Neurosurgery 665 Curriculum & Grading


Core Objectives

  1. Learn the Neurological Exam.

  2. Evaluate outpatients with a wide range of neurosurgical problems.

  3. Assist in the operating room with neurosurgical procedures.

  4. Demonstrate improved knowledge of patient care, neuroanatomy, and surgical pathologies of the nervous system.

Desired Objectives

  1. List the early symptoms and signs of increased intracranial pressure.

  2. Discuss the diagnosis, motoring and treatment of hydrocephalus.

  3. Discuss the initial evaluation and management of traumatic brain injury- from mild to severe (from concussion).

  4. Describe the clinical manifestations, diagnostic workup, conservative management and surgical indications for patients with spine disease or spinal cord injury.

  5. Discuss the diagnosis and management of intracranial hemorrhage.

  6. List the most common brain tumors that afflict adults and children, the prognosis of each and the symptoms that herald brain tumor.

  7. Identify the most common neuro-infections, and describe the diagnosis and treatment.

  8. Discuss casus and standards of care for stroke and movement disorders.

  9. Categorize headache presentations and offer relevant differential diagnosis.

Grade Policy

The final grade (100 points total) will be composed from:
6o points total: Summative evaluation (including clinical evaluation, assignment grades, and mid-rotation evaluation)
40 points total: Final examination
The clinical grade will be calculated based upon adding each of the 1-5 point ratings on the 12 items on the evaluation form used for the clerkship. This evaluation is a consensus grade from the faculty and residents, if applicable, and incorporates the work done on the History and Physical write-ups, the Case Presentation with Literature Review, and Patient Log.

The examination is a multiple-choice examination, wherein the percentage correct is equal to the number of questions answered correctly. That number will be multiplied by a factor of 0.4 to generate a possible total of 40 points. The final grade will be assigned according to the following point cut-offs:

  • Honors = 88 or above

  • High pass = 83-87

  • Pass = 66-82

  • Fail = 65 or below

Topic List / Required Case Types for Patient Log

-Examination of Neurosurgical patients
            -Neurological Exam
            -Exam of lumbar and cervical spine patients
            -Exam of comatose patients

-Spinal Disease
            -Disc disease
            -Degenerative (Spondylotic) disease

-Cerebrovascular Disease

-Brain Tumors
            -Adult: Malignant, Benign, Pituitary


-Congenital Malformations and Hydrocephalus



Procedures to Observe

  • Lumbar Puncture

  • Placement of EVD (External Ventricular Drain)

  • Placement of ICP (Intracranial Pressure) monitor

Advanced Objectives

**For students interested in Neurological Surgery, these Advanced Objectives offer a comprehensive list of expectations.**


Fundamentals of Neuro-imaging

  1. Recognize common spine fractures and dislocations

  2. Differentiate on computerized images between blood, air, fat, CSF, and bone

  3. Distinguish the typical imaging characteristics of epidural hematoma, acute subdural hematoma, chronic subdural hematoma, intracerebral hemorrhage, and subarachnoid hemorrhage

Diagnosis and Management of Head Trauma

  1. Learn the Glasgow Coma Score and its significance

  2. Initiate management of elevated intracranial pressure in head trauma

  3. Define sports concussion, brain contusion, and diffuse axonal injury, and initiate management of each

  4. Distinguish anatomically and radiographically acute subdural and epidural hematoma, and describe the surgical indications for each

  5. Describe the initial management of penetrating high and low velocity head trauma

  6. Describe the management of chronic subdural hematoma


Intracranial Hypertension

  1. Define cerebral perfusion pressure, and explain how it is used in the management of patients with elevated intracranial pressure

  2. Describe how blood gases, fluids, and electrolyte balance influence intracranial pressure

  3. Describe the clinical manifestations of acute brain herniation, including transtentorial, uncal, and subfalcine herniation syndromes

Diagnosis and Management of Ischemic Cerebrovascular Disease

  1. Distinguish the symptoms and signs of anterior and posterior circulation ischemia

  2. Differentiate the radiographic presentations of the different types of ischemic stroke: embolic, hemodynamic, and lacunar

  3. Describe the roles and indications of the following treatment options in ischemic disease: medical management, risk factor modification, and surgical therapy


