August 2007
ISCP
Egyptian Fellowship Board
Neurosurgery Curriculum
Contents:
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Rationale Statement
This curriculum was created in an effort to detail the body of knowledge and core
skills which should be attained by an individual completing fellowship training in
Neurological Surgery. As an absolute consensus concerning the definition of
essential knowledge and required skills for the practice of Neurological Surgery
has not, and will not, be achieved this program is periodically examined and
revised by the scientific committee. In many respects, this comprehensive and
specific curriculum delineates the "ideal" and therefore complete compliance to
the curriculum will be difficult or impossible to achieve for most. Nevertheless, it
represents a goal toward which to strive.
This document will assist educational supervisors, trainers, and trainees in
structuring an adequate postgraduate experience in Neurological Surgery. It
should serve to create an organizational structure of academic, clinical, and
technical criteria for training. The goal is to improve patient care by assuring that
trainees, who completed their training, have achieved the highest possible level
of competency.
Redundancy in the curriculum has arisen because many areas of neurosurgery
overlap. The curriculum structure is based on performance which will hopefully
facilitate self-directed study.
The curriculum is constructed in such a manner that the educational experience
is divided into four levels - General Surgery & Basic Sciences, Initial,
Intermediate and Final Neurosurgical training stage. The trainee should display
competency in each level before progressing to the next. Those individuals who
do not stay on track will be promptly identified in an objective manner, thereby
enabling more timely remedial attention or dismissal. The curriculum does not
define how information is imparted, only the body of knowledge which must be
mastered. These goals will be accomplished through conferences, required
readings, scheduled lectures or workshops, etc.
Adequate supervision of the trainee performance is critical to assure proper care
of the patient and learning of the trainee. Training should be structured to allow
trainees to act independently at various tasks commensurate with their skills and
the specific medical situation.
The curriculum contents have been formulated through the following:
1- Revision of previous fellowship neurosurgery curriculum
2- Revision of international curricula for postgraduate training in neurosurgery.
3- Consultation of experts in the Egyptian Board of Neurosurgery.
The Structure of the Neurosurgery Fellowship
Training Program
The Egyptian Fellowship Board requires seven years of supervised training
program that must be conducted in accredited hospital. A short thesis or audit
project on a selected subject should be fulfilled. A list of accredited hospitals will
be announced yearly.
General Surgery & Basic Sciences: First Year & Second Year
Initial Neurosurgery training stage: Third Year
Intermediate Neurosurgical training stage: Fourth and Fifth years
Final Neurosurgical training stage: Sixth & seventh year
General Surgery / Basic Sciences / Special Rotations:
First Year {R1} & Second Year {R2}……......Exam.
Initial Neurosurgery training stage:
Third Year {R3}…................................... Project or Mini Essay.
Intermediate Neurosurgical training stage:
Fourth and Fifth years {R4 & R5} …………...Exam.
Final Neurosurgical training stage:
Sixth and Seventh years {R6 & R7}………....Exam.
Requirements for trainees who are affiliated to Egyptian Neurosurgical
Fellowship:
1. Graduation from medical school and successful completion of the preregistration house
officers' year.
2. Enrollment in the Ministry of health and population residency program as a neurosurgery
resident.
3. Trainees who finished their master degree in General surgery or neurosurgery (within five
years) will join the program from its third year and are exempted from the first part exam. If more
than five year is passed, they must reside for the first part exam.
4. Trainees who finished their General surgery diploma might join the program from its second
year.
5. Trainees who finished their MD degree in neurosurgery will join the program from its seventh
year.
Trainee's Duties and Obligations
1. Trainees will take the position as neurosurgery residents and must fulfill all the job
requirements defined by supervisors and trainers.
2. They should be responsible under supervision for outpatients and inpatient's duties and
must take supervised shifts according to the hospital regulations.
3. They should be actively involved and fully responsible for patient care including sharing in
making decisions about diagnosis and management under supervision of the consultants.
4. They must attend 75% of weekly meetings including clinical round, tutorials, in addition to
journal clubs, morbidity and mortality meetings, etc...
5. Trainees must attend at least 75% of neurosurgery lectures.
6. Their performance will be monitored by a monthly-based report, issued to the Egyptian
fellowship Board.
General rules and regulations
Holidays and on call duties: According to Ministry of Health and population regulation.
Evaluation procedures: Performance of the trainee will be evaluated on regular and
continuous basis the evaluation process should involve all aspects of the training including
theoretical, clinical and operative procedures skills as well as the attendance and
participation.
*The trainers are required to write confidential reports periodically on the performance of
each trainee. The trainee should not be allowed to proceed in the training program and
move to the next stage of training unless he/she attains a satisfactory level of performance
acceptable to the responsible trainer and educational supervisor.
*The trainee shall not be allowed to proceed to year 3 before successfully passing the first
part Exam.
Interruption of training
It is not permissible to interrupt such a structural training program except in major
unavoidable circumstances. Such circumstances should be convincing and approved by
the secretary General .The Interruption once approved should not be for more than one
year. Interruption of the training program for more than one year shall result in dismissal
forms the program and cancellation of the preceding training period.
Curriculum Aim
To provide trainees with the essential updated knowledge, skills and attitudes that is
necessary for early identification, accurate assessment and proper management of
patients suffering from different Neurosurgical problems (elective or emergent) so as to
provide efficient, cost effective and human patient care.
Intended Learning Outcome (ILO)
Knowledge and understanding
By the end of training in Neurosurgery fellowship program, graduates must have adequate
knowledge and deep understanding of:
1. The detailed embryological features of CNS structures.
2. The growth and microsurgical neuro-anatomical fine details of significance to the practice of
Neurosurgery.
3. The etiology and pathology of important and/or common neurological diseases.
4. The clinical manifestations, complications, diagnostic modalities, outcomes and treatment plans
for common and/or important neurological problems.
5. The ethical principles that govern decision-making in surgical and medical practice.
6. The theoretical concepts that underpin common and important neurosurgical procedures and
operations
7. The principles and practices of preoperative preparation and postoperative care.
Skills
8. Obtain, perform and document a complete medical history and physical and neurological
examination in an organized manner.
9. Carry out an emergency-directed examination for emergencies patients.
10. Utilize sources of information like medical records, patient's family/friend to augment medical
and surgical history.
11. Interpret patient symptoms and physical findings in term of their anatomic, pathologic and
functional diagnostic significances.
12. Identify problems, prioritize them, and generate a list of differential diagnosis that is suited for
each patient.
13. Select the most appropriate and cost-effective diagnostic and therapeutic procedure for each
patient.
14. Identify medical and investigative parameters to be used in assessing the patient's response
to intervention and re-evaluate management plan accordingly.
15. Maintain a real-time and maintained insight of his real abilities, required skills and possible
iatrogenic insults for each management protocol.
16. Share effectively in electronic multi-media medical recording
Communication skills
17. Conduct sincere and effective patient interviews, properly explain their condition and plan of
management, obtain consents and convey bad news in a professional way.
18. Write patient records and properly present them.
19. Communicate, consult and respect the role of other health-care providers.
20. Work effectively and cooperatively in a team (intra-departmental, Inter- departmental, Interinstitutes).
Life-long Learning
21. Search effectively electronic resources to find valid appropriate information and use them in
patient management.
22. Continuously acquire and maintain up-to-date knowledge in the field of neurosurgery.
23. Participate in an evidence-based neurosurgical research project.
Ethical behavior
24. Respect patients' confidentiality and deliver care in an honest, considerate and
compassionate manner.
25. Appropriately and ethically get informed consent for indicated surgical interventions.
26. Discuss professional errors in an honest way.
Teaching will be conducted using the following techniques
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Bedside teaching and morning endorsement
Clinical rounds with participation of trainees in case presentation.
Apprenticeship teaching in the operative theatre.
Outpatient and inpatients work.
Journal club.
Morbidity and mortality conferences.
National and International meetings and workshops.
Involvement in research projects.
During the hospital rotations
1- Outpatient Clinics:
Patient’s evaluation and management is achieved through the different rotations.
Other responsibilities in the neurosurgery outpatient clinics
2- The admitted patients
a. The trainee will be responsible for supervised admission of patients from the neurosurgery
outpatient clinics or emergency.
b. Supervised performance of the following documents and activities:
 Complete history and physical examination form.
 Investigation requests, (laboratory, radiology, pathology, etc...) and in the process of analysis
of the results of the investigations.
 Plan of management (alternatives: medical, surgical, others…) and the rationale behind the
decision.
 Preoperative assessment and preparation.
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Detailed Operative Consent and invasive procedures consent.
Operative records.
Postoperative orders and medication sheets.
Daily progress notes.
Order of the necessary diagnostic procedures.
Discharge summaries.
Discussion of the case with the trainer and consultants (treatment plan evaluation and
outcome analysis).
Sick leaves and medical reports.
Notification of the senior staff for any high risk patient admission.
Review of the literatures.
3- Emergency Duties:
Emergency and urgent work accounts for more than 50% of neurosurgical caseload. All
trainees must be involved in the delivery of emergency services and must be competent to
manage both of basic adult and pediatric emergency care including:
