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AZHAR UNIVERSITY-AL

FACULTY OF MEDICINE

NEUROSURGERY DEPARTMENT

SPECIFICATIONS PROGRAM DM

:BASIC INFORMATION-A

3- Department:Neurosurgery 2- Title of the program: Neurosurgery MD program

1- Nature of the program: Single

:SPECIALIZED INFORMATION -B

1/1. -To enable candidates to keep with Satisfactory standards of Neurosurgery patients care by teaching high level of clinical skills, bedside care skills, in addition to update medical knowledge as well as clinical experience and competence in the area of Neurosurgery 1/2. - To be able to participate in research work and to give the candidate a chance to join an academic job and to teach young neurosurgeons. 1/3.- To be able to independently operate various neurosurgical operations. 1/4. To enable candidates to describe and follow the basic ethical and medicolegal principles relevant to Neurosurgery.

Objectives of General -1:programthe

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2-Intended learning outcomes (ILOs) for the whole program:

By the end of the program, the candidate should be able to:

2/1Knowledge and understanding:

A. Demonstrate in-depth knowledge and understanding of theories, basics and updated biomedical, clinical epidemiological and socio – behavioral science relevant to his specialty as well as the evidence – based application of this knowledge to patient care. B. Explain basics, methodology, tools and ethics of scientific medical, clinical research. C. Mention ethical, medico logical principles and bylaws relevant to his practice in the field of Neurosurgery. D. Mention principles and measurements of quality assurance and quality improvement in medical education and in clinical practice of Neurosurgery. E. Mention health care system, public health and health policy, issues relevant to Neurosurgery and principles and methods of system – based improvement of patient care in common health problems of the field of Neurosurgery.

2/2 Intellectual outcomes:

A. Apply the basic and clinically supportive sciences which are appropriate to Neurosurgery related conditions. B. Demonstrate an investigatory and analytic thinking “problem – solving “approaches to clinical situation related to Neurosurgery. C. plan research projects. D. Write scientific papers. E. Participate in clinical risk management as a part of clinical governance. F. Plan for quality improvement in the field of medical education and clinical practice in Neurosurgery. G. Create / innovate plans, systems, and other issues for

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improvement of performance in Neurosurgery. H. Present and defend his / her data in front of a panel of experts. I. Formulate management plans and alternative decisions in different situations in the field of the Neurosurgery.

2/3 Skills

2/3/1 Professional and practical skills:

A. Provide extensive level of patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. p.s. Extensive level means in-depth understanding from basic science to evidence – based clinical application and possession of skills to manage independently all problems in field of practice. B. Provide extensive level of patient care for patients with all common diagnoses and for uncomplicated procedures related to Neurosurgery. C. Provide extensive level of patient care for non-routine, complicated patients and under increasingly difficult circumstances, while demonstrating compassionate, appropriate and effective care. D. Perform diagnostic and therapeutic procedures considered essential in the field of Neurosurgery. E. Handles unexpected complications, while demonstrating compassion and sensitivity to patient needs and concerns. F. Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families in Neurosurgery related situations. G. Gather essential and accurate information about patients of Neurosurgery related conditions. H. Make informed decisions about diagnostic and therapeutic

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interventions based on patient information and preferences, up

to-date scientific evidence and clinical judgment for Neurosurgery related conditions. I. Develop and carry out patient management plans for Neurosurgery related conditions. J. Counsel and educate patients and their families about Neurosurgery related conditions. K. Use information technology to support patient care decisions and patient education in all Neurosurgery related clinical situations. L. Perform competently all medical and invasive procedures considered essential for Neurosurgery related conditions / area of practices. M. Provide health care services aimed at preventing Neurosurgery related health problems. N. Lead health care professionals, including those from other disciplines, to provide patient-focused care in Neurosurgery related conditions. O. Write competently all forms of patient charts and sheets including reports evaluating these charts and sheets ( Write

and evaluate a consultation note, Inform patients of a diagnosis

and therapeutic plan, completing and evaluating

comprehensive, timely and legible medical records)

2/3/2 General skills

Including:

Practice-based Learning and Improvement.

Interpersonal and Communication Skills.

Professionalism.

Systems-based Practice.

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Practice-Based Learning and Improvement A. Demonstrate continuous evaluation of different types of care provision to patients in the different area of Neurosurgery B. Appraise scientific evidence. C. Continuously improve patient care based on constant selfevaluation and life-long learning. D. Participate in clinical audit and research projects. E. Practice skills of evidence-based Medicine (EBM). F. Educate and evaluate students, residents and other health professionals. G. Design logbooks. H. Design clinical guidelines and standard protocols of management. I. Appraise evidence from scientific studies related to the patients’ health problems. J. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies. K. Use information technology to manage information, access on-line medical information; for the important topics. Interpersonal and Communication Skills L. Master interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals, including:-

Present a case.

Write a consultation note.

Inform patients of a diagnosis and therapeutic plan completing and maintaining comprehensive.

Timely and legible medical records.

