating room, the surgeon must
understand and be able to use specific concepts and skills related to neurosciences and specialties
including anatomy, neurology, pathology, pharmacology, physiology, radiation physiology, and
radiology.
Integration of the neurosciences and associated specialties by the neurosurgery resident into all aspects of
practice will enhance his or her ability to appropriately diagnose, organize a management plan, perform
necessary surgical procedures, and care for the postoperative surgical patient in the short and long term.
Neurosurgery residents learn neuroscience concepts and skills on all clinical rotations and in didactic
settings. Knowledge and skills are assessed informally and on a daily basis by faculty and attending
surgeons as well as formally. Since these neurosciences and associated specialties are part of a core
curriculum related to each and every principal surgical area, they are grouped together and not repeated in
separate surgical areas.
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences: Neuroanatomy
Developed by:
Steve Schneider, M.D.
Stephen J. Eichert, D.O., FACOS
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering a neurological surgery residency, the resident should:
· Understand the organization and development of the nervous system
· Understand the anatomic structures, their connections and relationship to function within the nervous
system
Learning Outcomes
Upon completion of the neurosurgery residency, the resident will:
· Understand the anatomy that is pertinent to the diagnosis of diseases of the nervous system and the
practice of neurological surgery
· Understand clinical syndromes as a correlate to neuroanatomy
Phase I: Performance Indicators Phase II: Performance Indicators
Cognitive
Embryology
Analyze the embryological development of the brain,
cerebellum, brain stem, glial elements, spinal cord,
conus medullaris, cauda equina, sympathetic and
parasympathetic systems and the peripheral nervous
system
Analyze the embryologic development of the skull,
craniovertebral junction, and spine
Histology
Describe and differentiate the types of neurons
Understand the microanatomy of the neuron including
the cell body, dendritic process and axonal process
Diagram and describe the microanatomy of the synapse
Identify the microglial elements and their microanatomy
Describe the anatomical basis for the blood brain barrier
Vascular Anatomy
Diagram and describe the carotid and vertebral arteries
and their branches which provide blood supply to the
face, scalp, skull, meninges, brain, brain stem,
cerebellum, and rostral spinal cord
Describe the arterial blood supply to the spinal cord
including the spinal and radicular arteries and explain
the concept of watershed ischemia
Identify the venous drainage of the central nervous
system
Osseous Anatomy
Identify the bones and sutures of the skull
Identify each named foramen of the skull and list its
contents
Extracerebral Anatomy
Describe the anatomy of the meninges including the
dura mater, arachnoid mater, pia mater
Describe the anatomy of the dura including the falx
cerebri and tentorium
Cognitive
Discuss the clinical presentation in anatomical
terms of syndromes of the brain and its
coverings
Discuss the syndromes produced by mass
lesions affecting the cranial nerves
Predict the expected effects of stroke or mass
lesion at different locations within the brain
stem and cerebellum
Predict the expected effects of destructive
lesions in the basal ganglia and cerebellum
Predict the expected effects of ischemic or
destructive lesions of the white matter tracts
of the cerebellum
Predict the expected effect of destructive
lesions of specific regions of the cerebral
cortex
Recognize the clinical presentation of strokes
in the distribution of the supratentorial
cerebral blood vessels
Describe the relationship of the spinal nerves
to the vertebral level of exit
Diagram the structures comprising the
boundaries of the spinal neural foramina
Recognize the clinical manifestation of injury
for each of the major peripheral nerves
Describe the anatomy and presentation of
common entrapment syndromes of peripheral
nerves
Describe the surgical exposure of common
peripheral nerve entrapments
Recognize the clinical presentation and
neurological deficits associated with common
lesions of and injuries to the spinal cord and
nerve roots
Identify the layers of the scalp and discuss scalp
innervation
Diagram the cerebral ventricles
Describe the major arachnoid cisterns and the anatomy
of the arachnoid villi
Analyze the anatomic correlates pertinent to the
production, flow, and reabsorption of cerebrospinal fluid
Spinal Anatomy
Identify and describe the gross anatomy of the spine
Identify the muscles related to the skull and spine
including suboccipital, anterior cervical, and posterior
cervical
Describe the gross anatomy of the neck
Central Nervous System
Describe the anatomy of cerebrum, cerebellum,
olfactory pathways, hippocampal formation, and
amygdala
Describe the anatomy of the corpus striatum
Describe the anatomy of the hypothalmus and pituitary
Describe the anatomy of the diencephalons and
mesencephalon
Identify the location and connections of each cranial
nerve nuclei
Trace the course of each cranial nerve from nucleus to
end organ termination.
Describe the external topography and landmarks of the
fourth ventricle
Describe the anatomy of the brain stem including pons
and medulla
Describe the anatomy of the spinal cord
Autonomic Nervous System
Distinguish pre- and postganglionic neurons
Describe the sympathetic nervous system and the
Technical
Identify at the time of surgery structures
visible in the lateral ventricles and understand
the flow of cerebrospinal fluid (CSF) through:
· Foramen of Monro
· Fornix
· Caudate
· Thalamus
· Choroidal fissure
· Named veins
· Glomus of choroid plexus
· Hippocampus
parasympathetic nervous system
Identify the visceral afferent fibers
Describe the structure of the autonomic ganglia and the
central autonomic pathways
Peripheral Nervous System
Differentiate between segmental and peripheral
innervation
Diagram the anatomy of the spinal nerve root
Diagram and discuss the cervical, brachial, and
lumbosacral plexi
Outline the anatomy of the major peripheral nerves of
the upper and lower extremities
Describe the microanatomy of the peripheral nerves
Compare myelinated and unmyelinated nerves
Describe the anatomy of the Schwann cell
Identify the peripheral afferent receptors and describe
the anatomy of each
Segregate peripheral neurons by size and explain the
rationale for such a classification scheme
Muscle
Explain the concept of the motor unit and describe the
anatomy of the motor end plate
Compare the microscopic anatomy of striated and
smooth muscle
Describe the subcellular components of muscle
Identify the parts of the vertebral column,
spinal cord, and nerve roots at the time of
surgery
Identify at the time of surgery:
· Occipital artery
· Superficial temporal artery
· Frontalis muscle
· Pterion
· Inion
· Asterion
· Coronal suture
· Sagittal suture
· Middle meningeal artery
· Sagittal sinus
· Transverse sinus
· Foramen rotundum
· Foramen ovale
· Foramen spinosum
· Superior orbital fissure
· Jugular foramen
· Internal auditory canal
· Superior sagittal sinus
· Sigmoid sinus
· Incisura
· Each cranial nerve
· Each named cerebral artery and vein
· Components of the brain stem
· Named structures on the floor of the
fourth ventricle
· Foramina of Magendie and Luschka
· Cerebral peduncles
· Components of the cerebellum
· Cerebellar tonsils
· Brachium cerebelli
· Vermis
· Major supratentorial gyri
· Supratentorial lobes
· Sylvian fissure
· Central sulcus
Adapted from the American Association of Neurological Surgeons/Congress of Neurological Surgeons
Neurosurgery Residency Curriculum Guide
7
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Resident Assessment
Written exams and slide/photograph identifications
Quarterly evaluations, case review, focused chart review, lecture attendance
Oral boards
Written boards
Annual In-service exams
Resources
8
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences:
Neurology
Developed by:
Stephen E. Eichert, D.O., FACOS; Dan Miulli,
D.O., FACOS; Javed Siddiqi, HBSc, M.D.,
Ph.D., FRCSC
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering a neurological surgery residency, the resident should:
· Understand localization within the central and peripheral nervous systems
· Perform a basic neurological exam
· Recognize the major categories of neurology disease: infections, neoplastic, traumatic, degenerative
and developmental
· Recognize major congenital malfunctions and the cause of hydrocephalous
· Recognize the major categories of headaches and epilepsy
· Understand the causes of stupor and coma
· Distinguish metabolic from structural presentation of coma
Learning Outcomes
Upon completion of the neurosurgery residency the resident will:
· Understand the anatomy, physiology and pathology of the nervous system
· Describe the etiology and pathogenesis of cerebrovascular disease
· Integrate the neurological examination with laboratory, physiologic and radiographic studies to
precisely locate lesions within the nervous system
· Form specific treatment plans and accurate prognoses based on localization, pathophysiology and
naturalization of a neurological disorder occurring in any specific patient
9
Phase I: Performance Indicators Phase II: Performance Indicators
Cognitive
Stroke
Understand and recognize the major causes of stroke
Compare the differences between hemorrhage
infraction and primary hemorrhage
Identify the appropriate diagnostic studies to support
the clinical impression of stroke
Select the appropriate therapeutic maneuvers for
effecting treatment of stroke in individual patients and
categories of patients
Educate patients and families about the risks of
recurrences and appropriate prophylactic measures
Localize affected area based on clinical presentation
Describe the etiology, pathogenesis, clinical
presentation, radiologic evaluation, clinical evaluation,
and management of the following:
· Transient ischemic attacks
· Cerebral infarction
· Cerebral and cerebellar hemorrhage
· Subarachnoid hemorrhage
· Venous infarction
Identify the primary causes of stroke in the pediatric
population
Meningitis and Encephalitis
Recognize bacterial and viral meningitis