Diagnosis and Management of Nontraumatic Neck and Back Problems

  1. Define radiculopathy, myelopathy, and cauda equina syndrome

  2. Describe the general management of cervical disc herniation, lumbar disc herniation, lumbar instability, and low back pain

  3. List the most common examples of extradural, intradural-extramedullary, and intramedullary spine tumors

Diagnosis and Management of Peripheral Nerve Injury and Entrapment

  1. Describe the differences in thee management of sharp lacerating injuries, blunt lacerating injuries, gunshot wounds, stretch injuries, compression injuries, and avulsion injuries to peripheral nerves

  2. Describe the signs and symptoms of carpal tunnel syndrome and ulnar neuropathy, and outline the surgical indications


Diagnosis and Management of Hydrocephalus and Spinal Dysraphism

  1. List common symptoms and signs of acute hydrocephalus in children

  2. List most common congenital problems in children: hydrocephalus, spina bifida, craniosynostosis, tumors and developmental anomalies.

  3. List common symptoms and signs of normal pressure hydrocephalus in adults

  4. Define communicating and noncommunicating hydrocephalus and describe the differences in their treatments

  5. List two examples each of open and closed spinal dysraphism

  6. Describe the principles of management of myelomeningocele

Diagnosis and Management of Surgically Treatable Pain Problems, Movement Disorders, and Epilepsy

  1. Describe the classic presentations of trigeminal neuralgia, failed back surgery syndrome, complex regional pain syndrome-1, and complex regional pain syndrome-

  2. Describe the differences in indications for spinal cord stimulation versus spinal infusion pump

  3. List at least one different surgical treatment each for Parkinson’s disease, dystonia, spasticity, and hemifacial spasm

  4. Define the different types of seizures (simple, partial, etc)

  5. Describe the differences between temporal lobectomy, lesionectomy, and disconnective surgery for seizure disorders



The Neurological Examination

  1. Evaluate patient’s mental status and speech

  2. Examine the cranial nerves

  3. Examine central and peripheral sensory function

  4. Examine motor function

  5. Examine cranial and peripheral reflexes

  6. Examine cerebellar function and gait


Diagnosis and Management of Brain Tumor and Abscess

  1. Know the relative incidence and location of the major types of primary and secondary brain tumors

  2. Describe the general clinical presentations of brain tumors in the following locations: cerebral hemisphere, cerebellum, brainstem, pituitary, and cerebellopontine angle

  3. List the advantages and limitations of the following diagnostic tools used in the evaluation of brain tumors: CT, MRI, MR spectroscopy, and angiography

  4. Describe the surgical indications for the most common benign and malignant tumors in the locations listed in #2

  5. Describe the indications for and the differences between radiotherapy and radiosurgery in the treatment of malignant brain tumors

  6. List the major differences between the diagnosis and management of brain tumor and abscess

  7. List the most common etiologies of cerebral abscess

Diagnosis and Management of Headache

  1. Distinguish the radiographic presentation of the major causes of intracranial hemorrhage: hypertensive intracerebral hemorrhage, amyloid intracerebral hemorrhage subarachnoid hemorrhage, arteriovenous malformation hemorrhage, tumor hemorrhage, and coagulopathy hemorrhage

  2. Apply the following diagnostic tools in evaluation of acute headache (CT, MRI, angiogram, and lumbar puncture)

  3. Describe the broad treatment strategies (surgery, radiosurgery, interventional radiology as well as treatment of vasospasm) of intracranial aneurysms and vascular malformations

  4. Differentiate the symptomatology of migraine, cluster, tension, and sinusitis headache

Spinal Trauma

  1. Describe the rapid assessment of the patient with spinal trauma

  2. Recognize the common spine fractures on X-ray

  3. Initiate acute management of spinal cord injury including immobilization, steroids, and systemic measures

  4. Define the unstable spine



Case Presentations

  1. Present a case to your preceptor, include relevant history, neurological examination, imaging findings, and treatment plan each week

Participation on the Neuro-ICU and Acute Care Areas of the Hospital

  1. Ask neurosurgical staff (residents, attendings, etc) questions as appropriate to enhance learning opportunities both in and out of the OR


Operating Room

  1. Demonstrate professionalism in the operating room; feel free to participate as medical students, including asking questions, reviewing images, pathology, intraoperative findings, etc.

  2. Demonstrate level of interest by scrubbing in on cases at the discretion of the resident and attending