Teamwork skills. M. Create and sustain a therapeutic and ethically sound relationship with patients.

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N. Elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills. O. Work effectively with others as a member or leader of a health care team or other professional group. Professionalism P. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and society. Q. Demonstrate a commitment to ethical principles including provision or withholding of clinical care, confidentiality of patient information, informed consent, and business practices. R. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender, and disabilities.

Systems-Based Practice S. Work effectively in health care delivery settings and systems related to Neurosurgery including good administrative and time management. T. Practice cost-effective health care and resource allocation that does not compromise quality of care. U. Advocate for quality patient care and assist patients in dealing with system complexities. V. Design, monitor and evaluate specification of under and post graduate course and programs. W. Act as a chair man for scientific meetings including time management.

3- Program Academic Reference Standards (ARS):

Neurosurgery departmrnt of Al –Azhar university refers to the

general academic standards of the National Authority for

Quality Assurance and Accreditation of Education (NAQAAE).

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4- Program External References (Benchmarks):

Neurosurgery departmrnt of Al –Azhar university refers to The American Board of neurological Surgery/

Also aware about . www.abns.org/content/default.asphttp/

and in contact with the international rules and new

researches and techniques.

5- Program Structure and contents:

:Time duration of the program-A

Basic topic in neurosurgery and general clinical topic(24

months)

Specific neurosurgical topic (36 months)

:Structure of the program -B

Currently 2 units are involved

The student will need 60 credit hours divided as follow

1- Basic science 6 credit hours

2- Specific neurosurgical 24 credit hours

Topic & practice

3-Thesis 15 credit hours

4- Log book 15 credit hours

N.B. one credit hour equal 15 hours of lectures

One credit hour equal 45 hours of skills .

http://www.abns.org/content/default.asp

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6- Contents, thesis and Log book:

Basic science for the Neurological surgeon :

1) Neuroanatomy: including surgical anatomy of the brain, spine and peripheral nerves with special emphasis on microsurgical anatomy and neuroembryology. 2) Neurophysiology: including physiology of cerebrospinal fluid and intra -cranial pressure, control of cerebral vasculature including the blood brain barrier. 3) Neuropathology: of diseases of C.N.S , peripheral nervous system, skull and spine. 4) Neuroradiology:

o Basic techniques of radiological studies. o Normal anatomic structures in plain x ray, CT, MRI

and angiographic films. o Indication of radiological tools in each pathology. o Recognition of common pathologies on radiographic

films. o Intraoperative fluoroscopy. o Transcranial Doppler. o Radionuclide scanning. o Interventional endovascular therapies. o Positron emission tomography. o MR spectroscopy.

5) Neurology:

1- Basic understanding of electrophysiological studies. 2- Delirium and dementia. 3- Coma. 4- Cerebro-vascular disease.

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5- Cerebral metabolism and pathophysiology of ischaemic brain damage.

6- Metabolic disorder of the nervous system. 7- Acquired neuropathies. 8- Heriditary disorders. 9- Epilepsy.

Specific neurosurgical topic and practice

Clinical examination of the Nervous system and approach to the patient :

1- History and physical examination. 2- Altered states of consciousness. 3- Neuro-ophthalmology. 4- Neuro- otology. 5- Neuro- urology. 6- Brain death & Legal issues.

General and perioperative Care 1- Initial evaluation and treatment of the comatose

patient. 2- Seizure disorders and their medical management. 3- Evaluation of the patient with dementia and

treatment of normal pressure hydrocephalus. 4- Increased intracranial pressure, Brain herniation. 5- Pseudotumour cerebri. 6- Preoperative evaluation of a neurosurgical patient. 7- Neuroanaesthesia and cerebral protection. 8- Intensive care for neurosurgical patient. 9- Postoperative care and evaluation.

10- Complication avoidance in Neurosurgery. 11- Rehabilitation of the neurologically disabled patient. 12- Restorative Neurology. 13- Nutrition and parenteral therapy.

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Neurosurgical and related techniques. 1- Principles of neurosurgical operative technique.

2- Instrumentation in neurosurgery including

microneurosurgery.

3- High speed drills and ultrasonic dissection in neurosurgery.

4- Endoscopic neurosurgery.

5- Prophylactic antibiotics.

6- Patient positioning.

7- Intraoperative ultrasound, CT and MR.

8- Intraoperative monitoring.

9- Endovascular therapy of vascular lesion of the C.N.S.

10- Interventional neuroradiology.

11- Stereotactic surgery , principles and techniques.

Neuro-oncology: 1- General information and basic science of Neuro-oncology:-

a) Oncogens and nervous system tumors. b) Genetic factors in brain tumors. c) Neurofibromatosis and other phacomatoses. d) Virus, radiation and chemical induced brain tumors. e) Biochemistry of brain tumors. f) Immunology of brain tumors. g) Primary brain tumors, aspects of imaging and

functional localization. h) Tumor markers. i) Brain edema and tumors –host interaction. j) Brain tumors during pregnancy.

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2- Gliomas:

- Pathology of gliomas.