 Basic life support measures.
 Initial evaluation and management of multiple trauma patients.
 Initial evaluation and management of head, spinal and peripheral nerve injuries.
 Other neurosurgical emergencies.
4- Academic Activities:
The neurosurgical curriculum will accommodate a wide range of academic training pathways
and provide an essential foundation for an academic career. An academic research or thesis
will be undertaken between the initial, intermediate and final training stages. Involvement in
regular research work of the departments, scientific writing and sharing in its presentation will
be accredited. Aiming to get:
 Research methodology and teaching to others.
 Ability to perform a simple research study and present the results.
 Ability to teach small groups, such as medical students.
 Ability to analyze published evidence
List of Essential Neurosurgical
Conditions
> Cranial trauma
> Spontaneous intracranial hemorrhage
> Hydrocephalus
> Intracranial tumeurs
> CNS infections
> Spinal trauma
> Benign intradural tumors
> Malignant spinal cord compression
> Degenerative spinal disorders
> Emergency pediatric neurosurgical problems
> Functional Neurosurgery
> Neurovascular Surgery
> Skull-base Surgery
Schedule of Essential Operative Competences
Summary of the level of operative competence that should be attained at each stage of
training:
Surgical approaches
year 3
Burr hole
Craniotomy – convexity
Craniotomy – pterional
Craniotomy – midline supratentorial
Craniotomy – midline posterior fossa
Lateral posterior fossa
Lumbar fenestration
Laminectomy
year 4-5 year 6-7
3
2
1
1
1
1
1
2
4
3
3
3
3
2
2
3
4
4
4
4
4
4
4
4
3
3
2
2
4
4
4
3
4
4
4
4
3
3
2
2
4
4
4
3
4
4
4
4
1
3
4
1
3
4
General procedures
Insertion of lumbar drain
Tapping/draining of CSF reservoir
Application of skull traction
Image Guidance/Stereotaxy set up
Management of Cranial trauma
Insertion of Intracranial (ICP) monitor
Burr hole evacuation of CSDH
Elevation of depressed skull fracture
Craniotomy for traumatic hematoma (ICH)
Management of spontaneous intracranial hemorrhage
Craniotomy for spontaneous intracerebral hematoma (ICH
supratentorial)
Craniotomy for spontaneous intracerebral hematoma (ICH
infratentorial)
Management of hydrocephalus
3
2
1
Insertion of ventricular drain/access device
Insertion of VP shunt
Revision of VP shunt
4
3
2
4
4
4
3
2
2
3
4
4
4
4
2
4
1
1
3
2
4
4
1
1
2
2
4
4
Management of intracranial tumours
Supratentorial tumour biopsy
Craniotomy for supratentorial intrinsic tumour/ metastasis
Craniotomy for posterior fossa intrinsic tumour / metastasis
Craniotomy for convexity meningioma
1
1
1
1
Management of intradural spinal tumours
1
Excision of intradural extramedullary tumour
Management of degenerative spinal disorders
Lumbar microdiscectomy
Anterior cervical discectomy
Emergency paediatric care
Insertion of EVD
Evacuation of intracranial hematoma (ICH)
1=observations and/ or assist
2=can do with assistance
3=performance under supervision
4=competent to do and manage complications.
CSF: cerebrospinal fluid
CSDH: chronic subdural hematoma
EVD: external ventricular drainage
ICH: Intracranial hemorrhage
ICP: intracranial pressure
VP: ventriculoperitoneal
General Surgery / Basic Sciences
First Year {R1} & Second Year {R2}
Neurosurgical trainees will acquire a broad foundation of theoretical knowledge; clinical experience,
skills and competence in:
 General surgery basics and relevant topics.
 Emergency (A&E) medicine
 Complementary surgical disciplines
 Basic neurosciences
Core Surgical Skills and Knowledge
Physiology: including the physiology of homeostasis, thermoregulation, metabolic pathways, blood
loss, sepsis, fluid balance and fluid replacement therapy, metabolic abnormalities
Pathology: including the pathology of inflammation, wound healing, cellular injury, vascular disorders,
disorders of growth, differentiation, and morphogenesis, tumours, surgical immunology, surgical
hematology
Microbiology: including the microbiology of surgically important micro-organisms, sources of
infection, asepsis and antisepsis, sterilization, antibiotics and high risk patient management
Basic surgical skills: including incision and suturing, tissue handling and retraction, hemostasis,
knotting and ligature, surgical assistance and exposure
Surgical care: including pre, intra and postoperative management; assessment and management of
the multiply-injured patient, management of bleeding diatheses; prevention and treatment of
thromboembolism; nutritional care; pain management and palliative care
General Surgical Procedures:
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Core Surgical Skills and Knowledge
(R1 and R2)
Basic sciences
Applied anatomy:
Development, organs and structures, surface and imaging anatomy of thorax, abdomen, pelvis,
perineum, limbs, neck as appropriate for surgical operations
Physiology:
Homeostasis
Thermoregulation
Metabolic pathways
Blood loss
Sepsis
Fluid balance and fluid replacement therapy
Metabolic abnormalities
Pathology:
Inflammation
Wound healing
Cellular injury
Vascular disorders
Disorders of growth, differentiation and morphogenesis
Tumours
Surgical immunology
Surgical hematology
Microbiology:
Surgically important microorganisms
Sources of infection
Asepsis and antisepsis
Sterilization
Antibiotics
High risk patient management
Radiology:
Principles of diagnostic and interventional radiology
Basic surgical skills
Incision of skin and subcutaneous tissue:
Langer’s lines
Healing mechanism
Choice of instrument
Safe practices
Basic Surgical Skills course
Closure of skin and subcutaneous tissue:
Options for closure
Suture and needle choice
Safe practice
Knot tying:
Single handed
Double handed
Instruments
Superficial
Deep
Choice of material
Haemostasis: Techniques
Control of bleeding vessel (superficial)
Diathermy
Suture ligation
Tie ligation
Clip application
Tissue retraction: Choice of instruments
Tissue forceps
Placement of wound retractors
Use of drains:
Indications
Types
Insertion
Fixation
Removal
Tissue handling:
Appropriate application of instruments and respect for tissues
Choice of instruments
Skill as assistant: Anticipation of needs of surgeon when assisting
The assessment and management of the surgical patient
Surgical history and examination (elective and emergency)
Construct a differential diagnosis
Plan investigations
Clinical decision making
Case work up and evaluation; risk management
Active participation in MDTs
Taking consent for intermediate level intervention; emergency and elective
Written clinical communication skills
Interactive clinical communication skills: patients
Interactive clinical communication skills: colleagues
Perioperative care
Ability to manage patient care in the perioperative period.
Preoperative assessment and management: Ability to assess the patient adequately prior to operation
and manage any preoperative problems appropriately.
Intraoperative care: Ability to conduct safe surgery in the operating theatre environment.
Postoperative care: Ability to care for the patient in the postoperative period.
Blood Products: Appropriate use of blood products.
Antibiotics: Appropriate use of antibiotics.
Preoperative assessment and management:
History and examination
Interpretation of preop. investigations
Management of co-morbidity
Resuscitation
Cardio-respiratory physiology
Diabetes mellitus
Renal failure
Pathophysiology of blood loss
Pathophysiology of sepsis
Risk factors for surgery and scoring systems
Principles of day surgery
Intraoperative care:
Safety in theatre
Sharps safety
Diathermy, laser use
Infection risks
Radiation use and risks
Tourniquets
Principles of local, regional and general anaesthesia
Postoperative care:
Assessment of patient’s condition
Postoperative analgesia
Fluid and electrolyte management
Monitoring of postoperative patient
Detection of impending organ failure
Initial management of organ failure
Use of MDT meetings
Cardio-respiratory physiology
Diabetes mellitus
Renal failure
Pathophysiology of blood loss
Pathophysiology of sepsis
Complications specific to particular operation
Critical care
Blood Products:
Components of blood
Appropriate use of blood products
Alternatives to use of blood products
Management of the complications of blood product transfusion
Antibiotics:
Common pathogens in surgical patients
Antibiotic sensitivities
Antibiotic side-effects
Principles of prophylaxis and treatment
Assessment of multiply injured patients:
Pathogenesis of shock / differences for Children
History and examination
Investigation
Resuscitation and early management
Referral to appropriate surgical subspecialties
Central venous line insertion
Chest drain insertion
Diagnostic peritoneal lavage
Bleeding diathesis
Mechanism of haemostasis
Pathology of impaired haemostasis e.g. hemophilia, liver disease, massive hemorrhage
Understands the use of blood products
Recognition of conditions likely to lead to the diathesis
Recognition of abnormal bleeding during surgery
Avoidance by correct surgical techniques
Corrective measures, e.g. warming, packing
Venous thrombosis + embolism
the prevention and management of Venous thrombosis and Embolism.
the physiology and pathophysiology of coagulation.
symptoms and signs associated with pulmonary embolism and DVT
basic investigation of patients with suspected venous thrombosis and embolism.
treatment of venous thrombosis and embolism.
Use of common methods of prophylaxis against venous thrombosis and embolism.
Anticoagulation, heparin and warfarin
Place of pulmonary embolectomy
Nutrition
Effects of malnutrition, both excess and depletion
Methods of screening and assessment
Dietary supplements
Enteral nutrition
Parenteral nutrition
Academic activity
research methodology and to teaching others.
Ability to perform a simple research study and present the results.
Ability to teach small groups such as medical students.
Ability to analyze published evidence
Management of the dying patient
Good management of the dying patient in consultation with the palliative care team.
Care of the terminally ill
Analgesia
Antiemetics
Laxatives
Principles of organ donation:
Circumstances in which consideration of organ donation is appropriate
Principles of brain death
Understanding the role of the coroner and the certification of death
Endocrine and metabolic disorders
Thyrotoxicosis: Pathophysiology and associated risks
Hypothyroidism: Pathophysiology and associated risks
Hypercalcaemia: Causes and effects
Corticosteroid therapy: Complications / Steroid insufficiency
Diabetes Mellitus: Complications
Hyponatraemia: Pathophysiology of fluid and electrolyte balance / Causes of hyponatraemia
Child protection
Child Protection Procedures
Understanding of Children's rights
types and categories of child maltreatment, presentations, signs and other features (primarily physical,
emotional, sexual, neglect, professional)
responsibilities and appropriate referral patterns in child protection
Recognize the possibility of abuse or maltreatment
Initial Stage Topics {R1 & R2}
Neuro-Embryology:
General Embryology:
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Trilaminar Embryonic Disc
Notochord
Neurolation
Somites
Special Embryology:
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Development of the Skull & Vertebral Column
Neural tube formation
Development of the brain / Cerebellum
Development of the Spinal Cord
Neural Crest
Pituitary Gland
Pharyngeal Arches / Pouches
Congenital Anomalies of CNS
Basic Neuro-Science Schedule
Topics
Applied neuroanatomy
Anatomy of the skull
Structure, blood supply, innervations, surface and three-dimensional relationships of the:
- scalp
- skull
- meninges
- orbit
- cranial fossae
- cranial foraminae
- cranial nerves
Anatomy of the brain
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Cortical topography
Projection and association tracts
Organization of the basal ganglia
Structure, organization and connections of the cerebellum, pons and brainstem
Cranial nerves and their relationships
Visual and auditory pathways
Ventricular system and choroid plexus
Subarachnoid space and cisterns
Circle of Willis and principle regional and segmental blood supply
Venous drainage and dural sinuses
Anatomy of the spine
Structure, blood supply, innervations, surface and three-dimensional relationships of the:
- vertebral column
- spinal cord: ascending and descending tracts
- spinal nerve roots
- cauda equina
Anatomy of the autonomic and peripheral nervous system
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Sympathetic and parasympathetic pathways
Visceral and pelvic innervations: control of sphincter function
Brachial plexus
Lumbosacral plexus
Course, distribution and innervations of the major peripheral nerves
Neurophysiology
Functional neurophysiology
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Structure and function of neurons and glial cells
Synaptic function, action potentials and axonal conduction
Higher cerebral functions
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Sleep and coma
Memory and disorders of the limbic system
Control of motor function: ascending and descending pathways, basal ganglia and cerebellar
function
The special senses
Functions of the autonomic nervous system
Hypothalamic-pituitary function
Principles of clinical neurophysiology
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Principles of electroencephalography
Principles of somatosensory, motor and brainstem evoked potential monitoring
Peripheral neuropathies and entrapment neuropathies including:
o structure and function of peripheral nerves
o use of nerve conduction studies
Disorders of the neuromuscular junction including:
o structure and function of smooth and striated muscle
o use of electromyographic studies
Pathophysiology of intracranial disorders
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Cerebral blood flow and metabolism
Cerebral autoregulation and vasospasm
Blood brain barrier and cerebral odema
Intracranial pressure dynamics
Cerebral ischaemia and neuroprotection
CSF hydrodynamics - production and absorption
Neuropharmacology
Principles of neuropharmacology
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Receptor and ion channel function
Neuropeptides and neurotransmitters
Principles of pharmacological neuroprotection
The pharmacology of anesthetic agents, muscle relaxants, barbiturates, anticonvulsants and
corticosteroids including:
o mechanisms of action
o pharmacodynamics
o interactions
Neuropathology and Neuro-oncology
Principles of neuropathology
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Acute and chronic inflammatory processes in the CNS including demyelination
Bacterial, fungal and parasitic meningitis, encephalitis and abscess formation
Viral encephalitis
Slow viruses, CJD and vCJD
HIV associated infections, tumours and leucoencehalopathies
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Cyto-pathology of neurons and glial in response to ischaemia, hypoxia and trauma
Diffuse axonal injury
Macroscopic brain and spinal cord injury including effects of brain shift, herniation and raised
ICP
Classification, epidemiology and pathology of CNS tumours
Tumour biology, cell kinetics, tumour markers, immune-cytochemistry
Neuroradiology
Principles of neuroradiology
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Interpretation of plain radiographs of the skull and spine
Principles of computerized tomography of the brain, skull and spine
Interpretation of CT scans with particular reference to acute spinal disorders, cranial trauma,
hydrocephalus, intracranial tumours and spontaneous intracranial haemorrhage
Principles of basic magnetic resonance imaging
Interpretation of MRI scans with particular reference to acute spinal disorders, cranial trauma,
hydrocephalus and intracranial tumours
Principles of advance magnetic resonance imaging including fMRI, DWI and spectroscopy
Interpretation of angiographic images: CTA, MRA and DSA
Neuropsychology
Principles of neuropsychology
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Principles of neuropsychological assessment
Common neuropsychological problems associated with:
o head injury
o subarachnoid haemorrhage
o hydrocephalus
o structural lesions of the frontal and temporal lobes
o disorders of the limbic system
Bed-side assessment of cognition and memory
Neurological Rehabilitation
Principles of neurological rehabilitation
The principles of neurological rehabilitation including strategies to optimize the recovery of:
- cognition,
- communication,
- continence
- selective movement
- gait, self-care
- psychological stability
- social adjustment and employment
Medical ethics
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Criteria for the diagnosis of brainstem death
Diagnosis and management of persistent vegetative states
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Prognosis in chronic progressive neurological disorders
Neurogenetics
Principles of neurogenetics
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Inherited neurological disorders
Genetic control of neural connectivity
Inborn errors of metabolism
Molecular genetics of CNS tumors
Neurosurgical trainees will acquire enough knowledge; clinical experience, skills and
competence in:
 Neuro-radiology
 Basic and applied clinical neurosciences, including neurology and acute neurology
service.
 Adequate experience in an emergency department
 Neuro-rehabilitation / neuropathology
 Exposure to neuro-intensive care
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Relevant micro-neurosurgical anatomy.
Neurosurgery Syllabus
Management of Common Neurological Conditions
Objectives:
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of
the aetiology, differential diagnosis, investigation and initial management of patients presenting with
common neurological conditions listed below
Clinical Skills
The trainee should be able to:
 Perform neurological assessment and initial resuscitation of patients
 Establish a neurological differential diagnosis, plan and interpret scans and other investigations
 Present and summarize data of patients in reports as well as in journal clubs
Technical Skills
The trainee must attain competency in the performance of the following procedures:
- Maintenance of airway
- Endotracheal intubation
- Central venous cannulation
- Lumbar puncture
These common neurological conditions include:
1. Impaired consciousness and non-traumatic coma
Including that due to:
- meningitis
- encephalitis
- intracranial haemorrhage
- acutely raised ICP
- hydrocephalus
- hypoxemia and ischaemia
- cardiogenic shock
- hypoglycaemia
- epilepsy
- metabolic encephalopathies
- drugs and toxins
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In addition, the trainee should recall the indications of intubation and ventilation in these
conditions as well as describe treatment of seizures.
2. Headache - acute and chronic, including that due to:
- benign headache syndromes
- migraine, cluster headache and related syndromes
- space occupying lesions
- meningitic disorders
- intracranial hemorrhage
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- trigeminal neuralgia
- atypical craniofacial pain syndrome
In addition, the trainee should describe Indications for different investigations for headache,
including scanning, lumbar puncture and angiography
3. Weakness and paralysis
Including: ocular, cranial nerve, limb, trunk and respiratory muscle weakness
4. Dizziness, unsteadiness and falls
including: cerebellar, vestibular, extra-pyramidal and autonomic dysfunction
5. Pain and sensory loss
including: musculoskeletal, neurogenic and neuropathic pain and sensory loss
6. Hearing disorders
Including: conductive and sensorineural hearing loss
In addition to the above mentioned knowledge & clinical skills, he
should also be able to:
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Knowledge: Recall the principles of audiological assessment
Skills: Interpret pure tone audiograms and auditory evoked potentials
7. Visual disorders: including:
Patterns of visual loss in relation to common bulbar, retrobulbar, sellar, parasellar and optic
pathway disorders
In addition to the above mentioned knowledge and clinical skills, the trainee should also:
 Knowledge: Analyze diplopia and nystagmus in relation to common cranial nerve and
brainstem disorders
 Skills: Perform computerized visual field assessment and detailed fundoscopy
8. Language and speech disturbance:
In addition to the above mentioned knowledge and clinical skills, the trainee should be able to:
Knowledge:
Classify and describe the causes and presentations of dysphasias, speech dyspraxia and
dyslexia, dysarthria and describe the role of speech and language therapists in assessment and
treatment
9. Swallowing disorders:
In addition to the above mentioned knowledge and clinical skills, he should be able also to:
Knowledge
List the neurological causes of dysphagia and describe the indications for laryngoscopy, videofluoroscopy, nasogastric and percutaneous gastric feeding
10. Disorders of the sphincteric and sexual function:
In addition to the above mentioned knowledge and clinical skills, he should be able also to Interpret
urodynamic studies
11. Movement disorders:
including: Parkinson's disease, Iatrogenic movement disorders, Dystonic syndromes, Choreiform
syndromes
12. Memory and cognitive disorders:
Including: disorders associated with head injury, subarachnoid haemorrhage, hydrocephalus,
structural lesions of the frontal and temporal lobes and disorders of the limbic system
13. Behavioral disorders:
Including: common acute and chronic presentations of organic and psychiatric behavioral disorders
relating to alcohol and drug abuse, encephalitis, organic dementia, and psychosis
Clinical Neurosurgery
At the end of the program, the trainee should possess the knowledge and technical skills
delineated below relevant to the listed conditions.
As regards clinical skills, they generally consist of:
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Assess patients clinically
Assess the unconscious patient
Perform neurological history taking and neurological examination
Request and interpret neuro-radiological investigations (plain radiography, CT, MRI.,
cerebral angiography at a basic level, MRA and digital subtraction angiography,
pressure studies and CSF infusion studies...etc)
Use and interpret multimodality monitoring
Counsel patients, take informed consent and perform peri-operative management
Advise family and careers regarding prognosis, professional and lay support
Diagnose and confirm brain death
Cranial Trauma
General management, neuro-intensive care and neurological rehabilitation of the head
injured patient
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Pathophysiology of head injury and of multiple trauma including an understanding of:
- Cerebral perfusion and oxygenation
- Raised intracranial pressure
- Impaired intracranial compliance
- Intracranial herniation
 Medical management of acutely raised intracranial pressure
 Indications for operation intervention including the use of pressure monitoring
 Principles, diagnosis and confirmation of brain death