Order appropriate laboratory and diagnostic studies in
patients with meningit is
Appropriately use antibiotics in meningitis
Describe the clinical manifestations of viral
encephalitis
Define the major viral causes of encephalitis
Describe the major magnetic resonance imaging (MRI)
and computerized tomography (CT) findings in
encephalitis
Cognitive
Oncology
Recognize the clinical presentation of patients
with mass lesions including intraaxial
supratentorial, extraaxial supratentorial,
intraaxial intracerebellar, extraaxial
intratentorial, intraaxial brain stem
Develop a differential diagnosis based on
location of the lesion, patient age, and
associated medical condition
Explain the role of corticosteroids in patients
with cerebral and spinal cord masses
Define the cerebrocutaneous syndrome and
their neoplastic accompaniments:
· Neurofibromatosis I and II
· Tuberous sclerosis
· Von Hippel-Lindau Syndrome
· Sturge-Weber Syndrome
Explain the major sources of metastatic
carcinoma to the brain
Identify and describe the clinical
manifestations and laboratory investigations of
the remote effects of cancer:
· Eaton-Lambert Syndrome
· Cerebellar degeneration
· Polyneuropathies
· Limbic encephalitis
· Marantic endocarditis
Acquired Immune Deficiency Syndrome
(AIDS)
Understand the manifestations of AIDS
encephalopathy
Establish the differential diagnosis and
understand the respective radiologic
presentation of mass lesions in patients with
AIDS
Describe the pathology and the clinical picture
of AIDS myelopathy
Identify the clinical indicators for nerve biopsy
10
Define the electro encephalogram (EEG) findings
peculiar to herpes encephalitic and Jacob–Kreatzfold
disease
Describe the clinical presentation of
polioencephalomyelitis
Disorders of CSF:
Describe the diagnosis and management of
pseudotumor cerebri
Describe the diagnosis and management of normal
pressure hydrocephalus
Cerebral & Epidural Abscess
Define the routes of infection including direct
extensions, post traumatic, and hematogenous
Explain the expectations of organisms including
bacterial, fungal, and parasitic
Use the indictions for surgical interevention
Prescribe appropriate antibiotics
Explain paradoxic embolization in the context of
cerebral abscess and hematogenous dissemination
Define neurosarcoidosis and its systemic
accompaniments
Explain the expected clinical presentation, diagnostic
adjuncts and prognosis of neurosarcoidosis
Trauma
Compare concussive cerebral injuries from classic
concussion to diffuse axonal injury (DAI)
Explain the expected radiographic findings in
concussion and DAI
Plan treatment in concussion and DAI
Describe the anatomic considerations, the clinical
presentation, and treatment for epidural hematoma and
acute subdural hematoma
Explain the role of secondary injury following acute
head injury inclu ding anoxia, ischemia, metabolic
insult
in patients with AIDS
Major Disorders
Categorize, define, and explain the clinical
presentation and the pathophysiology of the
major degenerative disorders
Define the clinical presentations, relevant
diagnostic studies, the therapeutic measures,
and prognostic indicators in the major
autoimmune disorders of the nervous system:
Understand the various movement disorders
and their associated clinical manifestations
Recognize the major peripheral neuropathies in
clinical practice
Analyze the role of alcohol in disease of the
nervous system
· Wernicke’s Encephalophy
· Korsakoff’s Psychosis
· Central Pontine Myelinolysis
· Alcoholic Peripheral Neuropathy
· Delirium Tremens
Understand the pathophysiology, clinical
presentation, diagnosis, treatment, and
prognosis various muscular disorders
Distinguish the major cerebral degenerative
disorders of childhood
Describe the neurological manifestations of
each of the major storage disorders
Define the major categories of headache, their
presentation, relevant diagnostic studies and
treatment
· Tension
· Cluster
· Migraine
· Analgesic Rebound
· Post-cerebral Hemorrhage
· Cerebral Neoplasm
Define the major categories of epilepsy, their
presentation and treatment as well as relevant
diagnostic studies
11
Compare cerebral contusion and delayed cerebral
parenchymal hemorrhage based on their clinical and
radiographic presentations; plan treatment for both
Define the anatomic considerations, the clinical and
radiographic appearance, and treatment for chronic
subdural hematoma
Identify the cause of subdural hematoma and rate of
reoccurrence
Explain Kernohan’s Notch
Counsel families of patients about treatment and
prognoses in acute head injury
Spine Trauma
Use a directed neurologic examination for patients with
acute and subacute spine trauma
Compare acute injury clinical presentations including
spinal shock, Brown-Sequard Syndrome, central cord
syndrome, and cauda equina syndrome
Identify the spinal level of injury based on physical
examination
Distinguish between acute polyneuropathyies and
myelopathy
Diagnostic Testing and Monitoring
Understand the indications, pathologic changes,
how test is performed, diagnostic use of the
following:
· Electroencephalography
· sensory evoked potential testing (SEP)
· visual evoked potential testing (VEP)
· motor evoked potential testing (MEP)
· electromyographic testing (EMG)
· nerve conduction velocity testing (NCV)
Technical
Perform lumbar puncture and differentiate among viral
meningitis, bacterial meningitis, and encephalitis based
on the result of the lumbar puncture
Define status epilepticus, its causes,
pathophysiology, clinical presentation,
diagnostic studies and treatment
Delirium and Dementia
Define delirium and dementia. List the
differential diagnoses for each
Describe coma and altered states of
consciousness and measure patient status using
the Glasgow Coma Scale
Evaluate a patient with syncope
13
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Resident Assessment
Written exams and slide/photograph identifications
Quarterly evaluations, case review, focused chart review, lecture attendance
Oral boards
Written boards
Annual In-service exams
Resources
14
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences:
Neuropathology
Developed by:
Stephen E. Eichert, D.O., FACOS; Dan
Miulli, D.O., FACOS; Javed Siddiqi, HBSc,
M.D., Ph.D., FRCSC
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering neurological surgery residency, the resident should:
· Recognize the correlation between neurological structure and function
· Analyze the variability of the effects on neurological function related to anatomic localization of the
disease
· Understand how the nervous system responds to insult based on:
o fixed size of space enclosing the central nervous system
o limited mobility of the nervous system within that space
o immobility of the dura and dural folds
o uniformity of structural change and progression of most serious (biologic behavior)
· Recognize the major cytological components of the central and peripheral nervous system
· Analyze the blood brain barrie r, its components and areas where it is defective
· Compare cytotoxic and cacogenic edema
· Understand the Monro-Kellie Doctrine
Learning Outcomes
Upon completion of a neurological surgery residency, the resident will:
· Compare relevant chromatic, chemical and immune-peroxides for specific tissues and disease
processes
· Correlate gross and histologic specimens to the pathologic process
· Correlate the chemical laboratory and radiologic data with the underlying pathologic process in
individual patients
· Explain the pathophysiology as it relates to the specific neurological clinical situations
Phase I: Performance Indicators
Cognitive
Understand CSF physiology as it relates to communicating hydrocephalus, non-communicating
hydrocephalus, benign intracranial hypertension, and cerebral herniation
Compare intracranial pressure volume relationships in the context of trauma, intracerebral and
subarachnoid hemorrhage, cerebral neoplasm, and cerebral herniation
Explain cerebral blood flow (CBF) in trauma, cerebral herniation, cerebral hemorrhage, and ischemic
cerebral vascular disease & subarachnoid hemorrhage
Compare the effects of ischemia, hypoxemia, trauma, cerebral hemorrhage and tumors on cerebral
autoregulation
Describe the effect of seizures on cerebral blo od flow and cerebral autoregulation
Explain fluid and electrolyte disorders as they relate to central nervous system disorders including
syndrome of inappropriate antidiuretic hormone secretion (SIADH), diabetes insidious, and cerebral salt
wasting
Describe the major developmental anomalies, their recognition, origin and treatment
· Chairi Malformations
· Anencephaly
· Arachnoids Cysts
· Dandy Walker Syndrome
· Down’s Syndrome
· Spinal Dysraphisms
· Agenesis of Corpus Callosum
· Klippel – Feil Syndrome
· Hydrocephalus
· Porencephaly
· Microcephaly
· Heterotopias
· Vein of Galen Aneurysm
Explain the major theories of development, the clinical presentation and the path physiology of cerebral
aneurysms, capillary telangiectasias, artero-venous malfunctions, cavernous hemangiomas, venous
angiomas
Describe the major theories and pathophysiology of cerebral vasospasm in relation to subarachnoid
hemorrhage
Differentiate cytotoxic edema, vasogenic edema, interstitial edema and congestive brain swelling
Describe the etiology, pathophys iology and clinical presentations of ischemic cerebral infraction,
ischemic cerebral infraction and secondary hemorrhage, primary intracerebral hemorrhage and venous
occlusion
Compare the pathophysiology of ischemic and hypoxic brain injury
Differentiate the pathophysiology of indirect brain injuries including cerebral concussion, diffuse axonal
injury, and acute subdural hemtoma
Differentiate secondary brain injuries including ischemic brain injury, cerebral herniation, contusional
hemorrhage, posttraumatic swelling, and posttraumatic edema
Analyze the pathophysiology, the clinical presentations and the etiology of reoccurrence in the chronic
subdural hematoma
Understand the pathophysiology of penetrating brain injury
Compare the pathophysiology and radiologic correlates of primary and secondary spinal cord injury
Differentiate the clinical presentation of and pathologic progression of spinal shock, Brown-Séquard
syndrome, anterior spinal syndrome, central cord syndrome, Guillain-Barré syndrome, and Tabes Dorsalis
Understand the cell rest and field theories in the development of tumors of the nervous system