- Imaging of supratentorial glioma.

- Clinical features and surgical therapy of supratentorial

gliomas.

- Management of recurrent gliomas.

- Unusual gliomas

3- Metastatic brain tumours.

4- Meningiomas (overview- pathology- imaging-

management)

5- Meningeal haemangiopericytoma & meningeal sarcoma.

6- Epidermoid and dermoid tumour (pathology-imaging and

management)

7- Pineal region tumours (pathology- imaging and

management)

8- Cerebellopontine angle tumors (pathology- imaging and

management)

9- Posterior fossa tumours (pathology – imaging

management).

- Cerebellar astrocytoma.

- Medulloblastomas.

- Brain stem glioma.

- Ependymomas & subependymomas.

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- Haemangioblastomas.

10- Sellar and parasellar tumours ;

- Anatomy and physiology of the pituitary gland.

- Classification and pathology of pituitary tumours

- Imaging of sellar and parasellar lesions.

- Endocrine diagnosis in neurosurgery.

- Functioning and non functioning pituitary tumours.

- Pituitary apoplexy.

- Craniopharyngioma.

- Optic gliomas.

- Suprasellar germinomas.

- Management of sellar tumours.

11- Ventricular tumours (pathology, imaging and

management)

12- Tumours of the orbit (pathology, imaging and

management)

13- Tumours of scalp , skull and skull base:

a) Non invasive tumors of the scalp. b) Tumours of the skull. c) Chordoma and chondrosarcoma. d) Glomus jugular tumours. e) Neoplasms of the paranasal sinuses. f) Trigeminal neurinoma. g) Other cranial nerve schwannomas h) Surgical approaches to tumours of the skull base.

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14- Miscellaneous neoplasms and nonneoplastic tumours :

a) Primitive neuroectodermal tumours. b) Central nevous system lymphomas. c) Intracranial sarcomas. d) Intrcranial lipomas. e) Sarcoidosis , tuberculosis and xanthogranuloma. f) Langerhans cell histocytosis.

15- Spinal tumours:

a) Imaging spinal tumours. b) Intradural tumours of the spine. c) Spinal epidural tumours. d) Primary neoplasm of the spine. e) Spinal chordomas. f) Vertebral haemangioma. g) Masses of the sacrum.

16- Tumour of cranio-cervical junction.

17- Adunctive therapy of central nervous system tumours:

a) Conventional radiotherapy. b) Radiosurgery for tumours. c) Interstitial brachytherapy. d) Chemotherapy of primary brain tumours. e) Photoradiation therapy for malignant gliomas. f) Hyperthermia in the treatment of intracranial tumours.

Vascular diseases of the Nervous system . 1 - General information and basic science:

a) Cerebral blood flow and metabolism. b) Acute medical management of ischemic disease and

stroke. c) Anaesthesia for neurovascular procedures and

introaperative cerebral protection. 2- Vascular and blood flow evaluations:

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a) Transcranial Doppler ultrasonography b) Neurosonology c) Xenon computed tomography d) MRA e) Positron emission tomography cerebrovascular disease

3- Occlusive vascular disease:

a) Carotid occlusive disease (natural history and medical management.

b) Carotid endarterectomy. c) Carotid angioplasty and stenting. d) Recurrent carotid stenosis. e) Traumatic carotid injury. f) Nonatherosclerotic carotid lesions. g) Extracranial vertebral artery disease. h) Intracranial occlusive disease and Moyamoya. i) Cerebral venous and sinus thrombosis.

4 - Intracerebral hemorrhage (non arteriovenous malformation

, nonaneurysm)

5- Hemorrhagic vascular disease:

A- Aneurysms:

1- Genetics of intracranial aneurysm. 2- The natural history of unruptured saccular cerebral

aneurysm. 3- Imaging of intracranial aneurysm. 4- Surgical decision making for treatment of cerebral

aneurysm. 5- Perioperative management of subarachnoid hemorrhage. 6- Cerebral vasospasm. 7- Aneurysm clips. 8- Surgical approaches for anterior circulation aneurysms . 9- Surgical treatment of intracavernous and paraclinoid

internal carotid artery aneurysms.

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10- Intracranial internal carotid artery aneurysm. 11- Anterior communicating artery and anterior cerebral

artery aneurysms. 12- Distal anterior cerebral artery aneurysms. 13- Middle cerebral artery aneurysms. 14- Surgical approaches for posterior circulation aneurysms. 15- Vertebral artery , posterior inferior cerebellar artery ,

and vertebrobasilar junction aneurysms. 16- Basilar trunk aneurysms

17- Basilar apex and posterior cerebral artery aneurysms. 18- Endovascular treatment of aneurysms. 19- Giant aneurysms. 20- Infectious intracranial aneurysms. 21- Revascularization techniques for complex aneurysms

and skull base tumours. 22- Traumatic cerebral aneurysms secondary to

penetrating intracranial injuries.

B- True arteriovenous malformation

1- Intracranial arteriovenous malformation.

