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Medical Student Curriculum in Neurosurgery

Developed by the CNS Education Committee

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    1. General Skills Topics

      1. The Neurological Examination

        1. Evaluate patient’s mental status and speech.
        2. Examine the cranial nerves.
        3. Examine central and peripheral sensory function.
        4. Examine motor function.
        5. Examine cranial and peripheral reflexes.
        6. Examine cerebellar function and gait.

      2. Fundamentals of Neuro-Imaging

        1. Recognize spine fractures and dislocations.
        2. Differentiate on computerized images between blood, air, fat, CSF, and bone.
        3. Recognize specific disease entities listed below such as epidural, subdural, intracranial hematoma, subarachnoid hemorrhage, brain tumors, and hydrocephalus.

      3. Intracranial hypertension

        1. Understand the pathophysiology of elevated intracranial pressure, cerebral perfusion and the influence of blood pressure, blood gases, and fluid and electrolyte balance.
        2. Recognize the clinical manifestations of acute brain herniation including the Cushing reflex, midbrain effects and vital signs.
        3. Understand the impact of focal mass lesions, structural shifts and their consequences.

    2. Intracranial Disease Topics

      1. Diagnosis and Management of Head Trauma

        1. Understand and assign the Glasgow Coma Score.
        2. Recognize the presentation of brain herniation syndromes in the setting of trauma.
        3. Initiate management of elevated intracranial pressure in head trauma.
        4. Recognize and initiate management of concussion, brain contusion and diffuse axonal injury.
        5. Recognize and initiate management of acute subdural and epidural hematoma, including surgical indications.
        6. Recognize and initiate management of penetrating trauma including gunshot wounds.
        7. Recognize and understand the principles of management of open, closed and basilar skull fractures, including cerebrospinal fluid leak, and chronic subdural hematoma (in children and adults).

      2. Diagnosis and Management of Brain Tumor and Abscess

        1. Know the relative incidence and location of the major types of primary and secondary brain tumors.
        2. Understand the general clinical manifestations (focal deficit and irritations, mass effect; supratentorial vs. infratentorial) of brain tumors.
        3. Recognize specific syndromes: extra-axial (cerebellopontine, pituitary, frontal….) and intra-axial, in brain tumor presentation.
        4. Review the diagnostic tools that are currently used for evaluation (laboratory tests, radiology, biopsy).
        5. Understand broad treatment strategies (surgery, radiosurgery, radiation, and chemotherapy) in the treatment of tumors.
        6. Recognize the clinical manifestations of abscess and focal infections due to local spread, hematogenous disease associated with immune deficiency, and how they differ from the mimic tumors.
        7. Understand the general principles in the treatment of abscess and focal intracranial infections.

      3. Diagnosis and Management of Headaches

        1. Know the major causes of intracranial hemorrhage: vascolopathy in the aged (hypertension and amyloidosis), aneurysm, vascular malformation, tumor and coagolopathy.
        2. Recognize the symptoms and signs of subarachnoid, cerebral and cerebellar hemorrhage.
        3. Apply diagnostic tools in evaluation of acute headache (CT and MRI, role of lumbar puncture).
        4. Understand the natural history and broad treatment strategies (surgery, radiosurgery, interventional radiology as well as treatment of vasospasm) of intracranial aneurysms and vascular malformations.
        5. Differentiate the symptomatology of migraine, cluster, and tension headache and sinusitis headache.

      4. Diagnosis and Management of Ischemic Cerebrovascular Disease

        1. Recognize the symptoms and signs of anterior and posterior circulation ischemia emphasizing carotid disease and contrasting it with hemorrhagic stroke.
        2. Differentiate among the types of ischemic stroke: embolic, hemodynamic, lacunar.
        3. Categorize etiologic factors of brain ischemia including atherosclerosis, cardiac disease, arterial dissection, fibromuscular dysplasia, vascolitis, venous thrombosis and hematologic disease.
        4. Understand the treatment options in ischemic disease and their indications, including medical management, risk factor modification and surgical therapy.
        5. Diagnose and monitor carotid occlusive disease using noninvasive methods and understand indications for angiography and carotid endarterectomy.

    3. Spinal disease

      1. Diagnosis and Management of Spinal Cord Injury

        1. The emergency room diagnosis and interpretation of radiologic studies in spinal trauma.
        2. Initiate acute management of spinal cord injury including immobilization, steroids and systemic measures.
        3. Understand the definition and subsequent management principles of the unstable spine.
        4. Understand management principles in spinal cord injury including indications for decompressive surgery and treatment of the medical complications associated with cord injury (skin, bladder, bowel movement, respiratory).

      2. Diagnosis and Management of Nontraumatic Neck and Back Problems

        1. Diagnose and understand the natural history and management principles of whiplash and soft tissue injury.
        2. Recognize the broad categories of spinal pain and radicolopathy:
        3. The signs and symptoms (including cauda equina syndrome).
        4. Their common causes, their diagnosis and their management (cervical and lumbar disc herniation, osteoarthritic disease, spondylolisthesis).
        5. Their differential diagnosis and management (including metastatic disease and primary spinal tumors).
        6. Recognize the broad categories of myelopathy:
        7. The signs and symptoms (including comparison of acute and chronic spinal cord injury).
        8. The common causes, their diagnosis and their management (cervical and lumbar disc herniation and osteoarthritic disease).
        9. Differential diagnosis and management (including transverse myelopathy, metastatic disease and primary spinal tumors).

    4. Peripheral nerve disease

      1. Diagnosis and Management of Peripheral Nerve Injury and Entrapment

        1. Diagnose traumatic nerve injury (laceration, stretch and compression) and understand indications and general strategies of treatment.
        2. Recognize the signs and symptoms of common nerve entrapment (carpal tunnel syndrome, ulnar nerve entrapment, thoracic outlet syndrome and meralgia paresthetica), their etiology, conservative management strategies and indications for surgical intervention.

    5. Other common neurosurgical problems

      1. Diagnosis and Management of Hydrocephalus and Spinal Dysraphism

        1. Recognize the symptoms and signs of hydrocephalus in children.
        2. Recognize the symptoms and signs of hydrocephalus in adults.
        3. Understand common etiologies of hydrocephalus in children and adults, and differentiate between communicating and obstructive hydrocephalus.
        4. Understand treatment strategies for hydrocephalus.
        5. Recognize common syndromes of spinal dysraphism, their neurologic manifestations and broad principles of management.

      2. Diagnosis and Management of Surgically Treatable Pain Problems, Movement Disorders and Epilepsy

        1. Recognize the features of trigeminal and glossopharyngeal neuralgia, causalgia and cancer pain, indications for surgical referral and the spectrum of surgical therapeutic options.
        2. Recognize movement disorders amenable to surgical intervention, including Parkinson’s disease, dystonia, spasticity, and hemifacial spasm, indications for surgical referral and the spectrum of surgical therapeutic options.
        3. Understand the general classification of seizure disorders, definition of intractable epilepsy, and the broad categories of surgical intervention for epilepsy including invasive electrodes, resective and disconnective surgery.

    6. Review Questions

    7. Review Question Answers