Third-Year Medical Students
Guy M. McKhann II, MD
Christopher J. Winfree, MD
Welcome to Neurosurgery! Your week with us is an educational opportunity that is provided by only about 10 percent of medical schools in this country. We want you to experience the field of neurosurgery, expand your knowledge about the nervous system, and enjoy yourselves.
Those of you destined to become primary care providers will develop a basic knowledge of how neurosurgeons can help with some of medicine’s most common problems, such as back pain and stroke. Those who will eventually choose a medical or surgical subspecialty will learn how neurosurgeons collaborate with a variety of subspecialists to treat complex neurological disorders that demand intensive, multidisciplinary disease management. Those interested in Neurosurgery as a career will finally get to experience an immersive experience within their desired area of study.
During your Neurosurgery week, you will observe and/or assist in neurosurgical operations, participate in daily preceptor meetings, see outpatients in the Neurosurgery Clinic and/or attending offices, and attend Grand Rounds and other academic conferences. You have the option to take one night of call if you so desire. This is a Pass/Fail one-week rotation.
We sincerely hope that you find your experience on the Neurosurgery Service to be rewarding and informative!
Fundamentals of neuroimaging
- Recognize common spine fractures and dislocations.
- Differentiate on computerized images between blood, air, fat, CSF, and bone.
- Distinguish the typical imaging characteristics of epidural hematoma, acute subdural hematoma, chronic subdural hematoma, intracerebral hemorrhage, and subarachnoid hemorrhage.
- Define cerebral perfusion pressure, and explain how it is used in the management of patients with elevated intracranial pressure.
- Describe how blood gases, fluids, and electrolyte balance influence intracranial pressure.
- Describe the clinical manifestations of acute brain herniation, including transtentorial, uncal, and subfalcine herniation syndromes.
Diagnosis and management of ischemic cerebrovascular disease
- Distinguish the symptoms and signs of anterior and posterior circulation ischemia.
- Differentiate the radiographic presentations of the different types of ischemic stroke: embolic, hemodynamic, and lacunar.
- Describe the roles and indications of the following treatment options in ischemic disease: medical management, risk factor modification, and surgical therapy.
Diagnosis and management of nontraumatic neck and back problems
- Define radiculopathy, myelopathy, and cauda equina syndrome.
- Describe the general management of cervical disc herniation, lumbar disc herniation, lumbar instability, and low back pain.
- List the most common examples of extradural, intradural-extramedullary, and intramedullary spine tumors.
Diagnosis and management of peripheral nerve injury and entrapment
- Describe the differences in the management of sharp lacerating injuries, blunt lacerating injuries, gunshot wounds, stretch injuries, compression injuries, and avulsion injuries to peripheral nerves.
- Describe the signs and symptoms of carpal tunnel syndrome and ulnar neuropathy, and outline the surgical indications.
Diagnosis and management of hydrocephalus and spinal dysraphism
- List common symptoms and signs of acute hydrocephalus in children.
- List common symptoms and signs of normal pressure hydrocephalus in adults.
- Define communicating and noncommunicating hydrocephalus and describe the differences in their treatments.
- List two examples each of open and closed spinal dysraphism.
- Describe the principles of management of myelomeningocele.
Diagnosis and management of surgically treatable pain problems, movement disorders, and epilepsy
- Describe the classic presentations of trigeminal neuralgia, failed back surgery syndrome, complex regional pain 2. syndrome 1, and complex regional pain syndrome-
- Describe the differences in indications for spinal cord stimulation versus spinal infusion pump.
- List at least one different surgical treatment each for Parkinson disease, dystonia, spasticity, and hemifacial spasm.
- Define the different types of seizures (simple, partial, etc.).
- Describe the differences between temporal lobectomy, lesionectomy, and disconnective surgery for seizure disorders.
The neurological examination
- Evaluate patient’s mental status and speech.
- Examine the cranial nerves.
- Examine central and peripheral sensory function.
- Examine motor function.
- Examine cranial and peripheral reflexes.
- Examine cerebellar function and gait.
Diagnosis and management of head trauma
- Assign the Glasgow Coma Score.
- Initiate management of elevated intracranial pressure in head trauma.
- Define concussion, brain contusion, and diffuse axonal injury, and initiate management of each.
- Distinguish anatomically and radiographically acute subdural and epidural hematoma, and describe the surgical indications for each.
- Describe the initial management of penetrating high and low-velocity head trauma.
- Describe the management of chronic subdural hematoma.
Diagnosis and management of brain tumor and abscess
- Know the relative incidence and location of the major types of primary and secondary brain tumors.
- Describe the general clinical presentations of brain tumors in the following locations: cerebral hemisphere, cerebellum, brainstem, pituitary, and cerebellopontine angle.
- List the advantages and limitations of the following diagnostic tools used in the evaluation of brain tumors: CT, MRI, MR spectroscopy, and angiography.
- Describe the surgical indications for the most common benign and malignant tumors in the locations listed in #2.
- Describe the indications for and the differences between radiotherapy and radiosurgery in the treatment of malignant brain tumors.
- List the major differences between the diagnosis and management of brain tumor and abscess.
- List the most common etiologies of cerebral abscess.
Diagnosis and management of headache
- Distinguish the radiographic presentation of the major causes of intracranial hemorrhage: hypertensive intracerebral hemorrhage, amyloid intracerebral hemorrhage subarachnoid hemorrhage, arteriovenous malformation hemorrhage, tumor hemorrhage, and coagulopathy hemorrhage.
- Apply the following diagnostic tools in the evaluation of acute headache (CT, MRI, angiogram, and lumbar puncture).
- Describe the broad treatment strategies (surgery, radiosurgery, interventional radiology, as well as treatment of vasospasm) of intracranial aneurysms and vascular malformations.
- Differentiate the symptomatology of migraine, cluster, tension, and sinusitis headache.
- Describe the rapid assessment of a patient with spinal trauma.
- Recognize the common spine fractures on X-ray.
- Initiate acute management of spinal cord injury, including immobilization, steroids, and systemic measures.
- Define the unstable spine.
Interpersonal and Communication Skills
Present a case to your preceptor, including relevant history, neurological examination, imaging findings, and treatment plan.
Participation on the wards
Ask neurosurgical staff (residents, attendings, etc.) questions as appropriate to enhance learning opportunities both in and out of the OR.
- Demonstrate professionalism in the operating room; do not be disruptive, but feel free to participate, including asking questions, reviewing images, pathology, intraoperative findings, etc.
- Demonstrate the level of interest by scrubbing in on cases at the discretion of the resident and attending.
- Attend all scheduled conferences.
- Feel free to participate and ask questions.