2- Natural history of intracranial vascular malformation.

3- Classification and decision making in treatment and

perioperative management including surgical and

radiosurgical decision making.

4- Endovascular management of brain arteriovenous

malformation.

5- Embolization of arteriovenous malformation.

6- Surgical management of supratentorial arteriovenous

malformation.

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7- Posterior fossa arteriovenous malformation.

8- Surgical and radiosurgical management of giant

arteriovenous malformation.

9- Treatment of lateral – sigmoid and sagittal sinus dural

arteiovenous malformation.

10- Vein of Galen malformation.

C - Cavernous malformations

D - Carotid cavernous fistulas

E - Spinal arteriovenous mal formations

F - Pregnancy and treatment of vascular disease

Pediatric Neurosurgery

- Overview

1- Neuro surgery of the fetus.

2- Neurological examination in infancy and childhood.

3- Neuro anesthesia in children.

- Developmontal and acquired anomalies:

1- Encephaloceles.

2- Myelomeningocele and myelocystocele.

3- Lipomyelomeningocele.

4- Tethered spinal cord.

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5- Occult spinal dysraphism.

6- Dandy walker syndrome.

7- Arachnoid cysts.

8- Craniopagus twins.

- Craniosynostosis.

- Craniovertebral junction anomalies.

- Chiari malformation, hydromyelia, syringomyelia.

- Hydrocephalus:

1- Physiology of cerebrospinal fluid shunt devices.

2- Hydrocephalus in children.

3- Infantile post-hemorrhagic hydrocephalus.

4- Shunt infection.

5- Neuroendoscopy.

- Vascular disease:

1- Vein of Galen malformation.

2- Arteriovenous malformation and intracranial aneurysms

in children.

- Head and brain trauma:

1- Pediatric head injury.

2- Mild brain injury in children including small fractures and

growing fractures.

3- Subdural hematoma and effusions.

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- Birth trauma:

1- Birth head trauma.

2- Brachial plexus injury.

3- Child abuses.

4- Vertebral column and spinal cord injuries.

- Benign spine lesions.

- Tumors:

1- Optic pathway and hypothalamic gliomas

2- Intracranial Germ cell tumors.

3- Choroid plexus tumors.

4- Intracranial ependymomas.

5- Medulloblastomas.

6- Cerebellar astrocytomas in children.

7- Brain stem gliomas.

8- Craniopharyngiomas.

9- Pediatric cerebral hemispheric tumors.

10- Intraspinal tumor in infants and children.

11- Benign tumors of the skull including fibrous dysplasias.

- Cerebral palsy and other spastic entities.

- Surgical treatment of epilepsy in children.

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Cranial and spinal trauma

Cranial trauma:

1- Cellular basis of injury and recovery from trauma.

2- Pathophysiology of traumatic brain injury.

3- Pathophysiology of closed head injury.

4- Neurological evaluation of a patient with head trauma,

coma scales.

5- Radiological evaluation of head trauma.

6- Resuscitation of the multiply injured patient.

7- Intensive management of traumatic brain injury.

8- Pediatric head injury.

9- Scalp injuries.

10- Cephalic hematoma and subgaleal hematoma.

11- Skull fractures.

12- Growing skull fractures of childhood.

13- Facial fracture.

14- Cerebrospinal fluid fistula and pneumocephalus.

15- Cranial defects and cranioplasty.

16- Traumatic intracranial hematoma.

17- Delayed and recurrent intracranial hematoma and post

traumatic coagulopathies

18- Penetrating wounds of the head.

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19- Vascular lesions resulting from head injury.

20- Diagnosis and management of seventh and eighth cranial

nerve injuries due to temporal bone fractures

21- Sequelae of head injury.

22- Rehabilitation and prognosis after traumatic brain injury.

Spinal trauma

1- Management of acute spinal cord injury.

2- Diagnostic evaluation of spinal trauma.

3- Cervical spine trauma.

4- Hyperextension and hyperflexion injuries of the cervical

spine.

5- Treatment of occipital C1 injury.

6- Treatment of axis fractures.

7- Diagnosis and management of thoracic spine fracture.

8- Diagnosis and management of thoraco-lumbar and lumbar

spine injuries.

9- Injuries to the sacrum and pelvis.

10- Penetrating wounds of the spine.

11- Posttraumatic syringomyelia.

Infections

1- Antimicrobials for use in neurosurgical patients. 2- Diagnosis and management of brain abscess.

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3- Acute bacterial meningitis. 4- Inflammatory thrombosis of major dural venous sinuses

and cortical veins. 5- Cranial epidural abscess and subdural empyema. 6- Infections of the scalp and osteomyelitis of the skull. 7- Pituitary abscess. 8- Spinal cord abscess. 9- Spinal epidural and subdural abscesses. 10- Pyogenis osteomyelitis of spine. 11- Chronic granulomatous lesions. 12- Neurosurgical aspects of immunodeficiency. 13- Herpes simplex virus infection. 14- Creutzleldt- Jacob disease and related diseases. 15- Fungal infection. 16- Parasitic infestations

Spine

- Basic science

1) Biologic strategies for central nervous system repair. 2) concepts and mechanisms of biomechanics. 3) Intraoperative electrophysiologic monitoring of spinal

cord and nerve roots. 4) Bone metabolism as it relates to spinal disease and

treatment. 5) Normal and abnormal embryology of the spinal cord and

spine.

