Neurosurgery Residency Didactics
Neurosurgery residents spend three months on a neurology rotation in the Mount Sinai Department of Neurology, a highly qualified accredited unit, where they have broad exposure to all types of neurological problems including stroke, trauma, demyelinating and degenerative diseases, peripheral neuropathies and myopathies. EMGs and EEGs are reviewed with the neurology residents and staff.
Neuropathology is taught in regular review sessions as well as during the one-month rotation in The Mount Sinai Department of Pathology. Weekly reviews of the surgical cases are done with the neurosurgery residents, staff, and neuropathology attending of the month. The entire Department of Neurosurgery and Division of Neuropathology attend monthly review conferences.
All neurosurgical operating rooms have equipment for intraoperative monitoring (IOM) which is used to monitor patient’s sensory and motor evoked potentials. Members of our intraoperative monitoring team perform microelectrode recordings of single units in patients with movement disorders who are undergoing surgery for the implantation of deep brain stimulating (DBS) electrodes. The IOM program physicians teach the neurosurgical residents daily in clinical neurophysiology. The IOM program runs a laboratory which functions for basic neurophysiological and neurological studies in which the residents may actively participate.
Neuroradiology is directed by Thomas P. Naidich, MD, a world-renowned expert in clinical and neuroanatomical radiology. Dr. Naidich is assisted by six other full-time neuroradiologists. Each resident has a one month rotation in neuroradiology as well as daily exposure to review sessions. Three mornings weekly, a conference is held for the entire resident and staff group to review all the films of the service. Residents often lead these sessions for more intensive teaching purposes. Dr. Naidich also has a formal lecture series in neuroradiology for the neurosurgery residents which covers the spectrum of neuroradiology. Neuroradiology fellows, six each year, interact very closely with the neurosurgery residents in clinical cases and conferences. Present equipment in Neuroradiology consists in 7 clinical MR scanners equipped for advanced MRI including functional MRI, 8+ advanced CT scanners, dual bi-plane rotational neuroangiographic suites, and 3 in-section sites for advanced post-processing of image data.
More than 60 procedures are performed each month, about half of which are endovascular interventions. The rest are diagnostic cerebral angiograms. Neurosurgical residents at The Mount Sinai Health System are involved in the pre-operative and post-operative daily care of all patients, including those with aneurysms, vascular malformations, spinal malformations, intracranial tumors, spinal tumors and spinal compression fractures, acute cerebral infarction, extracranial carotid stenosis and intracranial cerebral stenosis.
The residents participate in the decision making process about indications for treatment for all endovascular cases. They gain an understanding for carotid angioplasty, stenting, and vertebroplasty, for embolization of aneurysms, AVMs, spinal tumors and spinal vascular malformations as well as treatment for vasospasm and acute ischemic stroke. The endovascular suite is viewed as another operating room. All residents have free access to participating in the endovascular procedures, acting as first assistant in any endovascular or angiographic procedure. All residents now have a dedicated rotation on the endovascular service for a minimum of three months. During this time the residents learn basic skills of cerebral angiography, sharpen their vascular anatomic knowledge and learn the basics of endovascular decision making. For residents who have further interest in this subspecialty, an opportunity exists to spend a year on the diagnostic neuroradiology service in the capacity as a first year fellow to jump start fellowship training in endovascular neurosurgery.
The Neurosurgery Department at the Mount Sinai Health System provides a strong and broad exposure to neurosurgical oncology.
Joshua B. Bederson, MD, leads the Skull Base program. This multi-disciplinary group of neurosurgeons and ENT surgeons offers a new and less invasive form of surgery to patients who require surgery for their skull base tumor. Neurosurgery residents learn the multidisciplinary approach to patients with skull base tumors. Additionally, they are taught the surgical approaches and treatments for skull base surgery, including minimally invasive micro-surgery, endoscopy, and neuro-navigation.
Kalmon D. Post, MD, leads the Pituitary and Parasellar Tumors Treatment Program and is one of the most experienced pituitary surgeons in the world. His multi-disciplinary group of neurosurgeons and endocrinologists specializes in caring for patients with pituitary tumors. The resident will learn advanced surgical and medical treatments for pituitary and parasellar tumors.
Isabelle M. Germano, MD, leads The Mount Sinai Clinical Program for malignant brain tumors. This program provides comprehensive care to patients with central nervous system tumors and with neurological complications of systemic cancer. Intra-operative neuronavigation is used routinely. Brain mapping and awake craniotomy are used when clinically indicated for resection of tumors from eloquent areas.
The Neurosurgery residents participate in the surgical and multi-disciplinary medical treatment of brain primary and secondary brain tumors. They participate in the decision making process of determining when surgery is necessary and what kind of approach to use. They gain understanding in frame-based and frame-less stereotactic tumor biopsies and resections. Residents learn the indication and use of adjuvant brain tumor treatments such as intracavitary and intrathecal chemotherapy and gene therapy. A special emphasis is on put on teaching to focus not only on survival but also on the quality of the patient's life during and after treatment.
Arthur Jenkins, MD, leads the Spine Tumor Program. Complex instrumentation and minimally-invasive procedures are used to treat patients with metastatic spine tumors. Neurosurgery residents participate in the individualized surgical care and are exposed of all spine techniques and technologies to provide state-of-the art care for spine tumor patients.
Functional and Restorative Neurosurgery
The Center for Neuromodulation at Mount Sinai is headed by Brian H. Kopell, MD. The program is focused on the treatment of medically refractory movement disorders with Deep Brain Stimulation (DBS). Sixty to eighty such procedures are performed each year. Vagus Nerve Stimulation (VNS) is also performed for the treatment of generalized epilepsy and chronic depression. Dr. Kopell is pioneering the use of DBS for Obsessive-Compulsive Disorders, Chronic Depression, Tourette Syndrom and Epilepsy. He is also using Motor Cortical Stimulation to enhance motor recovery after stroke and for the treatment of atypical facial pain and secondary dystonia. Programs in neural transplantation and in vivo gene therapy are in their planning stages.
The Neurosurgery residents are involved intimately in the pre- and post-operative daily care of the all inpatients. They participate in the decision making process concerning surgical indications and target selection. They gain an understanding of advanced stereotactic techniques including the use of frame-less DBS lead implants and intra-operative single-cell microelectrode recording. Residents participate in all aspects of the DBS procedures including frame application, surgical planning, patient positioning, and the interpretation of physiological parameters.
The Stereotactic Radiosurgery Service of the Department of Neurosurgery at The Mount Sinai Health System is led by Isabelle M. Germano, MD. This multidisciplinary program provides state-of-the-art minimally invasive comprehensive treatment to patients with brain and spine tumors, in collaboration with the Departments of Radiation Oncology, Medical Physics and the Cancer Center. The program employs the Novalis Shaped Beam Surgery technology allowing delivery of fine-field shaping stereotactic radiation to cranial and extra-cranial nerves.
Neurosurgery residents are involved in the decision making process about indications for potential candidates who can benefit from stereotactic radiosurgery. They are encouraged to participate in the frame placement, treatment planning, treatment administration and clinical and radiographic follow up of these patients as well as in the post treatment care. The patients include those with metastatic brain disease, primary brain tumors, skull base tumors, vascular malformations and trigeminal neuralgia and spine tumors.
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