Explain the nature of local invasion of glial neoplasm and the structures of Scherer
Define the peaks of occurrence, locations, clinical presentations, histologic , cytologic and where relevant
immunologic characteristics of primary glial neoplasm’s including:
· Astrocytoma
· Oligodendroglioma
· Ependymoma
· Choroids Plexus Papillone
· Myxopapillary Eprndymomas
· Primitive Neuroectodermal Tumors (PNET)
· Germinomas
· Ganglioglioma
· Pleomorphic Xanthoastrocytoma
· Hemangioblastoma
Define the peaks of occurrence, locations, clinical presentation, development, histologic and cytologic
characteristics of:
· Meningiomas
· Hemangiopericytomas
· Colloid Cysts
· Rathke cleft cysts
· Pineal cysts
· Craniopharyngioma
· Dermoids
· Epidermoids
· Chordomas
· Gliosarcomas
· Lymphomas
Differentiate the accepted grading systems for glial neoplasms based on rationale: World Health
Orgniazation (WHO,) Kernahan, Danmas–Duport, Buerger
Compare of the pathophysiology and clinical correlates of carcinoma that is metastatic to the nervous
system by type: parenchymal, leptomeningeal, epidural
Explain the pathophysiology of paraneopla stic nervous system diseases
Describe the laboratory, clinical, histologic, cytologic and immunologic abnormalities found in
association with pituitary adenomas
Describe the laboratory studies indicative of the cause of hormone-secreting pituitary adenomas including
prolactinomas, Cushings syndrome, and acromegaly
Describe the clinical presentation, radiographic picture, genetics and pathologic manifestations of the
neurocutaneorus syndromes:
· Tuberous Sekrosis
· Neurofibromatosis I
· Neurofibromatosis II
· Von Hippe–Lindau’s Angiomatosis
· Encephalo facial Angiomatosis
· Ataxia–Telauogiectasia
Explain the clinical presentation, laboratory abnormalities, pathophysiology and possible sequellae of:
· Bacterial meningitis
· Viral meningitis
· Sporadic and Epidemic Encephalitis
· Herpes Encephalitis
· Tuberculosis (TB) meningitis
· Fungal meningitis
· Poliomyelitis
· Crentzfeld–Jacob disease
Differentiate the types of cerebral abscesses (bacterial, fungal, tuberculosis, sarcoid, parasitic) based on
the clinical presentation, pathophysiology, radiographic presentation and give the rationale for treatment
Discuss the clinical presentation and the pathologic correlates of AIDS as the well as associated infections
and neoplastic entitles as the affect the nervous system
Compare the pathophysiology and clinical presentation of demyelinating disorders of the nervous system
such as multiple sclerosis and central pontine myelinolysis
Describe the clinical and pathologic abnormalities in vitamin deficiency diseases of the central nervous
system including subacute combined degeneration, Wernicke’s encephalopathy, and Korsakoff’s
psychosis
Describe the clinical presentation and the pathologic substrate of the major degenerative central nervous
system disorders:
· Alzheimer’s Disease
· Vascular disease
· Parkinson’s Disease
· Wilson’s Disease
· Progressive Supranuclear Palsy
· Pick’s Disease
· Huntington’s Disease
· Motor Neuron Disease
· Post Polio Syndrome
· Spinocerebellar desecrations
· Striatonigral Degeneration
Describe the use of electron microscopy, and Nuclear Magnetic Resonance (NMR) spectroscopy as it
pertains to neurological disease
Perform basic preparation, frozen sectioning and microscopic identification of nervous tissue.
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Resident Assessment
Written exams and slide/photograph identifications
Quarterly evaluations, case review, focused chart review, lecture attendance
Oral boards
Written boards
Annual In-service exams
Resources
Lecture and slide material from Loyola University Medical center, Department of Pathology, Section of
Neuropathology
Fuller G and Goodman C. Practical Review of Neuropathology. Lippincott Williams & Wilkins, 2001.
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences:
Neuropharmacology
Developed by:
Javed Siddiqi, HBSc, M.D., Ph.D., FRCSC;
Dan Miulli, D.O., FACOS; Keith Kattner,
D.O., FACOS
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering a neurological surgery residency, the resident should:
· Understand basic pharmacology, physiology and neurology
Learning Outcomes
Upon completion of the neurological surgery residency, the resident will:
· Understand neuropharmacology that is pertinent to the treatment of neurological disorders and
diseases which affect the nervous system
Phase I: Performance Indicators
Cognitive
Describe basic cellular neurotransmission including;
· The synapse
· Membrane potentials
· Ion pumps
· Ion channels
· Transmitter secretion
· Transmitter identification
Classify and identify receptors and receptor pharmacodynamics including:
· Receptor classification
· Receptor identification
· Dose response curves
· Agonists and antagonists
· Receptor modulation
Classify the neurotransmitter acetylcholine including:
· Cholinergic receptor classification
· Functional aspects of cholinergic receptors
· Synthesis, storage, and release of acetylcholine
Analyze the catecholamine neurotransmitters (norepinephrine and dopamine) including:
· Biosynthesis of catecholamines
· Storage and release of catecholamines
· Anatomy of catecholamine receptors
· Adrenergic receptors
· Dopaminergic receptors
Analyze the neurotransmitter serotonin including:
· Anatomy of serotonin receptors
· Biosynthesis, storage, and release of serotonin
· Sub-types of serotonin receptors
Analyze the neurotransmitter glutamate including:
· Biosynthesis, storage, and release of glutamate
· Ionotropic glutamate receptors including N-methyl-D-aspartate (NMDA) and non-NMDA receptors
and subunits
· Metabotropic glutamate receptors: Groups I - III
· Role in neurological disorders
Analyze the neurotransmitters gamma-aminobutyric acid (GABA) and glycine including:
· Synthesis, uptake, and release
· Physiology and pharmacology
· Clinically relevant agonists and antagonists of GABA and glycine receptors
Analyze the peptide neurotransmitters
Evaluate the pharmacology of each of the drugs used to treat neurological disorders
Prescribe medication appropriately for nervous system diseases
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Resident Assessment
Written exams and slide/photograph identifications
Quarterly evaluations, case review, focused chart review, lecture attendance
Oral boards
Written boards
Annual In-service exams
Resources
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences:
Neurophysiology
Developed by:
Javed Siddiqi, HBSc, M.D., Ph.D., FRCSC;
Dan Miulli, D.O., FACOS; Keith Kattner,
D.O., FACOS
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering a neurological surgery residency, the resident should:
· Understand basic neuro-physiology including nerve cell and nervous system transmission,
homeostasis and repair
· Understand nervous system histology
· Understand the anatomy of the nervous system on a cellular and macroscopic level
· Describe the basic biology of the nerves including:
o Synthesis and movement of proteins in the nerve
o Membrane potential and membrane properties
o Ion channels
o Generation and conduction of an action potential
Learning Outcomes
Upon completion of the neurological surgery residency, the resident will:
· Understand neurophysiology and how it relates to neurological diseases
· Analyze the physiological mechanisms in the treatment of functional disorders
Phase I: Performance Indicators
Cognitive
Describe synaptic transmissions including:
· Types of synaptic transmission
· Transmitter release and uptake
· Nerve-muscle transmission
· Chemical messengers
· Direct gated receptors
· Second messenger linked receptors
Describe the physiology of the sensory systems including:
· Sensory receptor physiology
· Anatomy of somatic sensory system
· Coding of modality specific sensory information
· Pain and analgesia
· Cortical integration of sensory perception
· Visual system
o Processing of information in the retina
o Processing of vision in the central visual pathways
o Columnar units of visual cortex
o Processing in the geniculate nucleus
o Visual perception of motor and form
· Auditory system including the processing of hearing in the cochlea and the central auditory pathways
· Olfaction and taste
Describe the physiology of the motor system including:
· Mechanisms of muscle contraction
· Muscle receptors, spinal reflexes
· Spinal reflexes concerned with position
· Brain stem reflexes controlling motion
· Vestibular nuclei control of movement and posture
· Red nucleus control of movement
· Cortical control of movement
· Cerebellar control of movement
o Regional and cellular organization of the cerebellum
o Functional divisions of the cerebellum
o The role of the cerebellum in planning movement
· Basal ganglia anatomy and neuro transmitters
· Thalamus
Compare the attributes of the autonomic nervous system including both the sympathetic and
parasympathetic systems
Analyze the physiological basis of arousal and emotion, including:
· Noradrenergic systems
· Limbic system including the physiologic basis for emotion and memory
· Sleeping and sleep states
· Reticular activating system
Describe the higher cortical functions including:
· Anatomy of language
· Function of association cortex
Describe the physiological basis for cerebrospinal fluid production and re-absorption
Review the physiological control of the cerebral vasculature
Discuss the physiology of the hypothalmus and pituitary, particularly as related to endocrinology
Analyze the physiological dynamics of cerebral blood flow
Properly interpret tests of both global and regional blood flow:
· X-ray/CT scan method
· Thermal diffusion
· Laser and Transcranial Doppler
· Jugular bulb oximetry testing
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Review the basic physiological sciences through attendance at board review courses
Participate in laboratory research projects
Develop knowledge of physiological testing through a dedicated neurology rotation
Attend courses focused on intraoperative physiological monitoring
Resident Assessment
Written exams and slide/photograph identifications
Quarterly evaluations, case review, focused chart review, lecture attendance
Oral boards
Written boards
Annual In-service exams
Resources
Intraoperative Monitoring: Basics and Performance Issues. American Society of Electroneurodiagnostic
Technologists, 2001.