Principles of intensive care of head injured patients: including the management of raised
intracranial pressure, impaired intracranial compliance, and cerebral ischaemia and the
prevention and management of secondary insults
Principles of spinal stabilization and radiological assessment in head injured patients
Natural history of recovery from head injury including neurological, cognitive and behavioural
disability and post- traumatic epilepsy
Role of neurological rehabilitation
Clinical Skills
In addition to the above mentioned clinical skills, the trainee should be able to:
 Assess clinically the multiply-injured patient
 Perform neurological assessment of the head-injured patient including:
- Assessment and categorization of impaired consciousness
- Recognition and interpretation of focal neurological deficits
- Prioritization of clinical risk
- Interpretation of CT scans and plain radiology
Surgical management of cranial trauma
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:








Pathophysiology of raised intracranial pressure and space occupying haematomas
Applied surgical anatomy
Principles of peri-operative care
Indications for surgery and appropriate surgical approaches
Indications for open and endoscopic closure of traumatic CSF fistulae
Complications of surgery and their management
Competence in all aspects of peri-operative management of head-injured patients
Ability to diagnose and confirm brain death
Technical Skills
Perform competently the following procedures:
 Craniotomy for supratentorial traumatic haematoma, in particular:
o Plan and site craniotomies for evacuation of extradural and subdural hematomas
o Handle the "tight" brain
o Achieve haemostasis in the coagulopathic patient
o Achieve haemostasis from the skull base and venous sinuses
o Elevate compound depressed skull fracture with dural repair
o Perform delayed cranioplasty of skull vault
 Craniotomy for infratentorial extradural, subdural and intracerebral hematomas
 Lobectomy for hemorrhagic contusion
 Vault cranioplasty using in-situ or preformed prostheses
 Decompressive bifrontal craniotomy with extensive durotomy
 Subfrontal extradural or subdural repair of anterior fossa fractures
 Combined craniofacial repair of fronto-orbitomaxillary injuries (fellowship)
Insertion of ICP monitor
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
- Indications for ICP monitoring
- Applied anatomy of the skull vault
- Calibration, zeroing and interpretation of ICP traces
- Potential complications of the procedure
Technical Skills
 Insert competently frontal subdural and intraparenchymal ICP monitors using a standard frontal
burr hole and/or twist drill craniostomy.
Diagnostic lumbar puncture
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:



Indications for diagnostic lumbar puncture
Interpretation of basic microscopy and biochemistry
Principles of spectrophotometry
Technical Skills
 Perform competently lumbar puncture
Burr hole evacuation of chronic subdural haematoma
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Pathophysiology of chronic subdural hematomas
 Applied anatomy of the skull vault and subdural space
 Indications for surgery
 Surgical options
 Complications of surgery
 Management of anti-platelet and anticoagulant medication
Technical Skills
 Perform competently single and multiple frontal and parietal burr hole evacuation of CSDHs
Management of soft tissue trauma
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:



Anatomy and blood supply of the scalp
Indications for primary and secondary closure of wounds
Indications for antibiotic prophylaxis
Clinical Skills
 Assess tissue perfusion and viability
Technical Skills
 Perform the following competently:
o wound exploration under local and general anaesthesia
o Wound debridement
o Arrest of scalp haemorrhage
o Layered closure of the scalp without tension
o Suturing technique
o
Wound drainage and head bandaging
Paediatic head and spinal injury
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:


Pathophysiology of raised intracranial pressure in children following head injury
Prevention and treatment of secondary insults relating to transfer and emergency surgery in
head-injured children
 Medical management and intensive care in paediatric head injury
 Pathophysiology, legal and social aspects of non-accidental injury in children
 Management of perinatal trauma, growing fractures and penetrating injuries in children
 Indications for decompressive craniectomy in management of intractable increases in ICP
 Rehabilitation after mild, moderate and severe head injuries
 Diagnosis and certification of brain death in children
 Classification, assessment, investigation and management of paediatric spinal injuries
(including SCIWORA)
Technical Skills
Perform the following procedures:
o Insertion of ICP monitor
o Insertion of ventriculostomy
o Craniotomy for traumatic intracranial haematoma
o Repair of depressed skull fracture
Neurovascular Surgery:
Spontaneous Intracranial Haemorrhage
Subarachnoid haemorrhage (SAH) / Intracerebral Hematomas
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Aetiology of SAH
 Pathophysiology of SAH
 WFNS grading of SAH
 Principles of resuscitation and timing of interventions.
 Indications for CT scanning, diagnostic lumbar puncture, CT angiography and digital subtraction
angiography.
 Principles of management of post-hemorrhagic hydrocephalus: including indications for external
ventricular drainage and lumbar subarachnoid drainage
 Complications of surgery
 Indications for endovascular and surgical intervention
 Aetiology of supra and infratentorial intracerebral haemorrhage
 Pathophysiology of spontaneous intracerebral haemorrhage
 Prevention and management of delayed cerebral ischemia, cerebral vasospasm and
hydrocephalus
 Relative indications for endovascular and surgical interventions


Management strategies to reduce the risk of intra-operative re-bleeding in presence of
suspected aneurysm or AVM including partial haematoma evacuation, pre or post-operative
embolization and definitive surgical treatment
Concerning Pediatric intravascular disorders, the following should be stressed upon:
 Epidemiology, natural history, pathophysiology and clinical features of subarachnoid
haemorrhage, hemorrhagic stroke and ischemia stroke in children secondary to intracranial
aneurysms, arteriovenous malformations and fistulae, cavernomas, arterial dissection,
moya-moya disease and venous sinus thrombosis
 Surgical and endovascular strategies for the management of acute intracranial vascular
disorders in children
Technical Skills
 Perform competently lumbar puncture for management of SAH
 Perform craniotomy for supratentorial haematoma including:
 Planning and sitting of craniotomies
 Use of ventricular drainage
 Intracerebral haemostasis in the coagulopathic patient
 Manage patients with aneurismal SAH, non operatively, by endovascular coiling
 Manage aneurismal SAH through:
o External ventricular drainage
o Lumbar subarachnoid drainage
o Ventriculo-peritoneal shunting
o Revision of ventriculo-peritoneal shunt
o Craniotomy for intracerebral haematoma
 Manage post hemorrhagic hydrocephalus through:
o Insertion of lumbar drain
o Insertion of external ventricular drain
Intracranial aneurysms:
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:







Aetiology, epidemiology and natural history of unruptured and ruptured intracranial aneurysms
and intracranial vascular malformations including AVMs, A-V fistula, cavernomas and venous
malformations
Pathophysiology and general management of subarachnoid and intracranial haemorrhage
Angiographic and microsurgical anatomy of the cerebral circulation
Indications for surgical management of intracranial aneurysms by clipping, trapping,
microsurgical reconstruction and microvascular bypass
Indications for surgical and endovascular treatment of intracranial aneurysms
The principles of endovascular treatment
Indications for intra and extracranial bypass in the management of complex aneurysms
Technical Skills
Perform the following procedures:
 Standard pterional and subfrontal approaches
 Clipping of anterior circulation aneurysm
 Interhemispheric approaches
 Temporo-zygomatic and related approaches
 Exposure of the basilar termination




Exposure of the vertebral artery and PICA
Clipping of saccular anterior circulation aneurysm
Clipping of complex anterior circulation aneurysm
Harvest of saphenous vein and radial artery grafts
Intracranial arteriovenous malformations
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 The epidemiology, classification, natural history, embryogenesis and pathophysiology of AVMs
of the brain
 The indications for surgical, radiosurgical and endovascular treatment of asymptomatic,
symptomatic and ruptured brain AVMs
 Indications for embolization, radiosurgery and surgery for vascular malformations
 Complications of surgery and their management, including hyperperfusion syndromes
Technical Skills
Perform the following procedures:
 Evacuation of intracerebral haematoma associated with an AVM
 Microsurgical resection of superficial cortical AVM
 Microsurgical resection of paraventricular and posterior fossa AVM
 Image-guided craniotomy and exposure of supratentorial AVM
 Microsurgical resection of superficial gyral or sulcal AVM
Intracranial dural arteriovenous fistulae
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Applied anatomy of the cerebral venous circulation
 The epidemiology, classification, natural history, pathogenesis and pathophysiology of
intracranial dAVFs
 The indications for surgical and endovascular treatment of asymptomatic, symptomatic and
ruptured intracranial dAVFs
Technical Skills
 Perform exploration and closure of supratentorial dAFV
Occlusive cerebrovascular disease
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:





The epidemiology, natural history and pathophysiology of extra- and intracranial atherosclerotic
occlusive disease
The epidemiology, natural history and pathophysiology of non-atherosclerotic occlusive
diseases
Optimal medical management of occlusive and thrombo-embolic cerebrovascular disease
Imaging of the acutely ischemic brain using CT and MRI
Principles of non-invasive and invasive imaging of the extra and intracranial vasculature using
CT, MRI and catheter angiography

Principles of regional cerebral blood flow and metabolism measurement and imaging using CT
and MRI perfusion techniques; SPECT and PET scanning
 Indications for carotid endarterectomy
 Indications for endovascular intervention including intra-arterial thrombolysis; carotid angioplasty
and stenting; intracranial angioplasty
 Principles of cerebral revascularisation by indirect synangiosis, low-flow EC-IC anastomosis and
high flow EC-IC bypass grafting
Technical Skills
Perform the following procedures:
 Carotid endarterectomy
 Saphenous and radial artery graft harvest
 Extracranial vascular anastomosis
 Intracranial microvascular anastomosis
Management of delayed secondary ischemia
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:


Pathophysiology of delayed cerebral ischemia including the impact of secondary insults
Principles governing the augmentation of cerebral blood flow
Clinical Skills
 Assess a deteriorating patient
 Recognize and manage secondary insults
 Manage hypervolaemic hypertension
Technical Skills
 Insert central venous catheter
 Insert lumbar drain
 Insert external ventricular drain
Hydrocephalus (Adult and Pediatric)
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:





The pathophysiology of CSF circulation
Applied surgical anatomy of the ventricular system in adults and children
Indications for external ventricular drainage, ventriculo-peritoneal shunting, lumbar CSF
drainage and shunting, ventriculo-cisternostomy, principles of shunt function and selection
Complications of surgery and their management
The role of endoscopy in hydrocephalus
Clinical Skills
 Identify shunt malfunction and perform differential diagnosis in adults and children
 Interpret pressure studies and CSF infusion studies
Technical Skills
Perform the following procedures:
In pediatrics:
o Insertion, tapping and draining from a CSF reservoir
o External ventricular drainage including externalisation of VP shunts
o Ventriculo-peritoneal shunting
In adults:
 Lumbar subarachnoid drainage
 External ventricular drainage
 Lumboperitoneal shunt
 Insert ventricular drain/access device
 Insert VP shunt
 Revise VP shunt
Intracranial Tumours
-
Supra-tentorial intrinsic tumours and convexity meningioma
Anterior and middle fossa skull base tumours
Midline and malignant posterior fossa tumors
Cerebello-pontine angle tumours
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Classification, natural history and pathology of benign and malignant intracranial neoplasia
 Pathophysiology of raised intracranial pressure associated with space occupying tumours
 Clinical presentations of intracranial tumours
 Diagnostic imaging of intracranial tumours including the interpretation of CT and MRI scans and
the role of MRS and indications for neuroimaging
 Management of raised intracranial pressure
 Indications for biopsy of intracranial tumours, risks of biopsy and principles of image-guided
surgery
 Principles of operative management
 Detection and management of post-operative complications
 Principles of fractionated radiotherapy, stereotactic radiotherapy and radiosurgery
 Principles and practice of frameless image-guided surgery and the principles of frame-based
stereotactic surgery
 Role of adjuvant chemotherapy
 Principles of clinical trials and their application to neuro-oncology
 Principles of palliative care
Anterior and middle fossa skull base tumours: Applied microsurgical anatomy of the anterior
and middle cranial fossae, Principles of intra-operative management of patients undergoing resection of
anterior and middle fossa tumours including olfactory groove, planum sphenoidale, parasellar and
sphenoid wing and falcine meningiomas
 Selection of surgical approaches including principles of endoscopic biopsy and/or resection in
posterior fossa tumors
 Principles of intra-operative management of patients undergoing resection of midline sellar,
para-sellar, pineal and third ventricular tumours including colloid cysts as well as posterior fossa
tumors
Technical Skills
 Perform image-guided frameless and/or frame-based stereotactic biopsy including:
o Setting up a computer workstation and importing and interrogating image data
o Positioning the patient and applying a cranial fixator
o Obtaining and confirming accurate patient registration
o Positioning and performing a suitable burr hole
o Passage of biopsy probe and biopsy
o Preparation of smear histology (when available)
 Import, check and interrogate image data sets on a standard work station
 Set up an image-guidance system and obtain a satisfactory intra-operative registration
 Plan and site burr holes and craniotomy flaps using image-guidance
 Identify an intra-cranial tumour and its margins using image-guidance


Perform craniotomy for superficial, lobar supratentorial intrinsic tumour and resection of
a convexity meningioma, in particular:
o safe patient positioning
o planning and sitting of craniotomy with and without image-guidance
o intra-operative management of raised ICP
o appropriate exposure of the tumour, using operating microscope as necessary
o safe use of fixed retractors
o precise use of suction, electro-coagulation, ultrasonic aspiration and intracranial
haemostasis
o use of internal tumour decompression, dissection in the subarachnoid plane using the
operating microscope as necessary and use of duroplasty and cranioplasty in case of
convexity meningioma
Anterior and middle fossa skull base tumours::
 Standard pterional and subfrontal approaches including:
o Pterional resection and basal drilling
o Subfrontal approach to the optic nerve, chiasm and internal carotid arteries
o Sylvian fissure splitting and exposure of the MCA bifurcation
o CSF drainage by chiasmatic cisternal suction, intra-operative ventricular
puncture and lamina terminalis fenestration
 Bi-Frontal/Frontal and parietal parafalcine approaches
 Microsurgical resection of superficial skull base meningioma
 Anterior interhemispheric, fronto-orbital, zygomatic and temporo-zygomatic approaches
o use of internal tumour decompression, dissection in the subarachnoid plane using the
operating microscope as necessary and use of duroplasty and cranioplasty in case of
convexity meningioma

Midline and malignant posterior fossa tumors:




Trans-frontal, transcortical approach to the lateral and third ventricle
Microsurgical resection of lateral intraventricular tumour
Transfrontal endoscopic biopsy
Competence in midline, paramedian and retrosigmoid posterior fossa craniotomies,
including:
o safe patient positioning in the prone and semi-prone positions
o exposure of the lateral and sigmoid sinuses
o exposure and decompression of the foramen magnum
o use of cisternal CSF drainage
o safe use of fixed retractors
o

exposure and resection of superficial, lateral and mid-line intrinsic cerebellar tumours
and metastases
Cerebello-pontine angle tumors:



Retrosigmoid approach
Subarachnoid dissection and exposure of the tumour and lower cranial nerves
Subtotal microsurgical resection of acoustic neuroma
Transphenoidal surgery
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:







Classification, epidemiology, natural history, pathology and clinical presentation of tumors of the
pituitary and sellar region
Pathophysiology of the hypothalamic-pituitary axis
Indications for surgery
Selection of surgical approaches: sublabial, transnasal and endoscopic
Applied surgical anatomy of the skull base
Principles of peri-operative care
Complications of surgery and their management
Technical Skills
 Perform Microsurgical transphenoidal approach
 Perform Transphenoidal resection of non-functioning macroadenoma
Craniofacial repair







Applied surgical anatomy of the cranial base floor and paranasal sinus
Indications for open surgical and endoscopic repair of spontaneous, post-traumatic and postsurgical skull base defects and CSF fistulae
Principles of simple, pedicled and free vascularised tissue transfer
Use of simple autologous grafts and substitutes (fascia, pericranium, fat etc) in closing small
defects
Use of vascularised pericranial, temporalis muscle and galeal flaps for major defects
Endoscopic repair of anterior fossa defects
Free vascularised flap reconstruction following major cranio-facial resections
CNS Sepsis
Intracerebral abscess, subdural empyema
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:




The pathophysiology of intracranial and spinal sepsis
Principles of anti-microbial chemotherapy
Indications for operative intervention
Indications for surgery, applied surgical anatomy, principles of peri-operative care and
complications of surgery of intracerebral abscess



Indications for burr hole drainage, ventricular drainage and craniotomy in the management of
intracranial sepsis
Indications for combined otorhinological procedures
Applied surgical anatomy, principles of peri-operative care and surgical complications for
intracerebral abscess and subdural empyema
Technical Skills
Perform the following procedures:
 Burr hole aspiration of a cerebral abscess with and without image-guidanc
 Ventricular drainage
 Craniotomy for subdural empyema, including frontal and parietal parafalcine approache
 Craniotomy and resection of frontal, temporal and cerebellar abscess
 Anterior and middle fossa extradural and subdural duroplasty
Spinal Surgery
Acute Spinal Disorders, spinal trauma
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:

The assessment and peri-operative management of patients presenting with spinal cord, cauda
equina and spinal root compression
 The management of spinal shock
 The ward management of patients with spinal instability
 The detection and initial management of postoperative complications including compressing
hematomas, CSF fistula and spinal sepsis
 Pathophysiology of spinal cord injury
 Classification of spinal fracture dislocations(cervical, thoracolumbar dislocations)
 Biomechanics of spinal instability
 Indications for halo traction and external stabilization
 Indications for and principles of open reduction and stabilization
Clinical Skills
In addition to the above mentioned general clinical skills, the trainee should be also able to:
 Manage spinal shock
Technical Skills
 Use external mobilization including cervical collars and spinal boards
 Apply halo traction and halo-body jacket
 Apply cranial-cervical traction
 Perform Posterior reduction of thoracolumbar fractures by pedicle screw instrumentation and
ligamentotaxis
 Principles of anterior spinal approaches
Spinal Infection
Spinal epidural abscess
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 The aetiology and pathophysiology of spinal sepsis
 Indications for drainage of spinal epidural abscess by laminectomy and multiple laminotomies
 Applied surgical anatomy, principles of peri-operative care, surgical complications and their
management, principles of peri-operative care
Clinical Skills
In addition to the above mentioned general clinical skills, the trainee should be also able to:
 Manage anti-microbial therapy
Technical Skills
 Perform drainage of spinal epidural abscess by laminectomy and/or multiple laminotomies
Vertebral osteomyelitis and discitis
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 The aetiology and pathophysiology of vertebral osteomyelitis and discitis, including pyogenic,
tuberculous and atypical infections
 Indications for percutaneous and open biopsy
 Indications for spinal stabilization
 Principles of peri-operative care
 Surgical complications and their management
Technical Skills
 Perform Transpedicular and open vertebral and disc biopsy
Spinal Oncology
Malignant spinal cord compression
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:







The pathophysiology of spinal cord compression
The classification, aetiology and natural history of vertebral metastases
Spinal instability associated with vertebral malignancy
Indications for surgical intervention
Role of primary radiotherapy and adjuvant radiotherapy or chemotherapy
Indications for percutaneous and open spinal biopsy
Indications for spinal decompression with and without instrumented spinal stabilization
Technical Skills
Perform the following procedures:
 Decompressive thoracic and lumbar laminectomy with extradural tumour resection
 Posterior pedicle screw stabilization
 Anterior cervical corporectomy with anterior column re-construction and anterior cervical plating
Surgical management of thoraco-lumbar metastases
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:





Indications for surgery
The principles of operative spinal decompression and stabilization of patients with spinal cord
metastases
Applied surgical anatomy
Principles of peri-operative care
Complications of surgery and their management
Technical Skills
 Perform extradural spinal biopsy and decompression by laminectomy in selected patients
without segmental instability
 Perform instrumented posterior spinal stabilization
Benign Intradural Tumours
Intradural extramedullary and intramedullary tumours
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:








Classification, natural history and basic molecular biology of intradural extramedullary and
intramedullary spinal tumours
Pathophysiology of spinal cord compression
Indications for surgery, Selection of surgical approaches, Applied surgical anatomy, Principles
of peri-operative care, Complications of surgery and their management
Indications for biopsy, subtotal and radical excision of intramedullary tumors
Role of adjuvant treatment
Applied surgical anatomy of spine and spinal cord, Selection of surgical approaches
Principles of intra-operative management of patients undergoing resection of intramedullary
tumours
Complications of surgery and their management
Technical Skills
Perform the following procedures:
 Microsurgical excision of posterior and postero-lateral intradural extramedullary tumours
 Microsurgical excision of anterior intradural extramedullary tumours
 Microsurgical biopsy of intramedullary spinal cord tumour
 Subtotal microsurgical resection of intramedullary tumour
 Duroplasty
Degenerative Spinal Disorders
Lumbar radiculopathies and Compressive cervical myeloradiculopathies
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:

Indications for operative management




Applied surgical anatomy with particular reference to degenerative neural compression and
morphological variations in vertebral anatomy
Selection of minimally-invasive approaches
Principles of peri-operative care
Complications of surgery
Technical Skills
Perform the following procedures:
In lumbar radiculopathies:
 Perform Primary lumbar microdiscectomy
 Primary posterior decompression (laminotomy, hemilaminectomy etc): including
- Identification of spinal level by pre and intraoperative fluoroscopy
- Achieving safe access to the spinal canal by micro-surgical fenestration
- Achieving full decompression of the spinal canal, lateral recess and foramen by
appropriate bone and soft tissue resection
- Protection and safe retraction of neural tissues
 Revisional lumbar microsurgical discectomy with and without decompression
 Microsurgical lumbar discectomy for central disc protrusion with cauda equina compression
In Compressive cervical myeloradiculopathies:




Single level anterior cervical discectomy with and without fusion, in particular:
o Standard anterolateral approach to the cervical spine
o Use of fluoroscopy or plain radiographs to confirm spinal level
o Radical and subtotal excision of the cervical disc, PLL, central and unco-vertebral
osteophytes
o Protection and full decompression of the spinal cord and spinal nerve roots
o Interbody fusion using autologous bone with or without interbody cages
Anterior cervical plating
Posterior cervical microforaminotomy and microdiscectomy
Posterior cervical decompression (laminotomy, hemilaminectomy etc
Craniocervical Junction Disorders
Rheumatoid disease
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:






The pathology and natural history of rheumatoid spondylopathy
Indications for operative management of atlanto-axial subluxation, cranial settling and related
disorders
Applied surgical anatomy of the craniocervical junction
Selection of surgical approaches
Principles of peri-operative care
Complications of surgery
Technical Skills
 Perform Atlanto-axial wiring for reducible atlanto-axial subluxation
Hindbrain herniation
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:






The pathogenesis and natural history of hindbrain herniation, craniocervical stenosis,
syringomyelia and syringobulbia
Indications for foramen magnum decompression
Applied surgical anatomy of the craniocervical junction
Selection of surgical approaches
Principles of peri-operative care
Complications of surgery
Technical Skills
 Perform Foramen magnum decompression
Peripheral Nerve Surgery
Carpal tunnel compression, ulnar neuropathy, Peripheral nerve sheath tumours
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:





Presentation, differential diagnosis and management of carpal tunnel syndrome, ulnar
neuropathies
Pathology of peripheral nerve sheath tumours, indications for complete and subtotal resection
of tumours, applied surgical anatomy of the major peripheral nerves
Interpretation of nerve conduction studies
Indications for surgery, applied surgical anatomy of the major peripheral nerves
Technical Skills
Perform the following procedures:
 Carpal tunnel decompression
 Cubital ulnar nerve decompression with and without transposition
 Microsurgical excision of peripheral nerve sheath tumour
Paediatric Neurosurgery
Paediatric neuro-oncology
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:





Epidemiology, natural history and pathology of tumours of the central nervous system in
children including medulloblastomas, pilocytic astrocytoma, high grade gliomas, supratentorial
PNET, pineal region tumours, brain stem tumours and intramedullary spinal cord tumours
Imaging of paediatric CNS tumours
Radiological and biochemical staging of tumours
Indications for surgery, radiotherapy, primary and adjuvant chemotherapy
Goals of surgery



Long term effects of treatment on cognition, hypothalamic-pituitary function and quality of life
Availability of clinical trials
Management of delayed spinal deformity associated with treatment of spinal cord tumours
Technical Skills
Perform the following procedures:
 Emergency operative management of a deteriorating child with an intracranial haemorrhage
and/or hydrocephalus secondary to tumour
 CT, MRI, electromagnetic and ultrasound guided localization of tumours of the brain and spine
 Stereotactic, image-guided and endoscopic biopsy of intracranial tumours
 Supratentorial craniotomy for hemispheric tumour
 Approaches to the suprasellar region: pterional, orbitozygomatic and subfrontal
 Approaches to the third ventricle: transcortical-transventricular, transcallosal
 Approaches to the pineal region: endoscopic, supracerebellar, suboccipital transtentorial
 Midline posterior fossa craniotomy for tumour
 Retrosigmoid approach to tumour presenting in the CP angle
 Laminoplasty approach to spine cord tumours.
Paediatric head and spinal injury
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
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Pathophysiology of raised intracranial pressure in children following head injury
Prevention and treatment of secondary insults relating to transfer and emergency surgery in
head-injured children
 Medical management and intensive care in paediatric head injury
 Pathophysiology, legal and social aspects of non-accidental injury in children
 Management of perinatal trauma, growing fractures and penetrating injuries in children
 Indications for decompressive craniectomy in management of intractable increases in ICP
 Rehabilitation after mild, moderate and severe head injuries
 Diagnosis and certification of brain death in children
 Classification, assessment, investigation and management of paediatric spinal injuries
(including SCIWORA)
Technical Skills
Perform the following procedures:
 Insertion of ICP monitor
 Insertion of ventriculostomy
 Craniotomy for traumatic intracranial haematoma
 Repair of depressed skull fracture
 Anterior skull base repair
Pediatric Hydrocephalus
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
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Pathophysiology and investigation of abnormal CSF dynamics in hydrocephalus and BIH
Indications for third ventriculostomy and for shunt insertion
Principles of shunt design and function
Antenatal diagnosis of hydrocephalus and its prognosis
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Medical and ophthalmological treatment options for BIH.
Technical Skills
Perform the following procedures:
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Insertion of intracranial pressure monitor
Insertion of ventricular access device in neonates
Insertion and revision of ventriculoperitoneal shunt/subduroperitoneal shunt
Insertion and revision of ventriculoatrial /ventriculopleural shunt
Insertion and revision of lumboperitoneal shunt
Endoscopic third ventriculostomy
Endoscopic fenestration of loculated ventricles
CT, MRI and ultrasound guided ventricular access
Management of arachnoid cysts by shunting, open or endoscopic fenestration
Congenital spinal disorders
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
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Embryogenesis of craniospinal dysraphism
Pathophysiology of CSF circulation associated with hindbrain hernia, syringobulbia and
syringomyelia
Epidemiology, natural history and clinical features of congenital spinal disorders including
dysraphism, tethered cord syndrome, diastematomyelia, Chiari malformations, Klippel-Feil
syndrome, achondroplasia, Downs syndrome etc
Imaging of the neonatal and growing paediatric spine of children with congenital disorders
commonly
Antenatal diagnosis of dysraphism and its implications.
Technical Skills
Perform the following procedures:
 Closure of myelomeningocoele
 Foramen magnum decompression for hind brain herniation
 Syringostomy and shunting of syringomyelia
 Untethering of thickened filum
 Excision of simple dermal sinus tract
 Untethering and resection of bony spur in diastematomyelia
 Untethering of lipomyelomeningocoele
 Instrumented stabilization and fusion in the treatment of congenital spinal disorders
Craniofacial disorders
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Advances in the genetic understanding of craniofacial conditions
 Epidemiology, natural history and clinical features of simple and syndromic craniosynostosis
including cosmetic, cognitive and ophthalmological complications
 Imaging of simple and syndromic craniosynostosis
 Indication for and timing of surgical interventions
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Understanding of causes and management of positional plagiocephaly
Epidemiology, natural history, and clinical features of common skull vault conditions including
eosinophilic granuloma, fibrous dysplasia etc
Technical Skills
Perform the following procedures:
 Cranioplasty using autologous, titanium or acrylic implants
 Surgical management of non-syndromic single suture synostosis (in the context of a
multidisciplinary team)
Paediatric epilepsy
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Classification, epidemiology, natural history and clinical features of epilepsy in childhood
 Clinical, encephalographic, videotelemetric and radiological assessment of children entering a
surgical program
 Indications for, prognosis and complications of VNS, disconnection procedures and temporal
lobe surgery
Technical Skills
Perform the following procedures:
 Cortical lesionectomy
 VNS insertion/revision
 Invasive EEG recording by grid and depth electrode placement
 Surgery for temporal lobe epilepsy
 Non-temporal lobe resections
 Disconnection procedures
Intracranial vascular disorders
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Epidemiology, natural history, pathophysiology and clinical features of subarachnoid
haemorrhage, hemorrhagic stroke and ischemia stroke in children secondary to intracranial
aneurysms, arteriovenous malformations and fistulae, cavernomas, arterial dissection, moyamoya disease and venous sinus thrombosis
 Surgical, endovascular and radiosurgical strategies for the management of intracranial vascular
disorders in children
Technical Skills
Perform the following procedures:
 Emergency operative management of spontaneous intracerebral hemorrhage
 Resection of superficial vascular malformations and cavernomas
Spasticity and movement disorders
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
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Clinical presentations of spasticity and other movement disorders in childhood
Multi-disciplinary assessment of children entering a surgical program
The indications for, prognosis and complications of intrathecal baclofen therapy, dorsal
rhizotomy and deep brain stimulation in the management of spasticity and dystonia
Awareness of indications for CNS modulating procedures in the management of pain and
convulsive disorders
Technical Skills
Perform the following procedures:
 Baclofen pump insertion, assessment of function and revision
 Laminotomy for selective dorsal rhizotomy
 Removal/revision of pulse generator units
Neuro-oncology
Advanced surgical techniques
Knowledge
 Indications for; applications of; advantages and disadvantages of various advanced surgical
approaches and adjuncts
Technical Skills
Perform the following procedures:
 Stereotactic craniotomy
 Advanced image guidance techniques
 Use of intraoperative chemotherapy wafers
 Third ventriculostomy
 Awake craniotomy
 Intraoperative neurophysiological monitoring
Low-grade intrinsic tumours
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
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Epidemiology, natural history, genetic characteristics, pathology and clinical features of low
grade intrinsic cerebral tumours
Surgical and non-surgical management options for low grade intrinsic tumours
Technical Skills
 Perform Craniotomy for lobar low grade intrinsic tumours using appropriately selected advanced
surgical techniques
Tumours of the ventricular system and pineal
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Epidemiology, natural history, genetic characteristics, pathology and clinical features of
intraventricular and pineal region tumour
 Radiological and biochemical staging
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Surgical and non-surgical management options for low grade intrinsic tumours
Surgical anatomy relevant to approaches to the lateral and third ventricles and the pineal region
Technical Skills
Perform the following procedures:
 Transcallosal and transcortical approaches to ventricular tumours
 Microsurgical resection of lateral intraventricular tumour
 Microsurgical resection of third ventricular tumour/colloid cyst
 Transfrontal endoscopic biopsy and third ventriculostomy
 Supracerebellar infratentorial approaches to the pineal
 Occipital transtentorial approaches to the pineal
Brainstem tumours
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Epidemiology, natural history, genetic characteristics, pathology and clinical features of brain
stem tumours
 Management options for patient with brainstem tumours including open surgery, biopsy and
radiotherapy
Technical Skills
Perform the following procedures:
 Stereotactic biopsy of brainstem lesions
 Open resection of exophytic brainstem tumours
Radiosurgery and stereotactic radiotherapy
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 The principles of radiosurgery and stereotactic radiotherapy
 The indications for their use as adjunctive and/or primary treatment modalities
Technical Skills
Perform the following procedures:
 Application of stereotactic frames for radiosurgical treatment
Functional Neurosurgery
Surgical management of pain
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 The aetiology and pathophysiology of chronic pain syndromes
 Indications for medical, minimally-invasive and surgical management
 Applied surgical anatomy
 Complications of surgery and their management
Technical Skills
Perform the following procedures:
 Spinal cord stimulation
 DREZ lesion
 Open cordotomy
 Deep brain stimulation for pain
Neurovascular compression syndromes
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Aetiology, epidemiology and natural history of trigeminal neuralgia, and glossopharyngeal
neuralgia
 Differential diagnosis and management of related cranio-facial pain syndromes
 Medical management of cranio-facial pain
 Surface anatomy of the trigeminal nerve and microsurgical anatomy of the CP angle
 Indications for surgical management of trigeminal and glossopharyngeal neuralgia by peripheral
neurectomy, percutaneous rhizotomy, radiofrequency rhizotomy, microvascular decompression
 Complications of surgery and their management
Technical Skills
Perform the following procedures:
 Percutaneous trigeminal rhizotomy
 Trigeminal microvascular decompression
Spasticity
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 The aetiology and pathophysiology of spasticity
 Indications for medical, minimally-invasive and surgical management
 Applied surgical anatomy
 Complications of surgery and their management
Technical Skills
Perform the following procedures:
 Intrathecal drug delivery
 Deep brain stimulation
Epilepsy
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 The pathophysiology of idiopathic and lesional epilepsy
 Indications for medical and surgical management
 Principles of ictal, interictal, sphenoidal and intraoperative EEG
 Principles of video-EEG monitoring
 Applied surgical anatomy
 Complications of surgery and their management
Technical Skills
Perform the following procedures:
 Stereotactic placement of depth electrodes
 Placement of subdural electrode-grid
 Image-guided resection of cortical lesions
 Mesial temporal resection
 Vagal nerve stimulation
 Functional hemispherectomy
 Corpus callosotomy
Movement disorders
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 The aetiology and pathophysiology of movement disorders
 Indications for medical, minimally-invasive and surgical management
 Applied surgical anatomy
 Complications of surgery and their management
 Preoperative counselling and preparation
Technical Skills
Perform the following procedures:
 Deep brain stimulation
 Microvascular decompression for hemi-facial spasm
Surgery for mental illness
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Indications for surgical treatment of mental illness
 Ethical and regulatory aspects of surgical treatment of mental illness
 Surgical targets
Skull-base Surgery
Cranial base meningiomas
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Epidemiology, natural history, pathology and clinical presentation of meningiomas of the
anterior, middle and posterior fossae
 Indications for radical or subtotal resection of skull-base meningiomas
 Indications for radiosurgical treatment
 Applied surgical anatomy of the skull base and craniofacial skeleton
 Selection of optimal approaches in relation presenting pathology and imaging
Technical Skills
Perform the following procedures:
 Anterior interhemispheric, fronto-orbital, zygomatic and temporo-zygomatic approaches
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Resection of anterior fossa meningioma: olfactory, planum sphenoidale and outer sphenoid
wing
Resection of clinoidal and suprasellar meningioma
Resection of occipital, lateral petrosal and tentorial meningioma
Resection of cavernous sinus and petroclival meningioma
Pituitary and sellar region tumours
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Classification, epidemiology, natural history, pathology and clinical presentation of tumours of
the pituitary and sellar region
 Pathophysiology of the hypothalamic-pituitary axis
 Investigation of the hypothalamic pituitary axis in patients with hypopituitarism and
hypersecretion syndromes
 Indications for surgery, radiosurgery and adjuvant radiotherapy
 Selection of surgical approaches: sublabial, transnasal and endoscopic
 Applied surgical anatomy of the skull base
 Principles of peri-operative care
 Complications of surgery and their management
Technical Skills
Perform the following procedures:
 Transphenoidal exposure of the pituitary fossa (microsurgical transnasal or sublabial)
 Transphenoidal resection of non-functioning macroadenoma
 Transphenoidal selective microadenectomy
 Endoscopic transphenoidal resection of nonfunctioning adenoma
 Pterional craniotomy and microsurgical decompression of optic nerves and chiasm
Acoustic neuromas
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Epidemiology, natural history, pathology and clinical presentation of sporadic and NFII related
acoustic neuromas
 Relative indications for surgery, radiosurgery and conservative management
 Principles of intra-operative facial nerve and BAEP monitoring
 Applied microsurgical anatomy of the CP angle, brainstem and lower cranial nerves
 Relative indications for retrosigmoid, middle fossa, and translabyrinthine approaches with
respect to hearing preservation, tumour size and position
Technical Skills
Perform the following procedures:
 Retrosigmoid approach
 Retrosigmoid subtotal resection of acoustic neuroma
 Retrosigmoid radical resection
 Translabyrinthine resection of acoustic tumour
Other skull-base tumours
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Epidemiology, natural history, pathology and clinical presentation of benign and malignant
tumours of the skull base including cranial nerve schwannomas, chordomas, paragangliomas,
adenoid cystic carcinomas, angiofibromas and nasopharyngeal carcinomas
 Indications for radical or subtotal resection of skull-base tumours
 Indications for radiosurgical treatment
 Applied surgical anatomy of the skull base and craniofacial skeleton
 Selection of optimal approaches in relation presenting pathology and imaging
Technical Skills
Perform the following procedures:
 Frontobasal approaches to the anterior fossa and orbito-ethmoidal complex
 Transfacial and mid-face approaches to the skull base
 Lateral approaches to the infratemporal fossa and pterygo-palatine fossa
 Transtemporal approaches to the jugular bulb and petrous apex
Craniofacial repair
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Applied surgical anatomy of the cranial base floor and paranasal sinus
 Indications for open surgical and endoscopic repair of spontaneous, post-traumatic and postsurgical skull base defects and CSF fistulae
 Principles of simple, pedicled and free vascularised tissue transfer
Technical Skills
Perform the following procedures:
 Use of simple autologous grafts and substitutes (fascia, pericranium, fat etc) in closing small
defects
 Use of vascularised pericranial, temporalis muscle and galeal flaps for major defects
 Endoscopic repair of anterior fossa defects
 Free vascularised flap reconstruction following major cranio-facial resections
Spinal Surgery
Spinal trauma
Knowledge
 See before p
Technical Skills
In addition to what mentioned before p , the trainee should perform the following procedures:
 Instrumented stabilization of subaxial fracture dislocation by anterior cervical plate and/or lateral
mass screws
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Instrumented stabilization of atlanto-axial fracture dislocation by anterior odonto-axial screws
and/or posterior atlanto-axial screws/wiring
Combined anterior and posterior reduction and instrumented stabilization of thoracolumbar
fractures
Metastatic spinal disease
Knowledge
See before p
Technical Skills
Perform the following procedures:
 Decompressive thoracic and lumbar laminectomy with extradural tumour resection and pedicle
screw stabilization
 Anterior cervical corporectomy with anterior column re-construction and anterior cervical plating
 Cervical lateral mass stabilization
 Posterior corporectomy with anterior column replacement and posterior stabilization
 Combined anterior and posterior total vertebrectomy with stabilization
Intradural tumours
Knowledge
See before p
Technical Skills
See before
Syringomyelia and hind brain anomalies
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 The pathogenesis and natural history of hindbrain herniation, craniocervical stenosis,
syringomyelia and syringobulbia
 Indications for foramen magnum decompression
 Applied surgical anatomy of the craniocervical junction
 Selection of surgical approaches
 Principles of peri-operative care
 Complications of surgery
Technical Skills
Perform the following procedures:
 Foramen magnum decompression
 Syringostomy and syringo-pleural shunting
Advanced surgery of the ageing and degenerative spine
Knowledge
By the end of the program, the trainee should have adequate knowledge and deep understanding of:
 Techniques for operative stabilization of the osteoporotic spine
 Principles of surgery for degenerative scoliosis
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Biomechanical principles of and indications for cervical and lumbar disc replacement
Biomechanical principles of and indications for non-fusion spinal stabilization
Indications for, techniques and complications of vertebroplasty and Kyphoplasty
Principles of thoracoscopic and laparoscopic surgical techniques
Technical Skills
Perform the following procedures:
 Pedicle screw instrumentation of the thoracic and lumbar spine
 Lumbar interbody fusion by posterior(PLIF) and postero-lateral (TLIF) fusion
 Lumbar anterior interbody fusion
 Single and multi-level cervical corporectomy with anterior cervical plating
 Anterior cervical discectomy and cervical arthroplasty
 Cervical laminectomy with lateral mass and/or pedicle screw stabilization
 Cervical laminoplasty
 Postero-lateral thoracic discectomy
 Anterior (transthoracic) discectomy
 Thoracoscopic techniques
Surgery of the rheumatoid spine
Knowledge
See before p
Technical Skills
In addition to what mentioned before p ,the trainee should perform the following procedures:
 Atlanto-axial stabilization using transarticular screws or pedicle and lateral mass screws and
rods
 Instrumented atlanto-occipital fusion
 Transoral odontoidectomy