Stereotactic and Functional Fellowship Program Curriculum

Fellows are expected to learn the basics of patient assessment and EEG interpretation and spend dedicated time in the neurology epilepsy clinic to master the knowledge of medical management and when surgical intervention should be considered. They play an integral role in epilepsy conference discussions, where decisions about phase II monitoring and surgical interventions are made. They learn an algorithm for surgical diagnosis and intervention in epilepsy and apply it to presented cases. Finally, they master a variety of surgical cases including vagal nerve stimulation (VNS) placement and revision, cortical grid implantation and monitoring, SEEG, open resection (temporal lobectomy/selective amygdalohippocampectomy) of lesional and non-lesional epilepsies, laser ablation for epilepsy and cranial neuromodulation including Deep Brain Stimulation (DBS) and Responsive Neurostimulation (RNS). 

Fellows spend independent time with the anesthesia pain service to learn the basics of pain management and to see the context of the surgical interventions that can be offered. They attend monthly complex pain conferences to discuss treatment options for specific patients. Finally, they learn to master a rich variety of surgical techniques for pain management: percutaneous spinal cord stimulation (SCS) placement for trial and permanent implants, epidural SCS placement, open and percutaneous cordotomy techniques, thoracic midline myelotomy for visceral pain, DREZ procedure, thalamic sensory DBS for pain and cingulotomy for chronic cancer pain. They also learn a variety of techniques for treating trigeminal neuralgia including microvascular decompression, balloon rhizotomy, radiofrequency lesioning, radiosurgery and Nucleus Caudalis DREZ. Emphasis is placed on achieving a refined knowledge of pain mechanisms and the appropriate application of surgical procedures to different pain locations and causes. 

Fellows develop a mastery of the diagnosis, medical management and surgical indications for Parkinson's disease, essential tremor and dystonia. They become an expert in the surgical selection process including detailed knowledge of potential DBS and lesional targets and the subtleties that recommend one target over another in specific cases. They spend dedicated time in the movement disorders clinic to gain this expertise. They build a thorough knowledge of movement disorders surgery including stereotactic planning, the application of different stereotactic framed and frameless techniques and the use of intraoperative microelectrode recording neurophysiology and stimulation mapping to optimize lesions or DBS placement.

Fellows participate fully in the evaluation of patients in the outpatient clinic and learn all aspects of surgical treatments. This experience is complemented by a weekly series of teaching rounds and numerous interactions with visiting and partnered leading scientists with whom we collaborate from around world.

Clinical Duties

• Assist in the pre-operative, intra-operative and post-operative care of patients.
• Assist in the clinic, ward and didactic teaching responsibilities.
• Take general neurosurgery call in the role of an attending.
• Participate in the teaching of residents, medical students and nurses.

Fellows are welcome to discuss specific research interests with us prior to the start of their fellowship. In the first month of the fellowship, fellows are given the opportunity to explore available research projects both within our functional neurosurgery program and broadly throughout the medical center, including our many collaborating labs and other potential researchers. At the end of the first month Fellows identify, consulting with supervising faculty, one to two projects to serve as the focus of their research for the year. They create a rough timetable for the literature review, experimental design, data collection and analysis and manuscript production. Fellows have ample time each week to pursue research during non-surgery days or those times when faculty are engaged in other surgeries (e.g. trauma call, etc.). The expected goal is to have a body of research that can be presented at a national or international meeting and will be ready for publication by the end of the fellowship year. Fellows have a more in-depth scientific experience in the second year of fellowship, while the first year is dedicated to research.

Fellows actively participate in monthly or bi-weekly clinical conferences in epilepsy, DBS and complex pain. They also regularly attend our weekly Neurocognitive Research Group (NRG) lab meetings, journal club and departmental grand rounds. 

Research Interests of Faculty:

• Cognition and computational neuroscience
• Robotic and remote neurosurgery
• The science of death: What happens in our brain when we die?