Junior Level (NS-1 / NS-2)

Cerebrovascular

The junior level resident will be able to:

1. Basic intracranial/extracranial vascular anatomy- Read Osborne's Intro to Angiography or equivalent.
2. Understand basic management of patient with SAH including triple H therapy, BP management, use of TCDs, and indication for angiogram.
3. Understand perioperative management of occlusive disorders.
4. Understand anatomy of exposure for cervical carotid artery
5. Describe principles of pterional craniotomy.
6. Assist in pterional craniotomies for hematoma evacuation and vascular disease.

Neuro-Oncology

The junior level resident will be able to:

1. Describe natural history of tumors and be able to define the roles of biopsy, resection, radiation, and chemotherapy.
2. Describe the management of patients with brain abscess.
3. Describe the perioperative management of patients with pituitary masses.
4. Understand imaging characteristics of various tumors.
5. Understand positioning of patients for craniotomy and assist in opening and closing.

Trauma/Neuro ICU

The junior level resident will be able to:

1. Place A-line, central line, and Swan Ganz catheter.
2. Place ventriculostomy.
3. Perform LPs, lumbar drains, and shunt taps.
4. Be able to detect subtle neurological changes and display a sense of prioritization regarding timing and urgency of medical and surgical management of these patients.
5. Interpret CT scans accurately and recognize operative cases.
6. Discuss principles of resuscitation in polytrauma patients.
7. Understand role of IVFs, pressors, and blood products in CHI and SCI.
8. Manage vent settings in neurotrauma patients.
9. Understand risks/benefits of monitoring devices- jugular bulb, licox, Swan Ganz, etc.
10. Manage coagulopathy, nutrition, and seizures in these patients.
11. Understand principles of management of intracranial hypertension.
12. Understand use of steroids in SCI.
13. Understand use of traction in cervical fractures and perform.

Functional

The junior level resident will be able to:

1. Differentiate the basic categories of pain syndromes and identify the primary indications for stimulation, destructive procedures, microvascular decompression, and intraspinal drug infusions.
2. Assist with pain procedures- epidural blocks, SCS, TN procedures.
3. Place percutaneous electrodes for SCS with supervision.
4. Discuss use of stereotactic v. open biopsy.
5. Place frame for Gamma Knife and fiducials for frameless stereotaxy.

Pediatrics

The junior level resident will be able to:

1. Describe diagnostic approach to patient with suspected shunt malfunction and define how the diagnosis of hydrocephalus is met.
2. Describe and establish differential diagnosis for pediatric tumors.
3. Describe surgical and non-surgical management of spasticity, craniosynostosis, and non-accidental trauma.
4. Understand differences between CHI and spine injury in pediatrics v. adults.
5. Perform shunt taps, shunt injections, and subdural taps.
6. Assist in placements and revisions of VP shunt.
7. Position for intracranial and intraspinal surgery.

Peripheral Nerve

The junior level resident will be able to:

1. Describe symptoms and signs of typical nerve injuries.
2. Distinguish upper and lower motor neuron signs in nerve injury.
3. Assist in decompression of common entrapment syndromes.

Spine

The junior level resident will be able to:

1. Interpret imaging studies in patients with spinal disorders.
2. Review signs and symptoms of radiculopathy, myelopathy, and instability.
3. Position patients for all spine surgeries.
4. Place and manage halo and traction.
5. Perform exposure for a laminectomy and assist with discectomy and decompression.

Middle Level (NS-3 / NS-4):

ICU

The mid-level resident will be able to:

1. Correctly interpret and respond to changes in patient's condition independently while maintaining a clear reporting relationship with faculty.
2. Supervise junior residents in ICU management.
3. Independent management of intracranial hypertension and neurosurgical emergencies.

Cerebrovascular

The mid-level resident will be able to:

1. Perform a pterional craniotomy with supervision with initiation of microsurgical skills.
2. Perform the surgical approach to vascular structures other than via a pterional craniotomy.
3. Understand role of coiling and clipping in aneurysms.
4. Complete an endovascular rotation. Be able to perform an angiogram and assist in coiling/stent procedures.

Neuro-Oncology

The mid-level resident will be able to:

1. Understand the anatomy of the CPA and sella.
2. Explain the rationale and indications for various skull base approaches to anterior, middle, and posterior fossa. Identify landmarks for each approach, including but not limited to transtemporal, retrosigmoid, presigmoid, transpetrosal, transtemporal and transcondylar.
3. Describe the surgical management of frontal sinuses that have been violated.
4. Understand role of embolization of tumors.
5. Understand role of radiosurgery v. open surgery in tumors.
6. Independently determine a differential diagnosis based on history, physical, and imaging studies.
7. Position and perform opening/closing of craniotomies.
8. Assist in resection of neoplasms.

