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 Neurosurgery Residency ProgramMatthew R. Quigley M.D., Program Director Length of program: 6 years Number of position(s): 6 (1 at each level) The Neurosurgery Residency Program focuses on the three primary goals of excellence in patient care, education and research. These goals have been integrated into the neurosurgical training program through a combination of the following:
The Neurosurgery Residency Program spans six years and involves training in clinical neurosurgery, the allied neurosciences and neuroscience research. The primary objective is an ever-increasing level of knowledge, responsibility and technical expertise so as to allow independent neurosurgical practice in an academic or private setting. Before entering the program, residents must have completed one year of a general surgery residency program in an Accreditation Council of Graduate Medical Education-accredited program. The full-time faculty comprises 14 active neurosurgeons with subspecialty clinical and research interests in spine/spinal instrumentation, neurotrauma, neuro-oncology, vascular surgery, skull-base surgery, disorders of the cranial nerve, epilepsy and interventional neuroradiology. In addition, there are adjunct faculty in neurology, neuropathology, neuroradiology, neuro-otology, neurophysiology and neuroscience research. One residency position is available for each of the six years of the program Resident rotations include:
Because a significant component of neurosurgical care is provided on an outpatient basis, neurosurgery residents also assume an integral role in the clinical and outpatient office setting. In the clinic, residents see patients, diagnose conditions, plan diagnostic testing, discuss treatment options and follow-up, arrange preoperative consultations and follow the patients post-operatively with direct oversight from neurosurgical faculty. In most cases, follow-up includes rehabilitation settings as well. Residents are required to participate in the approximately 10,000 neurosurgical outpatient visits that occur each year. Examples of the neurosurgical subspecialty opportunities integrated into the residency that are available for clinical electives include: Pain Management and Movement DisordersThe institution supports one of the most active deep-brain stimulation programs in the nation, offering surgical alternatives to patients with Parkinson’s Disease, tremor and dystonia. This service is also integrated with a pain program with emphasis on surgical adjuncts such as spinal cord stimulators. Cranial NerveThe department is a national/international referral center for patients with various disorders of the lower cranial nerves. Spinal instrumentationA spine service has been established to provide a well-rounded experience in diagnosing and treating complex spinal disorders. The fundamental teaching is biomechanically based in relationship to spinal neoplasms, degenerative conditions, inflammatory, congenital and traumatic disorders. Residents actively participate in the weekly Spine Clinic for the primary evaluation and workup of patients. They also gain experience in a variety of anterior, posterior and posterolateral surgical approaches to the cervical and thoracolumbar spine, including instrumentation and bone-grafting techniques. The Biomechanics Research Laboratory serves as a hands-on workshop for practice with the various forms of instrumentation. Didactic instruction includes topics such as kinematics, biology of bone healing, physics of instrumentation constructs and treatment of instrumentation failures. Neuro-oncologyThe Neuro-Oncology Program follows approximately 200 tumors patients, acquiring 50 to 75 new patients each year. Approximately half of these new patients have malignant tumors. Residents and treating physicians from the departments of Neurology, Neurosurgery and Radiation Oncology and the Division of and Medical Oncology attend a weekly coordinated clinic and formally meet once each month to plan treatment. Residency training focuses on the coordinated, team approach to diagnosing and treating brain tumors. Residents are actively involved in all clinics and treatment decisions and have ample opportunity to acquire specific surgical skills, such as stereotactic localization and biopsy, cortical-mapping/guided tumor resections and stereotactic radiosurgery. A three-dimensional treatment computer and frameless stereotaxy also is available. The didactic component of the rotation includes lectures on tumor neurobiology, genetics, immunology, concepts of surgical treatment, radiotherapy and chemotherapy. Interventional neuroradiologyNeurosurgery residents are directly involved in the clinical decision-making processes concerning the indications and applications of interventional neuro-radiological techniques. Residents are involved in the evaluation and interventional treatment of appropriate patients with intracranial aneurysms, arteriovenous malformations, occlusive vascular disease and vasospasm. Balloon occlusion, balloon angioplasty, embolization and intra-vascular thrombolysis techniques are taught within the constraints of patient volume and level of training. Special emphasis is placed on the pathophysiology of such interventions on the cerebrovascular circulation and their implications for acute and long-term patient management. Epilepsy surgeryThe Allegheny General Comprehensive Epilepsy Service offers complete medical and surgical care to the patient with intractable epilepsy. During an epilepsy surgery rotation, residents divide their time between the Outpatient Epilepsy Clinic, the EEG Laboratory, the Epilepsy Monitoring Unit and the operating room. Residents recognize and participate in the surgical management of intractable epilepsy, including depth electrode placement, subdural grip placement, cortical mapping, temporal lobectomies, focal cortical resections, corpus callosum sectioning and vagal nerve stimulation. Emphasis is placed on understanding and directing the various components of an epilepsy surgery workup by working closely with other members of the epilepsy team, including neurologists, neuropsychologists, nurses and social workers. Clinical research conducted in association with this program includes a randomized clinical trial to document the long-term benefits of epilepsy surgery, the application of vagal nerve stimulation to epilepsy treatment and the evaluation of novel anti-convulsant medications.
Clinical Rotations
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