- Approach to the patient:

1) Approach to the patient and medical management of spinal disorders.

2) Evaluation and management of the failed back syndrome.

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3) Metabolic and other non degenerative causes of low back pain.

Degenerative diseases:

1) Treatment of disc and ligamentous disease of the cervical spine.

2) Posterior approach to cervical degenerative disease. 3) Anterior approach to cervical degenerative disease. 4) Anterior approach including cervical corpectomy. 5) Cervical spondylotic myelopathy. 6) Spondyloarthropathies including ankylosing spondylitis. 7) Ossifications of the posterior longitudinal ligament other

enthesopathies. 8) Benign extradural lesions of the dorsal spine. 9) Treatment of disc disease of the lumbar spine. 10) Lumbar spinal stenosis. 11) Spondylolysis and spondylolithesis. 12) Adult thoraco lumbar scolisis.

Adult congenital abnormalities

Acquired abnormalities of the craniocervical junction.

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Techniques

1- Basic principle of spinal internal fixation.

2- Technical aspects of bone graft harvest and spinal

fusion.

3- Biology of bone grafting and healing in spinal surgery.

* Instrumentation

1) Anterior cervical instrumentation. 2) Posterior cervical stabilization and fusion techniques. 3) Occipitocervical fusion. 4) Anterior thoracic instrumentation. 5) Posterior thoracic instrumentation. 6) Anterior lumbar instrumentation. 7) Posterior lumbar instrumentation. 8) Image-guided spinal navigation. 9) Endoscopic approaches to the spine. 10) Intradiscal and percutaneous treatment of lumbar disc

disease.

Tumors of the spine

a) Tumors of craniovertebral junction. b) Spinal cord tumors in adults. c) Tumors of the vertebral axis (benign, primary malignant

and metastatic tumors). Radiation therapy and radiosusgery

Basic science of radiotherapy:

1- Radiobiology.

2- Principles of radiotherapy.

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Fractionated radiation therapy:

1- Fractionated radiation therapy for malignant brain tumors.

2- Radiotherapy for benign skull base tumors.

3- Fractionated radiation therapy for pituitary tumors.

4- Radiotherapy of tumors of the spine.

5- Radiosusgery of brain tumors.

6- Radiosusgery for arteriovenous malformation.

7- Functional radiosusgery.

8- Interstitial and intracavitary irradiation of brain tumor.

Techniques of radiosurgery:

1- Linac radiosurgery.

2- Gamma knife radiosurgery.

3- Proton radiosurgery.

Disorders of peripheral and cranial nerves and autonomic

nervous system:

1- Physiology of the peripheral nerve 2- Peripheral nerves, approach to the patient. 3- Peripheral neuropathies. 4- Electrodiognostic evaluation of peripheral nerve, E.M.G,

Somatosensory evoked potential, nerve action potential.

5- Magnetic resonance imaging for peripheral nave disorders.

6- Peripheral nerve injuries; types, causes and grading. 7- Thoracic outlet syndromes.

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8- Entrapment neuropathies. 9- Brachial plexus injuries. 10- Management of peripheral nerve injuries.

o Carpal tunnel syndrome. o Ulnar nerve entrapment at the elbow. o Entrapment syndromes of peripheral nave injuries. o Management of peripheral nerve tumors. o Diagnostic biopsy of peripheral naves and muscles. o Management of acute peripheral nerve injuries.

11- Posterior fossa neurovascular compression syndromes

other than neuralgia.

12- Treatment of hemi facial spasm and essential

blepharospasm with botulinum toxin.

13- Vestibular nerve sectioning for Menier's disease.

14- Surgical sympathectomy.

15- Stereotactic radio frequency sympathectomy.

16- Endoscopic thoracic sympathectomy.

Epilepsy

- Overview

1- General and historical consideration of epilepsy surgery.

2- Basic science of posttraumatic Epilepsy

3- Approaches to the diagnosis and classification of

Epilepsy

4- Anti-epileptic medication, principles of clinical use.

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- Preoperative evaluation for Epilepsy

a) Single photon emission computed tomography and positron emission tomography.

b) Preoperative Evaluation for epilepsy surgery, computed tomography and magnetic resonance imaging.

c) The intracarotid amobarbital procedure (Wada test). d) Factional magnetic resonance imaging in Epilepsy

surgery. e) Identification of candidate for epilepsy surgery.

Intraoperative mapping and monitoring for cortical resections:

1- Motor, sensory, and language mapping and monitory for

cortical resections.

2- Monitory and mapping of vision in the neurosurgical

patient.

