In 2009, Mount Sinai neurosurgeons performed 1509 open neurosurgical procedures, approximately 450 of which were spinal surgeries. We performed an additional 200 open neurosurgical procedures with other services such as Orthopedics and ENT, approximately 250 open neurosurgical procedures performed at Elmhurst, and 750 neuroendovascular procedures.
Neurosurgical Intensive Care Unit
Rotating fellows will participate in the management of neurologic and neurosurgical intensive care issues lead by neurointensivists in a multidisciplinary environment. They will participate in the management of the following:
- Intracerebral hemorrhage (ICH) Surgical and medical management including the use of extraventricular drains and increased intracranial pressure (ICP) management, reversal of coagulopathy
- Subarachnoid hemorrhage (SAH) Understanding of early management to prevent rebleeding, seizure prophylaxis, treatment of hydrocephalus, management of vasospasm
- Subdural hemorrhage/Extradural hemorrhage (SDH/EDH) Understanding of ICP management and surgical timing
- Head trauma Understanding of ICP management, surgical options, seizure prophylaxis
- Status epilepticus Understanding of status algorithm, role of cEEG, basic EEG interpretation, evaluation, and prognosis
- Myasthenia gravis Understanding of identifying triggers for crisis, use of pyridostigmine, immunosuppressants, intubation, and weaning strategies
- ICP Understanding medical and surgical management of elevated ICP using ICP algorithm
- Acute stroke
- Use of IV tissue plasminogen activation (TPA)
- Use of IA TPA
- Use of clot retraction devices
Neurosurgical anesthesia fellows will also gain experience with transcranial Doppler, basic EEG interpretation, and Licox/Microdialysis interpretation. Educational experience will also include journal club, participation in the existing critical care lecture series, attendance of existing stroke and neuroradiology conference.
The intraoperative monitoring (IOM) team for Mount Sinai's Department of Neurosurgery, led by Donald Weisz, PhD, is a service which has consistently grown in number and types of cases monitored since its inception. The team performs all types of IOM that are currently in use in the United States, including motor evoked potentials, all modalities of sensory evoked potentials, EMG, compound nerve action potentials, and single unit microelectrode recordings during surgery for implantation of deep brain stimulating electrodes. The networked monitoring system employed by our department enables the recording of excellent neural responses by both technicians and attending neurophysiologists while always under very close supervision by an attending neurophysiologist.
Neuroanesthesia fellows will participate in a two-month intensive course in neuromonitoring including didactic and intraoperative teaching. Didactic activities include:
Intraoperative Neurophysiological Monitoring Mini-Course
The format of this mini-course will include discussion of readings and review of cases. Dr. Weisz will set up reviewing stations in our laboratory and select cases that he feels are particularly useful to demonstrate issues in the interpretation of neurophysiological recordings Fellows will also take on-line course sponsored by the American Society of Electrodiagnostic Technologists.
Procedures for real-time intraoperative neurophysiologic recordings have been refined over the past four decades, and the value of these recordings in improving outcome has been documented for many types of procedures. Because of this work, intraoperative monitoring (IOM) of the nervous system is provided at all major centers in the country.
Mount Sinai Hospital has a dedicated neurosurgical operating suite for performing all of the intracranial surgeries and most of the spinal surgical procedures. Cases include craniotomy for tumor resection and/or vascular malformations, stereotactic guided procedures, functional neurosurgery for Parkinson’s disease patients, dystonic children and adults, transsphenoidal and skull based endoscopic surgery. Spine procedures include tumor, vascular malformations, degenerative disease, and deformity surgery.
Two dual-trained neurosurgeon/interventional radiologists perform aneurysm coiling, carotid stents, and vertebroplasty and kyphoplasty procedures. Additionally we hold a biweekly neuroradiology conference in the mornings.
Irene Osborn, MD
Medical Education &
Fellowship Coordinator Anesthesiology
Department of Anesthesiology
One Gustave L. Levy Place
New York, NY 10029-6574