Development of professional collaboration is an important component of surgical training. When

considering the broad realm of patient care, both within and outside the operating room, the surgeon must

understand and be able to use specific concepts and skills related to neurosciences and specialties

including anatomy, neurology, pathology, pharmacology, physiology, radiation physiology, and

radiology.

Integration of the neurosciences and associated specialties by the neurosurgery resident into all aspects of

practice will enhance his or her ability to appropriately diagnose, organize a management plan, perform

necessary surgical procedures, and care for the postoperative surgical patient in the short and long term.

Neurosurgery residents learn neuroscience concepts and skills on all clinical rotations and in didactic

settings. Knowledge and skills are assessed informally and on a daily basis by faculty and attending

surgeons as well as formally. Since these neurosciences and associated specialties are part of a core

curriculum related to each and every principal surgical area, they are grouped together and not repeated in

separate surgical areas.

Steve Schneider, M.D.

Stephen J. Eichert, D.O., FACOS

Prior to entering a neurological surgery residency, the resident should:

system

Upon completion of the neurosurgery residency, the resident will:

practice of neurological surgery

Embryology

Analyze the embryological development of the brain,

cerebellum, brain stem, glial elements, spinal cord,

conus medullaris, cauda equina, sympathetic and

parasympathetic systems and the peripheral nervous

system

Analyze the embryologic development of the skull,

craniovertebral junction, and spine

Histology

Describe and differentiate the types of neurons

Understand the microanatomy of the neuron including

the cell body, dendritic process and axonal process

Diagram and describe the microanatomy of the synapse

Identify the microglial elements and their microanatomy

Describe the anatomical basis for the blood brain barrier

Vascular Anatomy

Diagram and describe the carotid and vertebral arteries

and their branches which provide blood supply to the

face, scalp, skull, meninges, brain, brain stem,

cerebellum, and rostral spinal cord

Describe the arterial blood supply to the spinal cord

including the spinal and radicular arteries and explain

the concept of watershed ischemia

Identify the venous drainage of the central nervous

system

Osseous Anatomy

Identify the bones and sutures of the skull

Identify each named foramen of the skull and list its

contents

Extracerebral Anatomy

Describe the anatomy of the meninges including the

dura mater, arachnoid mater, pia mater

Describe the anatomy of the dura including the falx

cerebri and tentorium

Discuss the clinical presentation in anatomical

terms of syndromes of the brain and its

coverings

Discuss the syndromes produced by mass

lesions affecting the cranial nerves

Predict the expected effects of stroke or mass

lesion at different locations within the brain

stem and cerebellum

Predict the expected effects of destructive

lesions in the basal ganglia and cerebellum

Predict the expected effects of ischemic or

destructive lesions of the white matter tracts

of the cerebellum

Predict the expected effect of destructive

lesions of specific regions of the cerebral

cortex

Recognize the clinical presentation of strokes

in the distribution of the supratentorial

cerebral blood vessels

Describe the relationship of the spinal nerves

to the vertebral level of exit

Diagram the structures comprising the

boundaries of the spinal neural foramina

Recognize the clinical manifestation of injury

for each of the major peripheral nerves

Describe the anatomy and presentation of

common entrapment syndromes of peripheral

nerves

Describe the surgical exposure of common

peripheral nerve entrapments

Recognize the clinical presentation and

neurological deficits associated with common

lesions of and injuries to the spinal cord and

nerve roots

Identify the layers of the scalp and discuss scalp

innervation

Diagram the cerebral ventricles

Describe the major arachnoid cisterns and the anatomy

of the arachnoid villi

Analyze the anatomic correlates pertinent to the

production, flow, and reabsorption of cerebrospinal fluid

Spinal Anatomy

Identify and describe the gross anatomy of the spine

Identify the muscles related to the skull and spine

including suboccipital, anterior cervical, and posterior

cervical

Describe the gross anatomy of the neck

Central Nervous System

Describe the anatomy of cerebrum, cerebellum,

olfactory pathways, hippocampal formation, and

amygdala

Describe the anatomy of the corpus striatum

Describe the anatomy of the hypothalmus and pituitary

Describe the anatomy of the diencephalons and

mesencephalon

Identify the location and connections of each cranial

nerve nuclei

Trace the course of each cranial nerve from nucleus to

end organ termination.

