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Curriculum for Subspecialty/Fellowship Training in Stereotactic and Functional Neurosurgery

The Stereotactic and Functional Neurosurgery (SFN) Fellowship is intended to supplement the core residency training in neurosurgery providing advanced knowledge and skills with a higher level of expertise in SFN. This fellowship is intended to include both clinical and educational training such that the following educational objectives are met:

Knowledge in basic sciences including anatomy, physiology and pharmacology pertinent to the clinical management of patients with functional neurosurgical disorders including chronic pain, movement disorders, spasticity, degenerative disorders of the nervous system, psychiatric disease, and others.

Knowledge of the pathophysiology, natural history and epidemiology, and clinical manifestations of the various disorders in SFN, particularly those subject to treatment by a neurosurgeon.

Knowledge and skills for competent performance of SFN procedures as well as knowledge for medical management alternatives. While all training programs should provide essential training in stereotactic techniques, specific curricula in functional neurosurgery may vary widely depending on the emphasis of each particular SFN program.

Core knowledge in technical aspects of SFN including frame-based and/or frameless localization, basic and advanced concepts in image-guided surgical navigation, and fundamentals of intraspinal and intracranial electrode and catheter placement. Specifically, trainees should have a thorough working knowledge of coordinate systems and the mathematical basis of stereotactic surgery, assessment and minimization of localization error, and delivery of therapeutic interventions to a well-defined target within the nervous system.

Knowledge in the various intraoperative neurophysiologic monitoring techniques including microelectrode recording, electrocorticography, somatosensory evoked potentials, tissue impedance measurements, and the interpretation of physiological effects induced by electrical stimulation.

Detailed understanding and technical skills for performance of both ablative and augmentative interventions in the CNS.

Basic understanding of principles of radiosurgery and indications for its use as well as contra-indications in SFN.

Because of the wide variety of neurological disorders and the rapidly changing nature of the field of functional neurosurgery, it is not possible to define a fixed curriculum. However, a basic conceptual framework is recommended in the following areas:

  • Basic neurophysiology including recording and stimulation of neural structures.
  • Neurochemistry and chemical modulation of the nervous system.
  • Lesioning techniques including radiofrequency, chemical and radiosurgical.
  • Technical aspects and basic mechanisms of deep brain stimulation, spinal cord stimulation, and peripheral nerve stimulation.
  • Diagnosis and surgical selection for movement disorders, pain and epilepsy.

Although not every fellowship will include all aspects of SFN, any representative subspecialty area within SFN should be adequately represented with current and updated knowledge in that area. Subspecialty areas may include:

  • Movement disorders
  • Pain
  • Epilepsy
  • Spasticity
  • Psychiatric disorders
  • Neurodegenerative disorders

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Copyright © 2008 The Society of Neurological Surgeons