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences:
Neuro-Radiation Physiology
Developed by:
Will Beringer D.O.; Keith Kattner D.O.,
FACOS, Javed Siddiqi, HBSc, M.D., Ph.D.,
FRCSC; Dan Miulli, DO, FACOS
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and
Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering a neurological surgical residency, the resident should:
· Identify devices commonly used to provide radiotherapy and radiosurgery – external beam / whole
brain, linac, gamma knife, cyberknife, intensity-modulated radiation therapy (IMRT)
· Understand use of ionizing radiation to induce potentially lethal mutations in cancerous and normal
tissues
· Compare the characteristics of cancer cells and normal tissues with regards to deoxyribose nucleic
acid (DNA) repairing capabilities following radiation injury
Learning Outcomes
Upon completion of the neurological surgical residency, the resident will:
· Analyze the indications, risks and benefits of radiotherapy and radiosurgery in treating neurosurgical
lesions
· Analyze current literature and apply the information to patient care
· Plan treatment doses and treatment schedules with radiotherapy or radiosurgery
· Collaborate on the radiobiological treatment of neurosurgical patients with radiation oncologists,
radiation physicists and oncologists
· Communicate with patients and their families in a knowledgeable, compassionate manner regarding
the risks, benefits and goals of radiotherapeutics in the treatment of neurosurgical lesions
Phase I: Performance Indicators Phase II: Performance Indicators
Cognitive
Differentiate treatment options for meningiomas,
gliomas, metastases, spinal cord tumors,
arteriovenous malformations (AVM), acoustic
neuromas, trigeminal neuralgia
Differentiate external beam radiotherapy from
stereotactic radiosurgery
Describe differences among linear accelerator
system (LINAC), GammaKnife, Cyberknife and
intensity-modulated radiation therapy (IMRT)
devices
Describe photon beam therapy
Describe the concept of brachytherapy
Explain why children are more susceptible to
radiation injury than adults
Cognitive
Analyze late responding and early responding
tissues & lesions and relate to different alpha / beta
ratios
Differentiate between intensity-modulated radiation
therapy (IMRT) and Cyberknife
Assess the indications for use of whole brain
radiotherapy in the management of brain
metastases
Assess the indications for using hypofractionation
Compare tissues that respond to single fraction
radiosurgery versus hypofractionation
Describe the onset, clinical manifestations and risks
for developing radionecrosis
Collaborate on the management of post radiationrelated
edema
Understand the effect of lesion size on the choice
of IMRT, single fraction radiosurgery and multi
staging radiosurgery
Describe common radiotherapeutic strategies for:
· meningiomas of the convexity, cavernous
sinus, dural sinuses
· metastases to the brain and spine
· gliomas – supratentorial and brainstem
· trigeminal neuralgia
· pituitary adenomas
· acoustic neuromas
· arteriovenous malformation (AVM)
Differentiate radionecrosis from recurrent tumor on
magnetic resonance imaging (MRI), positron
emission tomography (PET), and single-photon
emission computerized tomography (SPECT)
studies
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Interact with radiation oncologists, oncologists and neurosurgeons in an interdisciplinary approach to treat
patients with complex neuro-oncologic diseases.
Attend national conferences where the indications and various approaches to use of radiotherapeutics are
discussed.
Plan and treat under guidance of radiation oncologists, radiation physicists and neurosurgeons the
delivery of radiosurgery or radiotherapy.
Resident Assessment
Oral boards
Written boards
Annual in-service exams
Resources
Local / regional linac, IMRT, Cyberknife, Gamma Knife facilities and the staff who manage and use these
devices
Hall EJ, Brenner DJ. The radiobiology of radiosurgery: rationale for different treatment regimens for
AVMs and malignancies. Int. J. Radiat. Oncol. Biol. Phys. 1993: 25: 381-385.
Mehta MP. The physical, biologic, and clinical basis of radiosurgery. in: Current problems in cancer. 5th
edition, Vol. XIX, 1995.
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences:
Neuroradiology
Developed by:
Ajeet Gordhan, M.D.; Keith Kattner, D.O.,
FACOS; Javed Siddiqi, HBSc, M.D., Ph.D.,
FRCSC; Dan Miulli D.O., FACOS
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering a neurological surgical residency, the resident should:
· Relate neurological anatomy to imaging studies
· Understand the basic physics of magnetic imaging, computed tomography, and plain films
· Know the “gold standard” imaging for various neurological diseases
Learning Outcomes
Upon completion of the neurological surgery residency, the resident will:
· Recognize the appropriate imaging based on functional neuroanatomy findings
· Interpret magnetic resonance imaging (MRI), computed tomography (CT), and routine x-rays of the
brain and spinal column
· Determine the appropriate imaging to best diagnose neurological diseases
· Develop a treatment strategy based upon imaging findings and correlate imaging to surgical
techniques
· Utilize endovascular techniques in treating neurovascular disorders
Phase I: Performance Indicators Phase II: Performance Indicators
Cognitive
Identify normal neuroanatomical structures on
magnetic resonance imaging, computer
tomography, and x-rays
Evaluate the limitations, sensitivity, and specificity
and potential complications to intravenous contrast
agents and discuss their management
Plan the use of endovascular techniques to treat
various neurovascular diseases
Diagnose traumatic pathology to the nervous
system during trauma resuscitation by means of CT
scans and plain x-rays
Describe the plan for endovascular techniques to
treat various neurovascular diseases
Diagnose traumatic pathology to the nervous
system during trauma resuscitation by means of CT
scans and plain x-rays
Describe precautions that should be taken when
performing radiographic evaluations
Describe the use of myelogram in the treatment of
spinal disease
Identify diseased neuroanatomical structures on
magnetic resonance imaging (MRI), computer
tomography, cerebral angiogram, SPECT, PET,
spectroscopy, functional imaging and x-rays
Describe the concepts of ultrasonography
Identify the spine fractures on routine x-rays and
CT scan
Describe the findings of normal and abnormal
carotid ultrasound
Distinguish the various stages of intracranial
hematomas on MRI and CT scan
Cognitive
Distinguish the findings of normal and abnormal
neonatal cranial ultrasound
Use of transcrania l Doppler ultrasonography in the
management of patients with subarachnoid
hemorrhage, trauma, and occlusive vascular
disease, brain death, and the significance of
velocity changes and Lindergaard ratio
Diagnose brain and spine tumors using MRI and
CT scan
Use diffuse weighted imaging and perfusion
scanning to identify early ischemic stroke
Use MR spectroscopy and PET scan to distinguish
brain tumors
Interpret MRI, CT angiography, and standard
angiography to diagnose aneurysms and
malformations
Diagnose vasospasm with transcranial Doppler
Determine specific pituitary, brain, spine, and skull
base tumors based on characteristics in imaging
Discuss the indications and technique of
discography, epidural steroids, diagnostic selective
nerve root blocks, facet blocks
Discuss the indications and technique for
percutaneous vertebroplasty
Technical
Use image guidance to resect brain and pituitary
tumors
Use image guidance in placing instrumentation in
the spine
Assist in the treatment of neurovascular diseases
with endovascular techniques
Perform provocative discography to diagnose
discogenic disease
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Resident Assessment
Written exams and slide/photograph identifications
Quarterly evaluations, case review, focused chart review, lecture attendance
Oral boards
Written boards
Annual In-service exams
Resources
Osborn, AG, Maack, J. Diagnostic Neuroradiology. CV Mosby Publishers, 1994
American College of Osteopathic Surgeons
Neurological Surgery: Neurosciences
Development of professional collaboration is an important component of surgical training. When
considering the broad realm of patient care, both within and outside the operating room, the surgeon must
understand and be able to use specific concepts and skills related to neurosciences and specialties
including anatomy, neurology, pathology, pharmacology, physiology, radiation physiology, and
radiology.
