Stereotactic and Functional Neurosurgery

The Stereotactic and Functional Neurosurgery Fellowship Program at Emory University is under the direction of Robert E. Gross, MD, PhD.

Training Curriculum:

The Emory Functional Neurosurgery program provides an intensive surgical experience in all areas of functional neurosurgery, in collaboration with associated areas of neurology, psychology, radiology, physiology and anesthesia. In addition, opportunities are available for further training in clinical and translational research tools.

The training curriculum follows the recently developed “Matrix Curriculum” being developed by the Society for Neurological Surgeons for resident education. This curriculum details all skills necessary for a neurosurgeon to become competent in the area of stereotactic and functional neurosurgery.  Since fellows are post-residency and by and large going into academic practice they will be expected to become expert in most (non-experimental) areas by the completion of the fellowship. Fellows are required to be experts in movement disorders surgery, epilepsy surgery and pain surgery, as well as proficient in investigational psychiatric surgery.

The Training Curriculum is achieved by the following educational objectives:

Neurology

  • Neurology DBS and movement disorders clinic
  • DBS program case conference
  • DBS surgery planning conference (Neurology, Neurosurgery)
  • Comprehensive Epilepsy Surgery Conference (Neurology, Neurosurgery)
  • Ad hoc epilepsy intracranial EEG rounds
  • Clinical neurophysiology fellow teaching rounds
  • Emory Epilepsy Symposium

Neurosurgery

  • Didactic
    • Functional Neurosurgery Case Conference
    • Functional Neurosurgery Journal Club
    • Dr. Gross/Dr. Boulis Lab Meetings
    • Neurosurgery Clinical Research Meeting
  • Patient evaluation
    • Functional Neurosurgery Clinic
  • Procedural
    • DBS
      • DBS lead implantations
        • MER-guided lead implantation: two leads (1 bilateral or 2 unilateral procedures)
        • MRI-guided (Clearpoint) implantation: 2 – 4 cases/month
      • DBS IPG implantations and replacements
        • Staged 2 procedure and IPG replacements performed in separate room
      • DBS for depression: ~1 case/month
    • Epilepsy
      • Intracranial monitoring case
      • Resection (neocortical; amygdalohippocampectomy) or disconnection (callosotomy; hemispherotomy)
      • Visualase laser ablations: ~1/month in MRI scanner
      • Vagus nerve stimulation (~1-2/month)
    • Pain and Spasticity
      • Microvascular decompression (1-2/month)
      • Stereotactic glycerol or RF rhizotomy (1/month)
      • Percutaneous cordotomy, DREZ rhizotomy, myelotomy (~6/yr)
      • Intrathecal drug pump (baclofen, narcotic, Prealt) (2 – 4/month)
      • Peripheral nerve stimulators; decompression; repair (2-4/month)
      • Spinal cord stimulator implantation/revision (1-2/month)

 Translational Research

  • Personal instruction by mentors on grant applications, managing and integrating clinical practice/lab/grant writing.
  • Manuscript writing, providing clinical input to translational manuscripts with postdoctoral fellows and graduate students.

 Goals and Objectives:

  • To train neurosurgeons to a high degree of competency in the subspecialty practice of functional and stereotactic neurosurgery, including:
    • Movement disorders surgery: DBS, thermal ablation, gene/cell therapy
    • Epilepsy surgery: resective surgery, intracranial monitoring, disconnection surgery, neuromodulation
    • Pain surgery: neuromodulation, decompressive surgery, thermal ablation, peripheral nerve surgery
    • Psychiatric surgery: DBS, thermal ablation
    • Radiosurgery
  • To develop necessary skills required to effectively work within interdisciplinary clinical and research teams involved in the practice of functional neurosurgery.
  • To provide exposure to successful models of translational research in functional neurosurgery and mentorship in the skills and knowledge necessary to develop into a productive, funded neurosurgeon-scientist developing and translating novel neuromodulatory surgical therapies.

Method of Fellow Evaluation:

  • Milestones during operative procedures and progression towards independence.
  • Called upon to develop surgical plans, incorporating neurological factors, during movement disorders and epilepsy case conferences.
  • Present patient evaluation and independently develop plan of care during functional neurosurgery clinic.
  • Prepare and deliver didactic sessions
    • Neurosurgery resident conference
    • Functional neurosurgery case conference and journal club
    • Emory Epilepsy Symposium
  • Academic productivity
    • It is expected that fellow will publish as first author at least two manuscripts
    • Submission of at least one abstract to national meeting
  • Faculty evaluations

 Impact of Training/Outcomes:

  • Impact of training curriculum will be determined by progression to independent academic or private practice in functional neurosurgery.

 Alumni:

  • Present – Jonathan Riley
  • 2014 – David Lozada
  • 2012 – Willard Kasoff
  • 2012 – Jon Willie
  • 2011 – Jaliya Lokuketagoda
  • 2006 – Darlene Lobel