Clinical Fellowship Programme

Introduction

Sub-specialisation within neurosurgery is still in its infancy. Most neurosurgeons have been trained and practice all facets of neurological surgery. However, within the large academic neurosurgical departments of developed countries there is a trend towards sub-specialisation. Indeed, paediatric neurosurgery in the United States now has its own board, which requires its members to have at least 12 months of fellowship training and to pass a separate board exam. Similarly, the disciplines of vascular, functional, spinal, oncological and skull base neurosurgery are becoming more defined and complex often necessitating fellowship training.

The concept of minimally invasive neurosurgery originated with the keyhole craniotomy for intracranial pathology. Complications from the approach alone seemed unacceptable and from the desire to reduce the risk of craniotomy came this new discipline. Arguably the greatest breakthrough in minimally invasive techniques was the application of endoscopy to neurosurgery. The endoscope has revolutionised the treatment of patients with hydrocephalus, brain tumours, aneurysms, pituitary tumours and any intra-ventricular pathology. The 2 subspecialties of neuroendoscopy and paediatric neurosurgery are intimately related because more than 30% of paediatric cases involve conditions of cerebrospinal fluid dynamics or intra-ventricular pathology. Indeed, in order to practice contemporary paediatric neurosurgery one must be comfortable with all the aspects of endoscopy.

Other tools that have made neurosurgery less invasive and equally, or more, effective are radiosurgery, frame-based and frameless stereotaxy and advances in technology such as ultrasonic aspirators, laser fibres and microsurgical instrumentation.

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Programme Outline

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Goals and Objectives

The applicant after completion of fellowship will be trained in the following disciplines:

Paediatric Neurosurgery
The fellow will be comfortable with the diagnosis and management of all paediatric neurosurgical diseases including head and spine trauma,
hydrocephalus and other problems of CSF dynamics, paediatric brain tumours, the tethered cord, spina bifida, craniofacial anomalies and other congenital abnormalities of the neuraxis. He/she will be particularly familiar with the application of endoscopy to paediatric neurosurgery.

Neuroendoscopy
The fellow will be familiar with the various types of endoscopes and be able to assess the differences in their capabilities, know when to use a flexible or a rigid scope, how to handle the various endoscopic instruments and fixation devices and set up the video chain in order to visualise, as well as record, procedures. He/she will appreciate the various aspects of setting up the operating suite and positioning the patient optimally. The fellow will appreciate the applications, the techniques, results and complications of endoscopy. He/she will be able to remove intraventricular tumours, such as colloid cysts, perform third ventriculostomy in all clinical settings, simplify complex hydrocephalus, manage arachnoid cysts and other extra-axial cysts, use the endoscope to assist in visualisation of extra-axial tumours
and vascular malformations, remove pituitary tumours and other skull base lesions, both extra and intra-dural, purely endoscopically, perform endoscopic biopsy of tumours and evacuation of clots both intra-ventricular and intra-cerebral, perform microvascular decompression and other endoscopic procedures.

Other Minimally Invasive Techniques
The fellow will be familiar with the selection of patients for and be able to perform different keyhole craniotomies e.g.. the supra-orbital craniotomy for para-sellar and supra-sellar pathology, the retrosigmoid keyhole craniectomy for diseases in the cerebellopontine angle and the sub-temporal craniectomy for lesions in the middle cranial fossa and upper clivus.

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Clinical Activities

General Duties
The fellow will be expected to perform all aspects of patient care. He/she will assess and admit patients through the emergency department as well as those admitted electively, organise preoperative investigations, manage the postoperative care of patients and be on-call for their patients 24 hours a day. The fellow will NOT detract from the experience of the rotational registrar who will have priority over the fellow at times when clinical responsibilities may overlap [see Conditions]

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Educational Activities

General Duties
The fellow will be expected to participate in clinical research and produce at least one publication for a peer-reviewed journal. The time for this educational activity will be mostly on Fridays.

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Assessment

The fellow will be continually assessed throughout the term of training. He/she will then be assessed at the completion of the fellowship by a board, consisting of the supervisor, at least one of the relieving neurosurgical supervisors and at least one of the three hospitals' medical/clinical directors. Certificate of Training will then be issued after a consensus and submission of a manuscript for publication.

Application Process

If you are interested in applying for a position in our Clinical Fellowship Programme, send us an e-mail stating why you would be the best candidate. In addition, please include the following materials with your application.

• A detailed CV.
• Certified copies of your undergraduate and postgraduate qualifications.
• Two written references.