Describe the external topography and landmarks of the

fourth ventricle

Describe the anatomy of the brain stem including pons

and medulla

Describe the anatomy of the spinal cord

Autonomic Nervous System

Distinguish pre- and postganglionic neurons

Describe the sympathetic nervous system and the

Identify at the time of surgery structures

visible in the lateral ventricles and understand

the flow of cerebrospinal fluid (CSF) through:

parasympathetic nervous system

Identify the visceral afferent fibers

Describe the structure of the autonomic ganglia and the

central autonomic pathways

Peripheral Nervous System

Differentiate between segmental and peripheral

innervation

Diagram the anatomy of the spinal nerve root

Diagram and discuss the cervical, brachial, and

lumbosacral plexi

Outline the anatomy of the major peripheral nerves of

the upper and lower extremities

Describe the microanatomy of the peripheral nerves

Compare myelinated and unmyelinated nerves

Describe the anatomy of the Schwann cell

Identify the peripheral afferent receptors and describe

the anatomy of each

Segregate peripheral neurons by size and explain the

rationale for such a classification scheme

Muscle

Explain the concept of the motor unit and describe the

anatomy of the motor end plate

Compare the microscopic anatomy of striated and

smooth muscle

Describe the subcellular components of muscle

Identify the parts of the vertebral column,

spinal cord, and nerve roots at the time of

surgery

Identify at the time of surgery:

fourth ventricle

Adapted from the American Association of Neurological Surgeons/Congress of Neurological Surgeons

Neurosurgery Residency Curriculum Guide

7

Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)

Written exams and slide/photograph identifications

Quarterly evaluations, case review, focused chart review, lecture attendance

Oral boards

Written boards

Annual In-service exams

8

Stephen E. Eichert, D.O., FACOS; Dan Miulli,

Ph.D., FRCSC

Prior to entering a neurological surgery residency, the resident should:

and developmental

Upon completion of the neurosurgery residency the resident will:

precisely locate lesions within the nervous system

naturalization of a neurological disorder occurring in any specific patient

9

Stroke

Understand and recognize the major causes of stroke

Compare the differences between hemorrhage

infraction and primary hemorrhage

Identify the appropriate diagnostic studies to support

the clinical impression of stroke

Select the appropriate therapeutic maneuvers for

effecting treatment of stroke in individual patients and

categories of patients

Educate patients and families about the risks of

recurrences and appropriate prophylactic measures

Localize affected area based on clinical presentation

Describe the etiology, pathogenesis, clinical

presentation, radiologic evaluation, clinical evaluation,

and management of the following:

Identify the primary causes of stroke in the pediatric

population

Meningitis and Encephalitis

Recognize bacterial and viral meningitis

Order appropriate laboratory and diagnostic studies in

patients with meningit is

Appropriately use antibiotics in meningitis

Describe the clinical manifestations of viral

encephalitis

Define the major viral causes of encephalitis

Describe the major magnetic resonance imaging (MRI)

and computerized tomography (CT) findings in

encephalitis

Oncology

Recognize the clinical presentation of patients

with mass lesions including intraaxial

supratentorial, extraaxial supratentorial,

intraaxial intracerebellar, extraaxial

intratentorial, intraaxial brain stem

Develop a differential diagnosis based on

location of the lesion, patient age, and

associated medical condition

Explain the role of corticosteroids in patients

with cerebral and spinal cord masses

Define the cerebrocutaneous syndrome and

their neoplastic accompaniments:

Explain the major sources of metastatic

carcinoma to the brain

Identify and describe the clinical

manifestations and laboratory investigations of

the remote effects of cancer:

Acquired Immune Deficiency Syndrome

(AIDS)

Understand the manifestations of AIDS

encephalopathy

Establish the differential diagnosis and

understand the respective radiologic

presentation of mass lesions in patients with

AIDS

Describe the pathology and the clinical picture

of AIDS myelopathy

Identify the clinical indicators for nerve biopsy

10

Define the electro encephalogram (EEG) findings

peculiar to herpes encephalitic and Jacob–Kreatzfold

disease

Describe the clinical presentation of

polioencephalomyelitis

Disorders of CSF:

Describe the diagnosis and management of

pseudotumor cerebri

Describe the diagnosis and management of normal

pressure hydrocephalus

Cerebral & Epidural Abscess

Define the routes of infection including direct

extensions, post traumatic, and hematogenous

Explain the expectations of organisms including

bacterial, fungal, and parasitic

Use the indictions for surgical interevention

Prescribe appropriate antibiotics

Explain paradoxic embolization in the context of

cerebral abscess and hematogenous dissemination

Define neurosarcoidosis and its systemic

accompaniments

Explain the expected clinical presentation, diagnostic

adjuncts and prognosis of neurosarcoidosis

Trauma

Compare concussive cerebral injuries from classic

concussion to diffuse axonal injury (DAI)

Explain the expected radiographic findings in

concussion and DAI

Plan treatment in concussion and DAI

Describe the anatomic considerations, the clinical

presentation, and treatment for epidural hematoma and

acute subdural hematoma

Explain the role of secondary injury following acute

head injury inclu ding anoxia, ischemia, metabolic

insult

in patients with AIDS

Major Disorders

Categorize, define, and explain the clinical

presentation and the pathophysiology of the

major degenerative disorders

Define the clinical presentations, relevant

diagnostic studies, the therapeutic measures,

and prognostic indicators in the major

autoimmune disorders of the nervous system:

Understand the various movement disorders

and their associated clinical manifestations

Recognize the major peripheral neuropathies in

clinical practice

Analyze the role of alcohol in disease of the

nervous system

Understand the pathophysiology, clinical

presentation, diagnosis, treatment, and

prognosis various muscular disorders

Distinguish the major cerebral degenerative

disorders of childhood

Describe the neurological manifestations of

each of the major storage disorders

Define the major categories of headache, their

presentation, relevant diagnostic studies and

treatment

Define the major categories of epilepsy, their

presentation and treatment as well as relevant

diagnostic studies

11

Compare cerebral contusion and delayed cerebral

parenchymal hemorrhage based on their clinical and

radiographic presentations; plan treatment for both

Define the anatomic considerations, the clinical and

radiographic appearance, and treatment for chronic

subdural hematoma

Identify the cause of subdural hematoma and rate of

reoccurrence

Explain Kernohan’s Notch

Counsel families of patients about treatment and

prognoses in acute head injury

Spine Trauma

Use a directed neurologic examination for patients with

acute and subacute spine trauma

Compare acute injury clinical presentations including

spinal shock, Brown-Sequard Syndrome, central cord

syndrome, and cauda equina syndrome

Identify the spinal level of injury based on physical

examination

Distinguish between acute polyneuropathyies and

myelopathy

Diagnostic Testing and Monitoring

Understand the indications, pathologic changes,

how test is performed, diagnostic use of the

following:

Perform lumbar puncture and differentiate among viral

meningitis, bacterial meningitis, and encephalitis based

on the result of the lumbar puncture

Define status epilepticus, its causes,

pathophysiology, clinical presentation,

diagnostic studies and treatment

Delirium and Dementia

Define delirium and dementia. List the

differential diagnoses for each

Describe coma and altered states of

consciousness and measure patient status using

the Glasgow Coma Scale

Evaluate a patient with syncope

13

Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)

Written exams and slide/photograph identifications

Quarterly evaluations, case review, focused chart review, lecture attendance

Oral boards

Written boards

Annual In-service exams

14

Stephen E. Eichert, D.O., FACOS; Dan

Miulli, D.O., FACOS; Javed Siddiqi, HBSc,

M.D., Ph.D., FRCSC

Prior to entering neurological surgery residency, the resident should:

disease

Upon completion of a neurological surgery residency, the resident will:

processes

individual patients

Understand CSF physiology as it relates to communicating hydrocephalus, non-communicating

hydrocephalus, benign intracranial hypertension, and cerebral herniation

Compare intracranial pressure volume relationships in the context of trauma, intracerebral and

subarachnoid hemorrhage, cerebral neoplasm, and cerebral herniation

Explain cerebral blood flow (CBF) in trauma, cerebral herniation, cerebral hemorrhage, and ischemic

cerebral vascular disease & subarachnoid hemorrhage

Compare the effects of ischemia, hypoxemia, trauma, cerebral hemorrhage and tumors on cerebral

autoregulation

Describe the effect of seizures on cerebral blo od flow and cerebral autoregulation

