The objective of the Vanderbilt Fellowship in Functional Neurosurgery is multifold. Our first goal is to produce functional neurosurgeons with comprehensive expertise in functional neurosurgery, which today includes the neurosurgical management of movement disorders (DBS and spasticity management), epilepsy (definitive resections, diagnostic implants, lesioning, and palliative management through devices), and complex pain conditions (eg. Cancer pain, brachial plexus injury, stroke, trigeminal neuralgia, or other trauma induced pain). The management of these patients includes not only the procedural knowledge, but also deeper understanding of the diagnosis, and non-surgical management strategies. Our second goal is for fellows to develop an area of research focus that advances a specific area of our field to improve the care of patients with neurological dysfunction. Our final goal is for graduates of our fellowship to have developed the leadership skills to direct a multidisciplinary program in Functional Neurosurgery. We expect these general goals to be manifest as achievement of Milestone Level 5 competency in all areas of functional neurosurgery.
As our fellows develop an area of research focus we expect that, in the course of their fellowship, they will perform basic research or clinical study that results in 2 or more peer reviewed publications. These should add meaningfully to the understanding of functional neurological diseases and their treatment. We also expect that the fellow will be intimately involved in running the DBS and epilepsy program including planning the multidisciplinary conferences that plan patient care and review surgical outcomes. As an integral part of these conferences, fellows will be charged with identifying programmatic challenges and using a systems-based approach to improve patient care.
The fellow will assist in the teaching of residents and medical students during journal club, work rounds and in the operating room. In addition, the fellow will pursue collaborative research projects with a mentor of their choice within one of these affiliated disciplines. Non-fellowship related patient care in the form of general neurosurgical care at the Tennessee Valley Heath Care System Veterans Hospital is available and approval is dependent on fellow performance in the program. Graduating fellows should be poised to run an independent program and to advance some aspect of the field of Functional Neurosurgery.
Clinical Objectives:
- Develop a comprehensive understanding of the underlying disease state and its non-surgical management.
- Comprehend the key criteria for proceeding with surgeries.
- Technical mastery of the surgery and an expansive knowledge of the literature describing surgical options.
- Knowledge and comfort with avoiding and managing potential complications
- Ability to work closely with related clinical specialties, especially Neurology and Pain Management.
Areas of practice will include:
- Deep brain stimulation for movement disorders.
- Lesioning procedures including open RF lesioning and SRS for treatment of movement disorders, pain and epilepsy
- Mastery of framed and frameless stereotactic techniques for application beyond the indications above.
- Comprehension of the theory and methods of neurophysiology (Including MER, ECOG, SSEP, etc) and neural stimulation mapping.
- Diagnostic and therapeutic electrode placement for epilepsy evaluation.
- Treatment of epilepsy with resection, neurostimulation, laser ablation, and other procedures.
- Diagnosis and treatment of trigeminal neuralgia with either microvascular decompression, lesioning, or motor cortex stimulation.
- Spasticity management and intrathecal therapies.
- Spinal cord and peripheral stimulation for the treatment of chronic pain.
- Advanced procedures in cancer pain management including cordotomy and cingulotomy.
- Advanced pain procedures for other complex pain syndromes induced by trauma or natural disease, such as DREZ (dorsal root entry zone lesioning) for brachial plexus or spinal cord injury, DBS or motor cortex for stroke pain or atypical facial pain.
Research:
- Engage one or more research projects during their fellowship time and develop this into an area of academic expertise and research inquiry.
Structure
Monthly Rotations: Fellows will spend time with each of the full time Functional Neurosurgery Faculty
Dr. Bick - Clinic and surgical practice, research in device therapies
Dr. Englot - Epilepsy, movement disorders and epilepsy imaging research
Dr. Ball - Cancer pain therapies, spinal pain procedures, movement disorders
Clinical Responsibilities: Fellows are expected to attend all functional neurosurgeries performed by the faculty to whom they are assigned that month. They will attend the weekly clinic(s) and see patients independently. They are also expected to round daily on the functional patients who have been admitted to the hospital and discuss ongoing management. In addition they will attend all monthly surgery planning conferences.
Independent Practice: Fellows who are post-graduate and ABNS board eligible will be licensed to practice independently. As their experience and comfort permit they will decide with the Faculty to perform their own functional cases (with or without supervision).
Elective Time: Up to 4 weeks will be provided to allow fellows to explore an area of surgery or related practice that compliments the functional program. These will be determined with the Program Faculty. Recommended options include:
- Dedicated time with the movement disorders neurology and epileptology teams to master the preoperative assessment of patients
- Dedicated time with radiation oncology to expand knowledge or stereotactic radiosurgery
- Time with affiliated pain management teams; cancer pain and chronic pain services
- Travel to collaborating centers to engage in multicenter research or to identify emerging techniques.
Research: In the first month of fellowship, fellows will be given opportunities to explore available research projects both within the Division of Functional Neurosurgery and broadly throughout the medical center, including our many collaborating labs and other potential researchers. At the end of the first month they will identify with the Primary Faculty 1-2 projects that will serve as the focus of their research for the year. They will create a rough time-table of literature review, experimental design, data collection and analysis, and manuscript production. Fellows will have ample time during each week to pursue research on off surgery days or during times where faculty is engaged in other surgery types (e.g. trauma call, etc.). The expected goal is to have a body of research that can be presented at a national meeting and that will be publication ready by the end of the fellowship year.