Integration of the neurosciences and associated specialties by the neurosurgery resident into all aspects of
practice will enhance his or her ability to appropriately diagnose, organize a management plan, perform
necessary surgical procedures, and care for the postoperative surgical patient in the short and long term.
Neurosurgery residents learn neuroscience concepts and skills on all clinical rotations and in didactic
settings. Knowledge and skills are assessed informally and on a daily basis by faculty and attending
surgeons as well as formally. Since these neurosciences and associated specialties are part of a core
curriculum related to each and every principal surgical area, they are grouped together and not repeated in
separate surgical areas.
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences: Neuroanatomy
Developed by:
Steve Schneider, M.D.
Stephen J. Eichert, D.O., FACOS
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering a neurological surgery residency, the resident should:
· Understand the organization and development of the nervous system
· Understand the anatomic structures, their connections and relationship to function within the nervous
system
Learning Outcomes
Upon completion of the neurosurgery residency, the resident will:
· Understand the anatomy that is pertinent to the diagnosis of diseases of the nervous system and the
practice of neurological surgery
· Understand clinical syndromes as a correlate to neuroanatomy
Phase I: Performance Indicators Phase II: Performance Indicators
Cognitive
Embryology
Analyze the embryological development of the brain,
cerebellum, brain stem, glial elements, spinal cord,
conus medullaris, cauda equina, sympathetic and
parasympathetic systems and the peripheral nervous
system
Analyze the embryologic development of the skull,
craniovertebral junction, and spine
Histology
Describe and differentiate the types of neurons
Understand the microanatomy of the neuron including
the cell body, dendritic process and axonal process
Diagram and describe the microanatomy of the synapse
Identify the microglial elements and their microanatomy
Describe the anatomical basis for the blood brain barrier
Vascular Anatomy
Diagram and describe the carotid and vertebral arteries
and their branches which provide blood supply to the
face, scalp, skull, meninges, brain, brain stem,
cerebellum, and rostral spinal cord
Describe the arterial blood supply to the spinal cord
including the spinal and radicular arteries and explain
the concept of watershed ischemia
Identify the venous drainage of the central nervous
system
Osseous Anatomy
Identify the bones and sutures of the skull
Identify each named foramen of the skull and list its
contents
Extracerebral Anatomy
Describe the anatomy of the meninges including the
dura mater, arachnoid mater, pia mater
Describe the anatomy of the dura including the falx
cerebri and tentorium
Cognitive
Discuss the clinical presentation in anatomical
terms of syndromes of the brain and its
coverings
Discuss the syndromes produced by mass
lesions affecting the cranial nerves
Predict the expected effects of stroke or mass
lesion at different locations within the brain
stem and cerebellum
Predict the expected effects of destructive
lesions in the basal ganglia and cerebellum
Predict the expected effects of ischemic or
destructive lesions of the white matter tracts
of the cerebellum
Predict the expected effect of destructive
lesions of specific regions of the cerebral
cortex
Recognize the clinical presentation of strokes
in the distribution of the supratentorial
cerebral blood vessels
Describe the relationship of the spinal nerves
to the vertebral level of exit
Diagram the structures comprising the
boundaries of the spinal neural foramina
Recognize the clinical manifestation of injury
for each of the major peripheral nerves
Describe the anatomy and presentation of
common entrapment syndromes of peripheral
nerves
Describe the surgical exposure of common
peripheral nerve entrapments
Recognize the clinical presentation and
neurological deficits associated with common
lesions of and injuries to the spinal cord and
nerve roots
Identify the layers of the scalp and discuss scalp
innervation
Diagram the cerebral ventricles
Describe the major arachnoid cisterns and the anatomy
of the arachnoid villi
Analyze the anatomic correlates pertinent to the
production, flow, and reabsorption of cerebrospinal fluid
Spinal Anatomy
Identify and describe the gross anatomy of the spine
Identify the muscles related to the skull and spine
including suboccipital, anterior cervical, and posterior
cervical
Describe the gross anatomy of the neck
Central Nervous System
Describe the anatomy of cerebrum, cerebellum,
olfactory pathways, hippocampal formation, and
amygdala
Describe the anatomy of the corpus striatum
Describe the anatomy of the hypothalmus and pituitary
Describe the anatomy of the diencephalons and
mesencephalon
Identify the location and connections of each cranial
nerve nuclei
Trace the course of each cranial nerve from nucleus to
end organ termination.
Describe the external topography and landmarks of the
fourth ventricle
Describe the anatomy of the brain stem including pons
and medulla
Describe the anatomy of the spinal cord
Autonomic Nervous System
Distinguish pre- and postganglionic neurons
Describe the sympathetic nervous system and the
Technical
Identify at the time of surgery structures
visible in the lateral ventricles and understand
the flow of cerebrospinal fluid (CSF) through:
· Foramen of Monro
· Fornix
· Caudate
· Thalamus
· Choroidal fissure
· Named veins
· Glomus of choroid plexus
· Hippocampus
parasympathetic nervous system
Identify the visceral afferent fibers
Describe the structure of the autonomic ganglia and the
central autonomic pathways
Peripheral Nervous System
Differentiate between segmental and peripheral
innervation
Diagram the anatomy of the spinal nerve root
Diagram and discuss the cervical, brachial, and
lumbosacral plexi
Outline the anatomy of the major peripheral nerves of
the upper and lower extremities
Describe the microanatomy of the peripheral nerves
Compare myelinated and unmyelinated nerves
Describe the anatomy of the Schwann cell
Identify the peripheral afferent receptors and describe
the anatomy of each
Segregate peripheral neurons by size and explain the
rationale for such a classification scheme
Muscle
Explain the concept of the motor unit and describe the
anatomy of the motor end plate
Compare the microscopic anatomy of striated and
smooth muscle
Describe the subcellular components of muscle
Identify the parts of the vertebral column,
spinal cord, and nerve roots at the time of
surgery
Identify at the time of surgery:
· Occipital artery
· Superficial temporal artery
· Frontalis muscle
· Pterion
· Inion
· Asterion
· Coronal suture
· Sagittal suture
· Middle meningeal artery
· Sagittal sinus
· Transverse sinus
· Foramen rotundum
· Foramen ovale
· Foramen spinosum
· Superior orbital fissure
· Jugular foramen
· Internal auditory canal
· Superior sagittal sinus
· Sigmoid sinus
· Incisura
· Each cranial nerve
· Each named cerebral artery and vein
· Components of the brain stem
· Named structures on the floor of the
fourth ventricle
· Foramina of Magendie and Luschka
· Cerebral peduncles
· Components of the cerebellum
· Cerebellar tonsils
· Brachium cerebelli
· Vermis
· Major supratentorial gyri
· Supratentorial lobes
· Sylvian fissure
· Central sulcus
Adapted from the American Association of Neurological Surgeons/Congress of Neurological Surgeons
Neurosurgery Residency Curriculum Guide
7
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Resident Assessment
Written exams and slide/photograph identifications
Quarterly evaluations, case review, focused chart review, lecture attendance
Oral boards
Written boards
Annual In-service exams
Resources
8
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences:
Neurology
Developed by:
Stephen E. Eichert, D.O., FACOS; Dan Miulli,
D.O., FACOS; Javed Siddiqi, HBSc, M.D.,
Ph.D., FRCSC
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering a neurological surgery residency, the resident should:
· Understand localization within the central and peripheral nervous systems
· Perform a basic neurological exam
· Recognize the major categories of neurology disease: infections, neoplastic, traumatic, degenerative
and developmental
· Recognize major congenital malfunctions and the cause of hydrocephalous
· Recognize the major categories of headaches and epilepsy
· Understand the causes of stupor and coma
· Distinguish metabolic from structural presentation of coma
Learning Outcomes
Upon completion of the neurosurgery residency the resident will:
· Understand the anatomy, physiology and pathology of the nervous system
· Describe the etiology and pathogenesis of cerebrovascular disease
· Integrate the neurological examination with laboratory, physiologic and radiographic studies to
precisely locate lesions within the nervous system
· Form specific treatment plans and accurate prognoses based on localization, pathophysiology and
naturalization of a neurological disorder occurring in any specific patient
9
Phase I: Performance Indicators Phase II: Performance Indicators
Cognitive
Stroke
Understand and recognize the major causes of stroke
Compare the differences between hemorrhage
infraction and primary hemorrhage
Identify the appropriate diagnostic studies to support
the clinical impression of stroke
Select the appropriate therapeutic maneuvers for
effecting treatment of stroke in individual patients and
categories of patients
Educate patients and families about the risks of
recurrences and appropriate prophylactic measures
Localize affected area based on clinical presentation
Describe the etiology, pathogenesis, clinical
presentation, radiologic evaluation, clinical evaluation,
and management of the following:
· Transient ischemic attacks
· Cerebral infarction
· Cerebral and cerebellar hemorrhage
· Subarachnoid hemorrhage
· Venous infarction
Identify the primary causes of stroke in the pediatric
population
Meningitis and Encephalitis
Recognize bacterial and viral meningitis
Order appropriate laboratory and diagnostic studies in
patients with meningit is
Appropriately use antibiotics in meningitis
Describe the clinical manifestations of viral