Explain fluid and electrolyte disorders as they relate to central nervous system disorders including

syndrome of inappropriate antidiuretic hormone secretion (SIADH), diabetes insidious, and cerebral salt

wasting

Describe the major developmental anomalies, their recognition, origin and treatment

Explain the major theories of development, the clinical presentation and the path physiology of cerebral

aneurysms, capillary telangiectasias, artero-venous malfunctions, cavernous hemangiomas, venous

angiomas

Describe the major theories and pathophysiology of cerebral vasospasm in relation to subarachnoid

hemorrhage

Differentiate cytotoxic edema, vasogenic edema, interstitial edema and congestive brain swelling

Describe the etiology, pathophys iology and clinical presentations of ischemic cerebral infraction,

ischemic cerebral infraction and secondary hemorrhage, primary intracerebral hemorrhage and venous

occlusion

Compare the pathophysiology of ischemic and hypoxic brain injury

Differentiate the pathophysiology of indirect brain injuries including cerebral concussion, diffuse axonal

injury, and acute subdural hemtoma

Differentiate secondary brain injuries including ischemic brain injury, cerebral herniation, contusional

hemorrhage, posttraumatic swelling, and posttraumatic edema

Analyze the pathophysiology, the clinical presentations and the etiology of reoccurrence in the chronic

subdural hematoma

Understand the pathophysiology of penetrating brain injury

Compare the pathophysiology and radiologic correlates of primary and secondary spinal cord injury

Differentiate the clinical presentation of and pathologic progression of spinal shock, Brown-Séquard

syndrome, anterior spinal syndrome, central cord syndrome, Guillain-Barré syndrome, and Tabes Dorsalis

Understand the cell rest and field theories in the development of tumors of the nervous system

Explain the nature of local invasion of glial neoplasm and the structures of Scherer

Define the peaks of occurrence, locations, clinical presentations, histologic , cytologic and where relevant

immunologic characteristics of primary glial neoplasm’s including:

Define the peaks of occurrence, locations, clinical presentation, development, histologic and cytologic

characteristics of:

Differentiate the accepted grading systems for glial neoplasms based on rationale: World Health

Orgniazation (WHO,) Kernahan, Danmas–Duport, Buerger

Compare of the pathophysiology and clinical correlates of carcinoma that is metastatic to the nervous

system by type: parenchymal, leptomeningeal, epidural

Explain the pathophysiology of paraneopla stic nervous system diseases

Describe the laboratory, clinical, histologic, cytologic and immunologic abnormalities found in

association with pituitary adenomas

Describe the laboratory studies indicative of the cause of hormone-secreting pituitary adenomas including

prolactinomas, Cushings syndrome, and acromegaly

Describe the clinical presentation, radiographic picture, genetics and pathologic manifestations of the

neurocutaneorus syndromes:

Explain the clinical presentation, laboratory abnormalities, pathophysiology and possible sequellae of:

Differentiate the types of cerebral abscesses (bacterial, fungal, tuberculosis, sarcoid, parasitic) based on

the clinical presentation, pathophysiology, radiographic presentation and give the rationale for treatment

Discuss the clinical presentation and the pathologic correlates of AIDS as the well as associated infections

and neoplastic entitles as the affect the nervous system

Compare the pathophysiology and clinical presentation of demyelinating disorders of the nervous system

such as multiple sclerosis and central pontine myelinolysis

Describe the clinical and pathologic abnormalities in vitamin deficiency diseases of the central nervous

system including subacute combined degeneration, Wernicke’s encephalopathy, and Korsakoff’s

psychosis

Describe the clinical presentation and the pathologic substrate of the major degenerative central nervous

system disorders:

Describe the use of electron microscopy, and Nuclear Magnetic Resonance (NMR) spectroscopy as it

pertains to neurological disease

Perform basic preparation, frozen sectioning and microscopic identification of nervous tissue.

Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)

Written exams and slide/photograph identifications

Quarterly evaluations, case review, focused chart review, lecture attendance

Oral boards

Written boards

Annual In-service exams

Lecture and slide material from Loyola University Medical center, Department of Pathology, Section of

Neuropathology

Javed Siddiqi, HBSc, M.D., Ph.D., FRCSC;

Dan Miulli, D.O., FACOS; Keith Kattner,

D.O., FACOS

Prior to entering a neurological surgery residency, the resident should:

Upon completion of the neurological surgery residency, the resident will:

diseases which affect the nervous system

Describe basic cellular neurotransmission including;

Classify and identify receptors and receptor pharmacodynamics including:

Classify the neurotransmitter acetylcholine including:

Analyze the catecholamine neurotransmitters (norepinephrine and dopamine) including:

Analyze the neurotransmitter serotonin including:

Analyze the neurotransmitter glutamate including:

and subunits

Analyze the peptide neurotransmitters

Evaluate the pharmacology of each of the drugs used to treat neurological disorders

Prescribe medication appropriately for nervous system diseases

Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)

Written exams and slide/photograph identifications

Quarterly evaluations, case review, focused chart review, lecture attendance

Oral boards

Written boards

Annual In-service exams

Javed Siddiqi, HBSc, M.D., Ph.D., FRCSC;

Dan Miulli, D.O., FACOS; Keith Kattner,

D.O., FACOS

Prior to entering a neurological surgery residency, the resident should:

homeostasis and repair

Upon completion of the neurological surgery residency, the resident will:

Describe synaptic transmissions including:

Describe the physiology of the sensory systems including:

Describe the physiology of the motor system including:

Compare the attributes of the autonomic nervous system including both the sympathetic and

parasympathetic systems

Analyze the physiological basis of arousal and emotion, including:

Describe the higher cortical functions including:

Describe the physiological basis for cerebrospinal fluid production and re-absorption

Review the physiological control of the cerebral vasculature

Discuss the physiology of the hypothalmus and pituitary, particularly as related to endocrinology

Analyze the physiological dynamics of cerebral blood flow

Properly interpret tests of both global and regional blood flow:

Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)

Review the basic physiological sciences through attendance at board review courses

Participate in laboratory research projects

Develop knowledge of physiological testing through a dedicated neurology rotation

Attend courses focused on intraoperative physiological monitoring

Written exams and slide/photograph identifications

Quarterly evaluations, case review, focused chart review, lecture attendance

Oral boards

Written boards

Annual In-service exams

Intraoperative Monitoring: Basics and Performance Issues. American Society of Electroneurodiagnostic

Technologists, 2001.

Will Beringer D.O.; Keith Kattner D.O.,

FACOS, Javed Siddiqi, HBSc, M.D., Ph.D.,

FRCSC; Dan Miulli, DO, FACOS

Improvement

brain, linac, gamma knife, cyberknife, intensity-modulated radiation therapy (IMRT)

tissues

acid (DNA) repairing capabilities following radiation injury

Upon completion of the neurological surgical residency, the resident will:

lesions

radiation physicists and oncologists

the risks, benefits and goals of radiotherapeutics in the treatment of neurosurgical lesions

Differentiate treatment options for meningiomas,

gliomas, metastases, spinal cord tumors,

arteriovenous malformations (AVM), acoustic

neuromas, trigeminal neuralgia

Differentiate external beam radiotherapy from

stereotactic radiosurgery

Describe differences among linear accelerator

system (LINAC), GammaKnife, Cyberknife and

intensity-modulated radiation therapy (IMRT)