Trauma

The mid-level resident will be able to:

1. Position for and begin emergency procedures.
2. Perform the following surgeries in uncomplicated cases- craniotomy for SDH,EDH,ICH,GSW, depressed fractures and decompressive craniotomy.
3. Perform craniotomy for posterior fossa lesions and simple cranioplasty.
4. Manage trauma-related CSF leaks and infections associated with open CNS injuries

Functional

The mid-level resident will be able to:

1. Explain the roles of ablative brain and brain stem procedures (cingulotomy, mesencephalic tractotomy, trigeminal tractotomy).
2. Explain the roles for spinal ablative lesions (DREZ, cordotomy, myelotomy).
3. Employ Hartel technique in ablative neurolysis of TN.
4. Perform radiosurgery dose planning.
5. Assist in stereotactic craniotomies.

Pediatrics

The mid-level resident will be able to:

1. Understand management of spinal dysraphism.
2. Define and manage slit ventricle syndrome and low pressure hydrocephalus.
3. Discuss differential diagnosis and evaluation of suprasellar masses, pineal masses, and intraventricular masses.
4. Describe perioperative management of seizure surgery patients.
5. Assist in closing a neural tube defect.
6. Assist in Chiari malformation repair.
7. Assist in cranial vault expansion/tethered cord release.

Peripheral Nerve

The mid-level resident will be able to:

1. Discuss uncommon entrapment neuropathies- Guyon's, suprascapular, PIN, AIN, tarsal.
2. Perform a decompression/neurolysis.
3. Position for and expose the brachial plexus.

Spine

The mid-level resident will be able to:

1. Formulate a management plan in spinal disorders regarding anterior v. posterior approaches.
2. Explain options for bone grafts in spinal surgery.
3. Perform exposure for ACDF and assist with discectomy/fusion.
4. Perform cervical foraminotomy.
5. Perform exposure for complex posterior spinal fusions.
6. Perform exposure for tumor removal.
7. Perform vertebroplasty and kyphoplasty.

Senior Level NS-5 / NS-6:

ICU

The senior level resident will be able to:

1. Formulate independent assessments and management plans while reporting to faculty.
2. Supervise junior residents, ancillary personnel and medical students in both ICU and OR.
3. Assign responsibilities to junior residents with the aim of fulfilling their educational objectives.

Cerebrovascular

The senior level resident will be able to:

1. Perform a pterional craniotomy and supervise junior residents in this procedure.
2. Perform microsurgical dissection of the Sylvian fissure and exposure of the basal cisterns for vascular disease.
3. Perform microsurgical exposure and clipping of intracranial aneurysm.
4. Complete the planning, positioning, and execution of a non-pterional craniotomy for IC vascular disease.
5. Assist in microsurgical management of highly complex cerebrovascular disease.
6. Understand and utilize brain protective strategies peri-operatively.
7. Perform craniotomy for intracerebral hematomas.
8. Perform exposure for carotid endarterectomy and control of cervical carotid.
9. Describe exposure and treatment of intraspinal vascular lesions.

Neuro-Oncology

The senior level resident will be able to:

1. Discuss the surgical treatment of CPA tumors, posterior fossa neoplasms, clival lesions, and craniopharyngiomas.
2. Perform resection of supra- and infratentorial intra-axial and extra-axial neoplasms.
3. Perform resection of pituitary lesions.
4. Perform or first assist in complex skull base procedures.

Trauma

The senior level resident will be able to:

1. Perform the following surgeries in uncomplicated and complicated cases- craniotomy for SDH, EDH, ICH, GSW, depressed fractures, posterior fossa lesions. Perform cranioplasty.
2. Lead critical care team and supervise more junior residents with craniotomies.

Functional

The senior level resident will be able to:

1. Distinguish independently the indications for surgical and non-surgical treatment of pain.
2. Describe techniques for exposure of major peripheral nerves and correct placement of lesions for ablative procedures.
3. Perform microvascular decompression.
4. Perform and manage patients with SCS.
5. Assist in DREZ and cordotomy procedures.
6. Perform stereotactic craniotomies.

Pediatrics

The senior level resident will be able to:

1. Perform third ventriculostomies.
2. Close neural tube defects.
3. Repair Chiari malformations.
4. Perform a tethered cord release.
5. Perform temporal lobectomy and vagal nerve stimulator placement.
6. Perform exposure for suprasellar, pineal and intraventricular lesion.
7. Assist in hemispherectomy.

Peripheral Nerve

The senior level resident will be able to:

1. Formulate management for birth brachial plexus injury, acute nerve injury, failed decompression and neuromas.
2. Perform a nerve repair, i.e. neurolysis, intraoperative nerve conductions, placement and suture of nerve graft.
3. Excise a nerve sheath tumor.
4. Expose brachial plexus injury including the intercostal and spinal accessory nerves.

Spine

The senior level resident will be able to:

1. Compare and contrast transthoracic, transpedicular, costotransverse and lateral extracavitary approach to a herniated thoracic disc.
2. Perform fusions at all levels of the spine.
3. Perform removal of a thoracic disc via costotransverse, lateral extracavitary approach.