encephalitis
Define the major viral causes of encephalitis
Describe the major magnetic resonance imaging (MRI)
and computerized tomography (CT) findings in
encephalitis
Cognitive
Oncology
Recognize the clinical presentation of patients
with mass lesions including intraaxial
supratentorial, extraaxial supratentorial,
intraaxial intracerebellar, extraaxial
intratentorial, intraaxial brain stem
Develop a differential diagnosis based on
location of the lesion, patient age, and
associated medical condition
Explain the role of corticosteroids in patients
with cerebral and spinal cord masses
Define the cerebrocutaneous syndrome and
their neoplastic accompaniments:
· Neurofibromatosis I and II
· Tuberous sclerosis
· Von Hippel-Lindau Syndrome
· Sturge-Weber Syndrome
Explain the major sources of metastatic
carcinoma to the brain
Identify and describe the clinical
manifestations and laboratory investigations of
the remote effects of cancer:
· Eaton-Lambert Syndrome
· Cerebellar degeneration
· Polyneuropathies
· Limbic encephalitis
· Marantic endocarditis
Acquired Immune Deficiency Syndrome
(AIDS)
Understand the manifestations of AIDS
encephalopathy
Establish the differential diagnosis and
understand the respective radiologic
presentation of mass lesions in patients with
AIDS
Describe the pathology and the clinical picture
of AIDS myelopathy
Identify the clinical indicators for nerve biopsy
10
Define the electro encephalogram (EEG) findings
peculiar to herpes encephalitic and Jacob–Kreatzfold
disease
Describe the clinical presentation of
polioencephalomyelitis
Disorders of CSF:
Describe the diagnosis and management of
pseudotumor cerebri
Describe the diagnosis and management of normal
pressure hydrocephalus
Cerebral & Epidural Abscess
Define the routes of infection including direct
extensions, post traumatic, and hematogenous
Explain the expectations of organisms including
bacterial, fungal, and parasitic
Use the indictions for surgical interevention
Prescribe appropriate antibiotics
Explain paradoxic embolization in the context of
cerebral abscess and hematogenous dissemination
Define neurosarcoidosis and its systemic
accompaniments
Explain the expected clinical presentation, diagnostic
adjuncts and prognosis of neurosarcoidosis
Trauma
Compare concussive cerebral injuries from classic
concussion to diffuse axonal injury (DAI)
Explain the expected radiographic findings in
concussion and DAI
Plan treatment in concussion and DAI
Describe the anatomic considerations, the clinical
presentation, and treatment for epidural hematoma and
acute subdural hematoma
Explain the role of secondary injury following acute
head injury inclu ding anoxia, ischemia, metabolic
insult
in patients with AIDS
Major Disorders
Categorize, define, and explain the clinical
presentation and the pathophysiology of the
major degenerative disorders
Define the clinical presentations, relevant
diagnostic studies, the therapeutic measures,
and prognostic indicators in the major
autoimmune disorders of the nervous system:
Understand the various movement disorders
and their associated clinical manifestations
Recognize the major peripheral neuropathies in
clinical practice
Analyze the role of alcohol in disease of the
nervous system
· Wernicke’s Encephalophy
· Korsakoff’s Psychosis
· Central Pontine Myelinolysis
· Alcoholic Peripheral Neuropathy
· Delirium Tremens
Understand the pathophysiology, clinical
presentation, diagnosis, treatment, and
prognosis various muscular disorders
Distinguish the major cerebral degenerative
disorders of childhood
Describe the neurological manifestations of
each of the major storage disorders
Define the major categories of headache, their
presentation, relevant diagnostic studies and
treatment
· Tension
· Cluster
· Migraine
· Analgesic Rebound
· Post-cerebral Hemorrhage
· Cerebral Neoplasm
Define the major categories of epilepsy, their
presentation and treatment as well as relevant
diagnostic studies
11
Compare cerebral contusion and delayed cerebral
parenchymal hemorrhage based on their clinical and
radiographic presentations; plan treatment for both
Define the anatomic considerations, the clinical and
radiographic appearance, and treatment for chronic
subdural hematoma
Identify the cause of subdural hematoma and rate of
reoccurrence
Explain Kernohan’s Notch
Counsel families of patients about treatment and
prognoses in acute head injury
Spine Trauma
Use a directed neurologic examination for patients with
acute and subacute spine trauma
Compare acute injury clinical presentations including
spinal shock, Brown-Sequard Syndrome, central cord
syndrome, and cauda equina syndrome
Identify the spinal level of injury based on physical
examination
Distinguish between acute polyneuropathyies and
myelopathy
Diagnostic Testing and Monitoring
Understand the indications, pathologic changes,
how test is performed, diagnostic use of the
following:
· Electroencephalography
· sensory evoked potential testing (SEP)
· visual evoked potential testing (VEP)
· motor evoked potential testing (MEP)
· electromyographic testing (EMG)
· nerve conduction velocity testing (NCV)
Technical
Perform lumbar puncture and differentiate among viral
meningitis, bacterial meningitis, and encephalitis based
on the result of the lumbar puncture
Define status epilepticus, its causes,
pathophysiology, clinical presentation,
diagnostic studies and treatment
Delirium and Dementia
Define delirium and dementia. List the
differential diagnoses for each
Describe coma and altered states of
consciousness and measure patient status using
the Glasgow Coma Scale
Evaluate a patient with syncope
13
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Resident Assessment
Written exams and slide/photograph identifications
Quarterly evaluations, case review, focused chart review, lecture attendance
Oral boards
Written boards
Annual In-service exams
Resources
14
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences:
Neuropathology
Developed by:
Stephen E. Eichert, D.O., FACOS; Dan
Miulli, D.O., FACOS; Javed Siddiqi, HBSc,
M.D., Ph.D., FRCSC
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering neurological surgery residency, the resident should:
· Recognize the correlation between neurological structure and function
· Analyze the variability of the effects on neurological function related to anatomic localization of the
disease
· Understand how the nervous system responds to insult based on:
o fixed size of space enclosing the central nervous system
o limited mobility of the nervous system within that space
o immobility of the dura and dural folds
o uniformity of structural change and progression of most serious (biologic behavior)
· Recognize the major cytological components of the central and peripheral nervous system
· Analyze the blood brain barrie r, its components and areas where it is defective
· Compare cytotoxic and cacogenic edema
· Understand the Monro-Kellie Doctrine
Learning Outcomes
Upon completion of a neurological surgery residency, the resident will:
· Compare relevant chromatic, chemical and immune-peroxides for specific tissues and disease
processes
· Correlate gross and histologic specimens to the pathologic process
· Correlate the chemical laboratory and radiologic data with the underlying pathologic process in
individual patients
· Explain the pathophysiology as it relates to the specific neurological clinical situations
Phase I: Performance Indicators
Cognitive
Understand CSF physiology as it relates to communicating hydrocephalus, non-communicating
hydrocephalus, benign intracranial hypertension, and cerebral herniation
Compare intracranial pressure volume relationships in the context of trauma, intracerebral and
subarachnoid hemorrhage, cerebral neoplasm, and cerebral herniation
Explain cerebral blood flow (CBF) in trauma, cerebral herniation, cerebral hemorrhage, and ischemic
cerebral vascular disease & subarachnoid hemorrhage
Compare the effects of ischemia, hypoxemia, trauma, cerebral hemorrhage and tumors on cerebral
autoregulation
Describe the effect of seizures on cerebral blo od flow and cerebral autoregulation
Explain fluid and electrolyte disorders as they relate to central nervous system disorders including
syndrome of inappropriate antidiuretic hormone secretion (SIADH), diabetes insidious, and cerebral salt
wasting
Describe the major developmental anomalies, their recognition, origin and treatment
· Chairi Malformations
· Anencephaly
· Arachnoids Cysts
· Dandy Walker Syndrome
· Down’s Syndrome
· Spinal Dysraphisms
· Agenesis of Corpus Callosum
· Klippel – Feil Syndrome
· Hydrocephalus
· Porencephaly
· Microcephaly
· Heterotopias
· Vein of Galen Aneurysm
Explain the major theories of development, the clinical presentation and the path physiology of cerebral
aneurysms, capillary telangiectasias, artero-venous malfunctions, cavernous hemangiomas, venous
angiomas
Describe the major theories and pathophysiology of cerebral vasospasm in relation to subarachnoid
hemorrhage
Differentiate cytotoxic edema, vasogenic edema, interstitial edema and congestive brain swelling
Describe the etiology, pathophys iology and clinical presentations of ischemic cerebral infraction,
ischemic cerebral infraction and secondary hemorrhage, primary intracerebral hemorrhage and venous
occlusion
Compare the pathophysiology of ischemic and hypoxic brain injury
Differentiate the pathophysiology of indirect brain injuries including cerebral concussion, diffuse axonal
injury, and acute subdural hemtoma
Differentiate secondary brain injuries including ischemic brain injury, cerebral herniation, contusional
hemorrhage, posttraumatic swelling, and posttraumatic edema
Analyze the pathophysiology, the clinical presentations and the etiology of reoccurrence in the chronic
subdural hematoma
Understand the pathophysiology of penetrating brain injury
Compare the pathophysiology and radiologic correlates of primary and secondary spinal cord injury
Differentiate the clinical presentation of and pathologic progression of spinal shock, Brown-Séquard
syndrome, anterior spinal syndrome, central cord syndrome, Guillain-Barré syndrome, and Tabes Dorsalis
Understand the cell rest and field theories in the development of tumors of the nervous system
Explain the nature of local invasion of glial neoplasm and the structures of Scherer