devices

Describe photon beam therapy

Describe the concept of brachytherapy

Explain why children are more susceptible to

radiation injury than adults

Analyze late responding and early responding

tissues & lesions and relate to different alpha / beta

ratios

Differentiate between intensity-modulated radiation

therapy (IMRT) and Cyberknife

Assess the indications for use of whole brain

radiotherapy in the management of brain

metastases

Assess the indications for using hypofractionation

Compare tissues that respond to single fraction

radiosurgery versus hypofractionation

Describe the onset, clinical manifestations and risks

for developing radionecrosis

Collaborate on the management of post radiationrelated

edema

Understand the effect of lesion size on the choice

of IMRT, single fraction radiosurgery and multi

staging radiosurgery

Describe common radiotherapeutic strategies for:

sinus, dural sinuses

Differentiate radionecrosis from recurrent tumor on

magnetic resonance imaging (MRI), positron

emission tomography (PET), and single-photon

emission computerized tomography (SPECT)

studies

Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)

Interact with radiation oncologists, oncologists and neurosurgeons in an interdisciplinary approach to treat

patients with complex neuro-oncologic diseases.

Attend national conferences where the indications and various approaches to use of radiotherapeutics are

discussed.

Plan and treat under guidance of radiation oncologists, radiation physicists and neurosurgeons the

delivery of radiosurgery or radiotherapy.

Oral boards

Written boards

Annual in-service exams

Local / regional linac, IMRT, Cyberknife, Gamma Knife facilities and the staff who manage and use these

devices

Hall EJ, Brenner DJ. The radiobiology of radiosurgery: rationale for different treatment regimens for

edition, Vol. XIX, 1995.

Ajeet Gordhan, M.D.; Keith Kattner, D.O.,

FACOS; Javed Siddiqi, HBSc, M.D., Ph.D.,

FRCSC; Dan Miulli D.O., FACOS

Prior to entering a neurological surgical residency, the resident should:

Upon completion of the neurological surgery residency, the resident will:

brain and spinal column

techniques

Identify normal neuroanatomical structures on

magnetic resonance imaging, computer

tomography, and x-rays

Evaluate the limitations, sensitivity, and specificity

and potential complications to intravenous contrast

agents and discuss their management

Plan the use of endovascular techniques to treat

various neurovascular diseases

Diagnose traumatic pathology to the nervous

system during trauma resuscitation by means of CT

scans and plain x-rays

Describe the plan for endovascular techniques to

treat various neurovascular diseases

Diagnose traumatic pathology to the nervous

system during trauma resuscitation by means of CT

scans and plain x-rays

Describe precautions that should be taken when

performing radiographic evaluations

Describe the use of myelogram in the treatment of

spinal disease

Identify diseased neuroanatomical structures on

magnetic resonance imaging (MRI), computer

tomography, cerebral angiogram, SPECT, PET,

spectroscopy, functional imaging and x-rays

Describe the concepts of ultrasonography

Identify the spine fractures on routine x-rays and

CT scan

Describe the findings of normal and abnormal

carotid ultrasound

Distinguish the various stages of intracranial

hematomas on MRI and CT scan

Distinguish the findings of normal and abnormal

neonatal cranial ultrasound

Use of transcrania l Doppler ultrasonography in the

management of patients with subarachnoid

hemorrhage, trauma, and occlusive vascular

disease, brain death, and the significance of

velocity changes and Lindergaard ratio

Diagnose brain and spine tumors using MRI and

CT scan

Use diffuse weighted imaging and perfusion

scanning to identify early ischemic stroke

Use MR spectroscopy and PET scan to distinguish

brain tumors

Interpret MRI, CT angiography, and standard

angiography to diagnose aneurysms and

malformations

Diagnose vasospasm with transcranial Doppler

Determine specific pituitary, brain, spine, and skull

base tumors based on characteristics in imaging

Discuss the indications and technique of

discography, epidural steroids, diagnostic selective

nerve root blocks, facet blocks

Discuss the indications and technique for

percutaneous vertebroplasty

Use image guidance to resect brain and pituitary

tumors

Use image guidance in placing instrumentation in

the spine

Assist in the treatment of neurovascular diseases

with endovascular techniques

Perform provocative discography to diagnose

discogenic disease

Learning Experiences (list titles of teaching conferences, labs, procedure workshops, etc.)

Written exams and slide/photograph identifications

Quarterly evaluations, case review, focused chart review, lecture attendance

Oral boards

Written boards

Annual In-service exams