- Specific operative approaches

1- Intracranial monitoring. 2- Epilepsy surgery, outcome and complication. 3- Surgery for extra-temporal lobe epilepsy. 4- Standard temporal lobectomy and transsylvian

amygdalo-hippocampectomy 5- Tailored Resection for Epilepsy. 6- Lobectomy uses and indication. 7- Multiple subpial transaction. 8- Vagus nerve stimulation for intractable epilepsy.

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Functional neurosurgery.

A- Movement disorders:

- Basic science

1- Rationale for surgical intervention in movement

disorders.

2- Anatomy and synaptic connectivity of the basal ganglia.

3- Neuro pathology of movement disorders.

- Approach to the patient and the diagnosis:

1- Approach to movement disorders.

2- Patient selection in movement disorder.

3- Positron emission tomography in movement disorders.

- Surgery of movement disorders

1- Thalamotomy for tremor.

2- Pallidotomy for Parkinson's disease.

3- Surgery for dystonia.

4- Deep brain stimulation for movement disorders.

5- Cellular transplantation in the central nervous system.

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B- Spasticity:

1- Ablative surgery for spasticity.

2- Management of spasticity by central nervous system

infusion.

3- Selective peripheral denervation for spasmodic torticollis.

4- Treatment of intractable vertigo.

C- Pain

1- Physiologic anatomy of pain.

2- Approach to the patient:

- Approach to the patient with chronic pain.

- Medical management of chronic pain.

- Management of pain by anesthetic techniques.

3- Trigeminal neuralgia:

- Diagnosis and non-operative management.

- Percutaneous techniques.

- Microvascular decompression of the trigeminal nerve.

- Alternative surgical treatment for trigeminal neuralgia.

4- Surgical treatment of pain:

o Neurosurgical management of intractable pain. o Dorsal rhizotomy and dorsal root ganglionectomy. o Dorsal root entry zone and brain stem ablative

procedures. o Cordotomy for pain. o Brain stem procedures for management of pain.

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o Caudalis nucleus dorsal root entry zone procedure for the treatment of intractable facial pain.

o Sympathectomy for pain. o Spinal cord and peripheral nerve stimulation for chronic

intractable pain. o Deep brain stimulation for chronic pain. o Intrathecal drug infusion for pain.

Stereotactic surgery:

Stereotactic surgery principles and techniques. Image guided stereotactic surgery. Computer assisted stereotactic microsurgery. Frameless stereotactic interactive image guided

neurosurgery. Radiofrequency lesion-making in the nervous system. Neurosurgery for behavioral disorders. Neural prosthesis. Transplantation of tissue to the brain.

Miscellaneous topics

Disability evaluation; Patient education. Clinical research. The arts and scinse of clinical research. Brain death. Transplantation of cadaver tissue and organs. Intraoperative microphotography. Intraoperative video in neurosurgery.

Thesis:

The candidate makes the thesis within 2 years(minimally) and

should be finished before the exam.

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Log book:

The Log book is specified for each MD candidate, starts

from the date of registration for the degree and continues for

the whole study and training period, fulfillment of the Log book

criteria is considered a mandatory requirement for the final

exam. It includes:

A-Surgical procedures:

1- Surgical assistance for at least 100 surgical

procedure that include different neurosurgical variants

with at least 50 of major cranial and spine surgeries.

2-Doing at least 50 surgical operations that include

different cranial, spine and peripheral nerves surgery

that results in the end of the program by being able to

do the cranial and spine surgery himself.

3-Doing or assistance in urgent and emergency

operations for the cranium, spine and peripheral

nerves (at least 50 operations) provided that he does

at least 25 procedures himself.

B- Clinical rounds for the inpatients:

Once a week with presentation of a case and

discussion with the staff of the department.

C- On-call at least once a week.

D- Management of the clinic cases.

E- Scientific activity:

1-Regular weekly attendance of the scientific day of

the department with active participation and

presentation of a subject according to the schedule.

2- Nreurosuregry lectures attendance in the

department.

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3- Attendance of the scientific meetings of the

department and those done with other departments.

4- Attendance of neurosurgery conferences.

5- Attendance of thesis discussions in

the department.

7- Prerequisites for admission to the program:

According to the rules made by Al-Azhar faculty of medicine:

1-The candidate should pass 3 years of residency of neurosurgery and should

present the documents.

2-Should be practicing in the field of neurosurgery in one of the known centers or

working in our department in fixed position or as a fellow or visitor and should

present the documents.

3-The candidate should have passed the master degree in the field or an equivalent

degree.

8- Methods and rules for assessment for attendance of the

program:

What to measure of ILOS Method

Knowledge and understanding Written exam

Knowledge & understanding

Intellectual skills

Oral exam

Professional skills & general skills Clinical exam

Professional skills & Intellectual skills OSCE

8- Methods of evaluation of the program:

Sample Method Evaluator

attached questionair 2-Graduates

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Prof Dr Mamdouh

Salama

3-External evaluator

Co-ordinators Head of the department

Prof. Dr Magdy El Hawary

Dr Usama El Shokhaiby

Prof. Dr Ibraheem Ewis

1

AZHAR UNIVERSITY-AL

FACULTY OF MEDICINE


Neurosurgery course specifications for MD

A – Course data

:Course title

Neurosurgery specific course for MD.