Define the peaks of occurrence, locations, clinical presentations, histologic , cytologic and where relevant
immunologic characteristics of primary glial neoplasm’s including:
· Astrocytoma
· Oligodendroglioma
· Ependymoma
· Choroids Plexus Papillone
· Myxopapillary Eprndymomas
· Primitive Neuroectodermal Tumors (PNET)
· Germinomas
· Ganglioglioma
· Pleomorphic Xanthoastrocytoma
· Hemangioblastoma
Define the peaks of occurrence, locations, clinical presentation, development, histologic and cytologic
characteristics of:
· Meningiomas
· Hemangiopericytomas
· Colloid Cysts
· Rathke cleft cysts
· Pineal cysts
· Craniopharyngioma
· Dermoids
· Epidermoids
· Chordomas
· Gliosarcomas
· Lymphomas
Differentiate the accepted grading systems for glial neoplasms based on rationale: World Health
Orgniazation (WHO,) Kernahan, Danmas–Duport, Buerger
Compare of the pathophysiology and clinical correlates of carcinoma that is metastatic to the nervous
system by type: parenchymal, leptomeningeal, epidural
Explain the pathophysiology of paraneopla stic nervous system diseases
Describe the laboratory, clinical, histologic, cytologic and immunologic abnormalities found in
association with pituitary adenomas
Describe the laboratory studies indicative of the cause of hormone-secreting pituitary adenomas including
prolactinomas, Cushings syndrome, and acromegaly
Describe the clinical presentation, radiographic picture, genetics and pathologic manifestations of the
neurocutaneorus syndromes:
· Tuberous Sekrosis
· Neurofibromatosis I
· Neurofibromatosis II
· Von Hippe–Lindau’s Angiomatosis
· Encephalo facial Angiomatosis
· Ataxia–Telauogiectasia
Explain the clinical presentation, laboratory abnormalities, pathophysiology and possible sequellae of:
· Bacterial meningitis
· Viral meningitis
· Sporadic and Epidemic Encephalitis
· Herpes Encephalitis
· Tuberculosis (TB) meningitis
· Fungal meningitis
· Poliomyelitis
· Crentzfeld–Jacob disease
Differentiate the types of cerebral abscesses (bacterial, fungal, tuberculosis, sarcoid, parasitic) based on
the clinical presentation, pathophysiology, radiographic presentation and give the rationale for treatment
Discuss the clinical presentation and the pathologic correlates of AIDS as the well as associated infections
and neoplastic entitles as the affect the nervous system
Compare the pathophysiology and clinical presentation of demyelinating disorders of the nervous system
such as multiple sclerosis and central pontine myelinolysis
Describe the clinical and pathologic abnormalities in vitamin deficiency diseases of the central nervous
system including subacute combined degeneration, Wernicke’s encephalopathy, and Korsakoff’s
psychosis
Describe the clinical presentation and the pathologic substrate of the major degenerative central nervous
system disorders:
· Alzheimer’s Disease
· Vascular disease
· Parkinson’s Disease
· Wilson’s Disease
· Progressive Supranuclear Palsy
· Pick’s Disease
· Huntington’s Disease
· Motor Neuron Disease
· Post Polio Syndrome
· Spinocerebellar desecrations
· Striatonigral Degeneration
Describe the use of electron microscopy, and Nuclear Magnetic Resonance (NMR) spectroscopy as it
pertains to neurological disease
Perform basic preparation, frozen sectioning and microscopic identification of nervous tissue.
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Resident Assessment
Written exams and slide/photograph identifications
Quarterly evaluations, case review, focused chart review, lecture attendance
Oral boards
Written boards
Annual In-service exams
Resources
Lecture and slide material from Loyola University Medical center, Department of Pathology, Section of
Neuropathology
Fuller G and Goodman C. Practical Review of Neuropathology. Lippincott Williams & Wilkins, 2001.
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences:
Neuropharmacology
Developed by:
Javed Siddiqi, HBSc, M.D., Ph.D., FRCSC;
Dan Miulli, D.O., FACOS; Keith Kattner,
D.O., FACOS
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering a neurological surgery residency, the resident should:
· Understand basic pharmacology, physiology and neurology
Learning Outcomes
Upon completion of the neurological surgery residency, the resident will:
· Understand neuropharmacology that is pertinent to the treatment of neurological disorders and
diseases which affect the nervous system
Phase I: Performance Indicators
Cognitive
Describe basic cellular neurotransmission including;
· The synapse
· Membrane potentials
· Ion pumps
· Ion channels
· Transmitter secretion
· Transmitter identification
Classify and identify receptors and receptor pharmacodynamics including:
· Receptor classification
· Receptor identification
· Dose response curves
· Agonists and antagonists
· Receptor modulation
Classify the neurotransmitter acetylcholine including:
· Cholinergic receptor classification
· Functional aspects of cholinergic receptors
· Synthesis, storage, and release of acetylcholine
Analyze the catecholamine neurotransmitters (norepinephrine and dopamine) including:
· Biosynthesis of catecholamines
· Storage and release of catecholamines
· Anatomy of catecholamine receptors
· Adrenergic receptors
· Dopaminergic receptors
Analyze the neurotransmitter serotonin including:
· Anatomy of serotonin receptors
· Biosynthesis, storage, and release of serotonin
· Sub-types of serotonin receptors
Analyze the neurotransmitter glutamate including:
· Biosynthesis, storage, and release of glutamate
· Ionotropic glutamate receptors including N-methyl-D-aspartate (NMDA) and non-NMDA receptors
and subunits
· Metabotropic glutamate receptors: Groups I - III
· Role in neurological disorders
Analyze the neurotransmitters gamma-aminobutyric acid (GABA) and glycine including:
· Synthesis, uptake, and release
· Physiology and pharmacology
· Clinically relevant agonists and antagonists of GABA and glycine receptors
Analyze the peptide neurotransmitters
Evaluate the pharmacology of each of the drugs used to treat neurological disorders
Prescribe medication appropriately for nervous system diseases
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Resident Assessment
Written exams and slide/photograph identifications
Quarterly evaluations, case review, focused chart review, lecture attendance
Oral boards
Written boards
Annual In-service exams
Resources
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences:
Neurophysiology
Developed by:
Javed Siddiqi, HBSc, M.D., Ph.D., FRCSC;
Dan Miulli, D.O., FACOS; Keith Kattner,
D.O., FACOS
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering a neurological surgery residency, the resident should:
· Understand basic neuro-physiology including nerve cell and nervous system transmission,
homeostasis and repair
· Understand nervous system histology
· Understand the anatomy of the nervous system on a cellular and macroscopic level
· Describe the basic biology of the nerves including:
o Synthesis and movement of proteins in the nerve
o Membrane potential and membrane properties
o Ion channels
o Generation and conduction of an action potential
Learning Outcomes
Upon completion of the neurological surgery residency, the resident will:
· Understand neurophysiology and how it relates to neurological diseases
· Analyze the physiological mechanisms in the treatment of functional disorders
Phase I: Performance Indicators
Cognitive
Describe synaptic transmissions including:
· Types of synaptic transmission
· Transmitter release and uptake
· Nerve-muscle transmission
· Chemical messengers
· Direct gated receptors
· Second messenger linked receptors
Describe the physiology of the sensory systems including:
· Sensory receptor physiology
· Anatomy of somatic sensory system
· Coding of modality specific sensory information
· Pain and analgesia
· Cortical integration of sensory perception
· Visual system
o Processing of information in the retina
o Processing of vision in the central visual pathways
o Columnar units of visual cortex
o Processing in the geniculate nucleus
o Visual perception of motor and form
· Auditory system including the processing of hearing in the cochlea and the central auditory pathways
· Olfaction and taste
Describe the physiology of the motor system including:
· Mechanisms of muscle contraction
· Muscle receptors, spinal reflexes
· Spinal reflexes concerned with position
· Brain stem reflexes controlling motion
· Vestibular nuclei control of movement and posture
· Red nucleus control of movement
· Cortical control of movement
· Cerebellar control of movement
o Regional and cellular organization of the cerebellum
o Functional divisions of the cerebellum
o The role of the cerebellum in planning movement
· Basal ganglia anatomy and neuro transmitters
· Thalamus
Compare the attributes of the autonomic nervous system including both the sympathetic and
parasympathetic systems
Analyze the physiological basis of arousal and emotion, including:
· Noradrenergic systems
· Limbic system including the physiologic basis for emotion and memory
· Sleeping and sleep states
· Reticular activating system
Describe the higher cortical functions including:
· Anatomy of language
· Function of association cortex
Describe the physiological basis for cerebrospinal fluid production and re-absorption
Review the physiological control of the cerebral vasculature
Discuss the physiology of the hypothalmus and pituitary, particularly as related to endocrinology
Analyze the physiological dynamics of cerebral blood flow
Properly interpret tests of both global and regional blood flow:
· X-ray/CT scan method
· Thermal diffusion
· Laser and Transcranial Doppler
· Jugular bulb oximetry testing
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Review the basic physiological sciences through attendance at board review courses
Participate in laboratory research projects
Develop knowledge of physiological testing through a dedicated neurology rotation
Attend courses focused on intraoperative physiological monitoring
Resident Assessment
Written exams and slide/photograph identifications
Quarterly evaluations, case review, focused chart review, lecture attendance
Oral boards
Written boards
Annual In-service exams
Resources
Intraoperative Monitoring: Basics and Performance Issues. American Society of Electroneurodiagnostic
Technologists, 2001.
