Clinical Opportunities

In 2015, Mount Sinai neurosurgeons performed 2,027 open neurosurgical procedures and managed 1,253 endovascular cases.

As a fellow in the Neuroanesthesia Fellowship at The Mount Sinai Hospital, you participate in a variety of rotations, including the neurosurgical intensive care unit (ICU), neuroradiology, neuromonitoring, and in the operating room. Rotations occur during designated months:

Neurosurgical Intensive Care Unit

In your neurosurgical ICU rotation, you will participate in the management of neurologic and neurosurgical intensive care issues lead by neurointensivists in a multidisciplinary environment. You will help diagnose and treat:

• Intracerebral hemorrhage, a condition we treat surgically and medically using extraventricular drains, increased intracranial pressure (ICP) management, and reversal of coagulopathy.
• Subarachnoid hemorrhage, which involves early management to prevent rebleeding, seizure prophylaxis, treatment of hydrocephalus, and management of vasospasm.
• Subdural hemorrhage/extradural hemorrhage, a condition that requires understanding ICP management and surgical timing.
• Head trauma, which requires ICP management, surgical options, and seizure prophylaxis.
• Status epilepticus, a condition that necessitates understanding status algorithm; prolonged continuous digital video and electroencephalographic (EEG) monitoring; and basic electroencephalogram interpretation, evaluation, and prognosis.
• Myasthenia gravis, which entails identifying triggers for crisis; use of pyridostigmine, immunosuppressants, and intubation; and weaning strategies.
• ICP, which requires understanding medical and surgical management of elevated intracranial pressure using ICP algorithm.
• Acute stroke, which involves use of intravenous tissue plasminogen activation, intra-arterial plasminogen activator, and clot retraction devices.

You will also gain experience with transcranial Doppler, basic EEG interpretation, and Licox/Microdialysis interpretation. Didactic experiences include our journal club, critical care lecture series, and stroke and neuroradiology conferences.

Neuromonitoring

In the two-month neuromonitoring rotation, you will participate on the intraoperative monitoring (IOM) team for Mount Sinai's Department of Neurosurgery led by Donald Weisz, PhD. This team performs all types of IOM currently in use in the United States, including motor-evoked potentials, all modalities of sensory-evoked potentials, electromyography, compound nerve action potentials, and single unit microelectrode recordings during surgery for implantation of deep brain stimulating electrodes. The networked monitoring system enables both technicians and attending neurophysiologists to record excellent neural responses, always under close supervision by an attending neurophysiologist.

You will also participate in a two-month intensive course in neuromonitoring, including didactic and intraoperative teaching. Our Intraoperative Neurophysiological Monitoring Mini-Course entails discussing readings and case reviews. Dr. Weisz will set up reviewing stations in our laboratory and select cases that are particularly useful to demonstrate issues in the interpretation of neurophysiological recordings. In addition, you will take an online course sponsored by the American Society of Electrodiagnostic Technologists.

Operating theater

A large part of the fellowship, the operating theater rotation enables you to become part of our dedicated neurosurgical operating suite. You will participate in cases such as craniotomy for tumor resection and vascular malformations, stereotactic guided procedures, functional neurosurgery for Parkinson’s disease patients, dystonic children and adults, and transsphenoidal and skull base endoscopic surgery. Spine procedures include tumor, vascular malformations, degenerative disease, and deformity surgery.

Neuroradiology

In this one-month neuroradiology rotation, you will work with our two dual-trained neurosurgeon/interventional radiologists. You will be able to observe and perform aneurysm coiling, carotid stents, and vertebroplasty and kyphoplasty procedures. Additionally, you will attend our biweekly neuroradiology conferences.