:Speciality

Neurosurgery.

Number of hours:

*- Specific neurosurgical 24 points

Topic & practice

*-Thesis 15 points

*- Log book 15 points

N.B. one point equals 15 hours of lectures

One point equals 45 hours of skills .

2

:Departments

Neurosurgery

:sorCoordinat

Pof Dr:Ibraheem Ewais


:General Requirements

Candidate should have master degree in general

suregery or neurosurgery while being a trainee of

neurosurgery in qualified hospital(see progam for

details).

B – Course aims

1- Graduate a candidate who is able to demonstrate

Knowledge and understanding of basics, methodology, tools and ethics of scientific medical, clinical research in the field of Neurosurgery. 2. Graduate a candidate who is able to independently manage different simple and complicated neurosurgical cases. 3. Graduate a candidate who has a knowledge and understanding of: - Detailed gross anatomy of CNS and boney structure related to CNS like skull and vertebral column - Detailed neuro-anatomy of the brain cortex, brain stem, basal ganglia, tracts, spinal cord, peripheral nerves.

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4- Graduate a candidate who has knowledge and understanding of theories, basics and updated biomedical, clinical epidemiological of socio – behavioral science relevant to surgical neuropathology of CNS as well as the evidence – based In-depth application of this knowledge to patient

care.

C – Course intended learning outcomes(ILOS)

:and understandingKnowledge – 1

A-knowledge and understanding: By the end of the course, students should be able to: a.1-Describe the theories and principles, and updates in neurosurgery a.2- Demonstrate the ethical and legal principles of medical and professional practice a.3- Recognize the principles of quality assurance in medical practice a.4- Recognize the effect of medical practice on surrounding environment ,and how to develop and protect environment

Diagnose & manage most of neurosurgical cases -a. 5

:Intellectual outcomes – 2

By the end of the course, students should be able to: b.1- Analyze, and evaluate medical information in neurological diseases to elicit new conclusions. b.2-Predict solving medical and surgical problem related to neurological diseases. b.3- Imagine & evaluate risks in medical practice b.4- plane to develop progress in his career practice through using consensus to develop guidelines for patients managements either medically or surgically b.5- Make professional medical decisions according to different situations when facing medical or surgical problem (during clinical training course).

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b.6-Innovate solutions to medical and surgical problems in his specialty b.7-Argue, and discuss medical issues on evidence based

.r, especially in the field of neurosurgerymanne

:Practical skills – 3

By the end of the course, students should be able to: c.1- Perfect basic and recent professional medical and surgical skills in neurosurgery c.2-write and evaluate a professional medical report related to neurological diseases, reflecting case diagnosis and management plane , and respecting medico legal aspects c.3- evaluate medical methods and surgical tools c.4-Use recent technological tools as computer and internet, to serve his career through searches and assignments c.5- plane to develop his career and improve others

performance through team working during his training course..

:General skills – 4

By the end of the course, students should be able to: d.1-Communicate effectively with the patients and their relatives, transferring them information about illness in clear and suitable word d.2- Search specified topics on the library books, medical journals, and internet( e.g.: assignments, journal club). d.3- Apply self evaluation and specify his medical and surgical educational needs (e.g. through tutorials) d.4- Mange time and practice team working through case presentations and seminars d.5- Mange the medical assisting team through medical care application to the patients d.6- Perform continuous medical education through updating assignments, and optional training courses. d.7- adopt respect to all colleagues in his medical team d.8-apply ethical principles on treating the patients.

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D – Course contents:

The theoritical topics are mentioned in details in

program describtion however, the followings are the

methods for content application and activities.

A) Lectures: Two theoretical lectures every week. B) Clinical discussions: For cases admitted or referred to Neurosurgical department and sharing in choosing proper surgical plan. C) Participating in operative activity As an active member in operations lists twice weekly. Being the main sponsor for casualty department & emergency cases which attend Neurosurgical department & performing the required operative work after consulting the higher staff. D) Attending discussion of thesis E) Attending local, regional and international conferences in neurosurgical specialties. F) Presenting papers and talks in local & regional clinical meetings. G) Seminars: A weekly clinical seminar in every Monday with extensive clinical discussions on the clinical cases admitted in the department or referred from other departments (held in seminar room in the department) H) Round table discussions: For outcome of operated cases, existing complications & how could be avoided. Discussing new papers as a journal club.

E – Course methods of learning/teaching

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Lectures, seminars, journal clubs, bed side teaching,

case presentation, assignments, conference

participation and observation and hands on practice

F – Course assessment methods:

What to measure of ILOS Method

Knowledge and understanding Written exam

Knowledge & understanding

Intellectual skills

Oral exam

Professional skills & general skills Clinical exam

Professional skills & Intellectual skills OSCE

Professional and intellectual Observation during surgery

G - List of references:

* Neurosurgery departmrnt of Al –Azhar university refers to The American Board of neurological Surgery/

Also aware about . www.abns.org/content/default.asphttp/

and in contact with the international rules and new

researches and techniques.