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences:
Neuro-Radiation Physiology
Developed by:
Will Beringer D.O.; Keith Kattner D.O.,
FACOS, Javed Siddiqi, HBSc, M.D., Ph.D.,
FRCSC; Dan Miulli, DO, FACOS
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and
Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering a neurological surgical residency, the resident should:
· Identify devices commonly used to provide radiotherapy and radiosurgery – external beam / whole
brain, linac, gamma knife, cyberknife, intensity-modulated radiation therapy (IMRT)
· Understand use of ionizing radiation to induce potentially lethal mutations in cancerous and normal
tissues
· Compare the characteristics of cancer cells and normal tissues with regards to deoxyribose nucleic
acid (DNA) repairing capabilities following radiation injury
Learning Outcomes
Upon completion of the neurological surgical residency, the resident will:
· Analyze the indications, risks and benefits of radiotherapy and radiosurgery in treating neurosurgical
lesions
· Analyze current literature and apply the information to patient care
· Plan treatment doses and treatment schedules with radiotherapy or radiosurgery
· Collaborate on the radiobiological treatment of neurosurgical patients with radiation oncologists,
radiation physicists and oncologists
· Communicate with patients and their families in a knowledgeable, compassionate manner regarding
the risks, benefits and goals of radiotherapeutics in the treatment of neurosurgical lesions
Phase I: Performance Indicators Phase II: Performance Indicators
Cognitive
Differentiate treatment options for meningiomas,
gliomas, metastases, spinal cord tumors,
arteriovenous malformations (AVM), acoustic
neuromas, trigeminal neuralgia
Differentiate external beam radiotherapy from
stereotactic radiosurgery
Describe differences among linear accelerator
system (LINAC), GammaKnife, Cyberknife and
intensity-modulated radiation therapy (IMRT)
devices
Describe photon beam therapy
Describe the concept of brachytherapy
Explain why children are more susceptible to
radiation injury than adults
Cognitive
Analyze late responding and early responding
tissues & lesions and relate to different alpha / beta
ratios
Differentiate between intensity-modulated radiation
therapy (IMRT) and Cyberknife
Assess the indications for use of whole brain
radiotherapy in the management of brain
metastases
Assess the indications for using hypofractionation
Compare tissues that respond to single fraction
radiosurgery versus hypofractionation
Describe the onset, clinical manifestations and risks
for developing radionecrosis
Collaborate on the management of post radiationrelated
edema
Understand the effect of lesion size on the choice
of IMRT, single fraction radiosurgery and multi
staging radiosurgery
Describe common radiotherapeutic strategies for:
· meningiomas of the convexity, cavernous
sinus, dural sinuses
· metastases to the brain and spine
· gliomas – supratentorial and brainstem
· trigeminal neuralgia
· pituitary adenomas
· acoustic neuromas
· arteriovenous malformation (AVM)
Differentiate radionecrosis from recurrent tumor on
magnetic resonance imaging (MRI), positron
emission tomography (PET), and single-photon
emission computerized tomography (SPECT)
studies
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Interact with radiation oncologists, oncologists and neurosurgeons in an interdisciplinary approach to treat
patients with complex neuro-oncologic diseases.
Attend national conferences where the indications and various approaches to use of radiotherapeutics are
discussed.
Plan and treat under guidance of radiation oncologists, radiation physicists and neurosurgeons the
delivery of radiosurgery or radiotherapy.
Resident Assessment
Oral boards
Written boards
Annual in-service exams
Resources
Local / regional linac, IMRT, Cyberknife, Gamma Knife facilities and the staff who manage and use these
devices
Hall EJ, Brenner DJ. The radiobiology of radiosurgery: rationale for different treatment regimens for
AVMs and malignancies. Int. J. Radiat. Oncol. Biol. Phys. 1993: 25: 381-385.
Mehta MP. The physical, biologic, and clinical basis of radiosurgery. in: Current problems in cancer. 5th
edition, Vol. XIX, 1995.
American College of Osteopathic Surgeons
Neurological Surgery Residency
Neurosciences:
Neuroradiology
Developed by:
Ajeet Gordhan, M.D.; Keith Kattner, D.O.,
FACOS; Javed Siddiqi, HBSc, M.D., Ph.D.,
FRCSC; Dan Miulli D.O., FACOS
Resident Competencies
Ø Osteopathic Principles and Practices
Ø Patient Care
Ø Medical Knowledge
Ø Practice-Based Learning and Improvement
Ø Interpersonal and Communication Skills
Ø Professionalism
Ø Systems-Based Practice
Prerequisites
Prior to entering a neurological surgical residency, the resident should:
· Relate neurological anatomy to imaging studies
· Understand the basic physics of magnetic imaging, computed tomography, and plain films
· Know the “gold standard” imaging for various neurological diseases
Learning Outcomes
Upon completion of the neurological surgery residency, the resident will:
· Recognize the appropriate imaging based on functional neuroanatomy findings
· Interpret magnetic resonance imaging (MRI), computed tomography (CT), and routine x-rays of the
brain and spinal column
· Determine the appropriate imaging to best diagnose neurological diseases
· Develop a treatment strategy based upon imaging findings and correlate imaging to surgical
techniques
· Utilize endovascular techniques in treating neurovascular disorders
Phase I: Performance Indicators Phase II: Performance Indicators
Cognitive
Identify normal neuroanatomical structures on
magnetic resonance imaging, computer
tomography, and x-rays
Evaluate the limitations, sensitivity, and specificity
and potential complications to intravenous contrast
agents and discuss their management
Plan the use of endovascular techniques to treat
various neurovascular diseases
Diagnose traumatic pathology to the nervous
system during trauma resuscitation by means of CT
scans and plain x-rays
Describe the plan for endovascular techniques to
treat various neurovascular diseases
Diagnose traumatic pathology to the nervous
system during trauma resuscitation by means of CT
scans and plain x-rays
Describe precautions that should be taken when
performing radiographic evaluations
Describe the use of myelogram in the treatment of
spinal disease
Identify diseased neuroanatomical structures on
magnetic resonance imaging (MRI), computer
tomography, cerebral angiogram, SPECT, PET,
spectroscopy, functional imaging and x-rays
Describe the concepts of ultrasonography
Identify the spine fractures on routine x-rays and
CT scan
Describe the findings of normal and abnormal
carotid ultrasound
Distinguish the various stages of intracranial
hematomas on MRI and CT scan
Cognitive
Distinguish the findings of normal and abnormal
neonatal cranial ultrasound
Use of transcrania l Doppler ultrasonography in the
management of patients with subarachnoid
hemorrhage, trauma, and occlusive vascular
disease, brain death, and the significance of
velocity changes and Lindergaard ratio
Diagnose brain and spine tumors using MRI and
CT scan
Use diffuse weighted imaging and perfusion
scanning to identify early ischemic stroke
Use MR spectroscopy and PET scan to distinguish
brain tumors
Interpret MRI, CT angiography, and standard
angiography to diagnose aneurysms and
malformations
Diagnose vasospasm with transcranial Doppler
Determine specific pituitary, brain, spine, and skull
base tumors based on characteristics in imaging
Discuss the indications and technique of
discography, epidural steroids, diagnostic selective
nerve root blocks, facet blocks
Discuss the indications and technique for
percutaneous vertebroplasty
Technical
Use image guidance to resect brain and pituitary
tumors
Use image guidance in placing instrumentation in
the spine
Assist in the treatment of neurovascular diseases
with endovascular techniques
Perform provocative discography to diagnose
discogenic disease
Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)
Resident Assessment
Written exams and slide/photograph identifications
Quarterly evaluations, case review, focused chart review, lecture attendance
Oral boards
Written boards
Annual In-service exams
Resources
Osborn, AG, Maack, J. Diagnostic Neuroradiology. CV Mosby Publishers, 1994