*Books:

Youmans neurological surgery and Wilkins neurosurgery.

Co-ordinator Head of the department

Prof. Dr Magdy El Hawary Dr Usama El Shokhaiby

Prof. Dr Ibraheem Ewis

http://www.abns.org/content/default.asp

1

AZHAR UNIVERSITY-AL

FACULTY OF MEDICINE


MD Neuroanatomy course specifications

A – Course data

:Course title

Surgical Neuroanatomy for the Neurosurgery MD

program.

:Speciality

Neurosurgery.

Number of hours:

hours of lecturespoints = 45 3

:Departments

Neursurgery

2

:sorCoordinat

Prof Dr Ibraheem Ewais






details).

B – Course aims

The student should acquire the the basic

knowledge of surgical neuroanatomy necessary

for the practice of a qualified neurosurgeon and

participation in research.

3


:Knowledge and understanding – 1

A. DESCRIBE Anatomic details of : 1-skull and vertebral column 2- Head, neck scalp 3-Intracranial content Meninges and CSF Gross anatomy of brain Cerebral cortex Structure-of epencephalon,diencephalon, Basal ganglia, Gross anatomy of the ventricular system 4- blood supply of central nervous system 5-development and histogenesis of central nervous system 6-Autonomic nervous system 7-spinal cord -Gross anatomy - Tract of spinal cord 8- segmental innervations, plexuses and peripheral nerve

B. Mention the principles of anatomy of : - Abdominal wall -Peritoneum -Head and neck


A. Correlate the fact of anatomy with clinical reasoning,

diagnosis and management of common diseases related to

neurosurgery.

B. Demonstrate an investigatory and analytic thinking “problem – solving “approaches to clinical situation

.related to Neurosurgery

4


Currently no cadaveric or applied sessions but to be joined in

the future to the recently constructed microneuroanatomical

unit.

:General skills – 4

Demostrate illustrated Neurosurgical anatomy using different

technological ways including photos and drawing.


*Supratentorial surgical neuroanatomy including

meninges, brain surfaces, interior of thye brain, ventricles,

vasculature, tractology and neuclei of the brain.

thincluding posterior fossa(cerebellum, 4Infratentorial *

ventricle, brainstem, peduncles, tractology and neuclei)

* Skull, spinal column, head and neck and cranial nerves,

abdominal and thoracic structures related to neurosurgery

and neuroembryology.


Lectures*

*Application of knowledge.

* Future plan for arrangement with the

microneuroanatomy unit.

5


*Written exam.

*Oral exam.

*Clinical exam.

*MCQs.

*Log book.


*Books for Prof Dr Albert Rhoton for microneurosurgical

approaches.

orsCoordinatCourse Head of the department

Prof Dr Ibraheem Ewais Prof. Dr Magdy El Hawary Dr Usama El Shokhaiby


AZHAR UNIVERSITY-AL

FACULTY OF MEDICINE


Neuropathology course specifications for MD

A – Course data

:Course title

Surgical neuropathology for neurosurgery MD prgram.

:Speciality

Neurosurgery.

Number of hours:

45 hours of lecturespoints = 3

:Departments

Neurosurgery

:Coordinators


Prof. Dr Magdy El Hawary






details).

B – Course aims

The student should acquire the the basic

knowledge of neuropathology necessary for the

practice of a qualified neurosurgeon and

participation in research.


:Knowledge and understanding – 1

A. Demonstrate pathologic details of : 1- General topics of: inflammation, degeneration, tumors, trauma, air embolism, infarction, thrombosis 2-Gross ,histological and pathological feature of: a- CNS congenital anomalies b- intracranial infection c- vascular lesion d- traumatic lesion e- CNS neoplasm f- peripheral nerve disorder: trauma, inflammation, tumors 3- Neuropathology of skull

Spine: disc, trauma, tumors-4

B-Mention the principles of pathology of: -Peritoneum

Peripheral vascular disorders-


A. Correlates the facts of pathology with clinical reasoning,

diagnosis and management of common diseases related to

Neurosurgery.

B. Demonstrate an investigatory and analytic thinking (problem

solving) approaches to common clinical situations related to

Neurosurgery.


Not included.

General skills – 4

Demostrate the gross and microscopic neurosurgical

pathological features using different technological ways

including photos and drawing.


Neuropathology of diseases of C.N.S , peripheral nervous system, skull and spine.


Lectures*

*Application of knowledge


*Written exam.

*Oral exam.

*Clinical exam.

*MCQs.

*Log book.


Textbooks of the program, e.g. Youman and Wilkins.

Course Coordinators Head of the department Prof Dr Ibraheem Ewais Prof. Dr Magdy El Hawary Dr Usama El Shokhaiby


md program specificationsmedicineazhar.edu.eg/attachments/brainsurgical/md program an… · d....

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