Special Interest Training
There are a number of online resources for Neurosurgery, available through ebrain. Neurosurgery SAC has mapped individual Special Interest Stage syllabus topics to ebrain, which are available here. ebrain is a resource that can be used by both trainees and trainers to support continuous professional development. (Please note that the ISCP is not responsible for the content of external sites)
Special Interest Training Stage
Trainees in special interest training will develop a comprehensive and in-depth knowledge of their field. By the end of specialist interest training they will be competent to undertake selected operative procedures relating to the common presentations in their specialist field without direct supervision. They will be competent to undertake other procedures in their field under the mentorship of a senior colleague. The specialist interest summaries indicate the breath and depth of training required in a specialist interest fellowship.
Paediatric neurosurgery
On completion of a special interest fellowship in paediatric neurosurgery trainees will be competent in all aspects of the non-operative neurosurgical management of children presenting with disorders of the nervous system. They will have detailed knowledge of the statutory framework governing the care of children, paediatric neurointensive care, the principles of paediatric neurorehabilitation and of the management of non-accidental injury. They will be competent to undertake all aspects of the emergency neurosurgical operative care of children and to undertake a range of elective procedures in the following fields with appropriate supervision:
- Hydrocephalus: including the insertion and revision of ventriculo-peritoneal, ventriculo-atrial and lumbo-peritoneal shunts; endoscopic third ventriculostomy; image-guided placement of ventricular catheters; management of neonatal post-haemorrhagic hydrocephalus
- Paediatric neuro-oncology: including stereotactic and image-guided biopsy of paediatric tumours; endoscopic biopsy of third ventricular tumours; resection of supratentorial and infratentorial intrinsic tumours; approaches to suprasellar, third ventricular and pineal tumours; management of spinal cord tumours
- Paediatric head injury: including decompressive craniectomy; cranioplasty; management of growing fractures; craniofacial reconstruction; management of CSF fistulae
- Spinal dysraphism: including the management of neonatal spina bifida, meningoceles and encephaloceles; spinal cord tethering syndromes
- Congenital and acquired spinal deformity: including the management of syndromic spinal deformity and post-operative spinal deformity
- Craniofacial disorders: including the management of simple craniosynostosis, syndromic craniosynostosis, post-traumatic deformity
Neuro-oncology
All trainees will be competent to manage patients with high grade intrinsic tumours, metastases and convexity meningiomas. Trainees will a special interest in neuro-oncology will participate fully in the multidisciplinary management of neuro-oncology patients and will be familiar with current developments in molecular neuro-oncology, emerging surgical techniques and the ethical, regulatory and practical considerations governing clinical trials in neuro-oncology. They will develop additional expertise as follows:
- Advanced surgical techniques: including awake craniotomy; stereotactic craniotomy, intraoperative neurophysiological monitoring; advanced image guidance with integration of functional data; intraoperative imaging techniques; the use of intraoperative chemotherapy wafers; third ventriculostomy
- Low-grade intrinsic tumours: the management of low grade intrinsic tumours using advanced techniques; optimal resection of lobar low grade intrinsic tumours
- Tumours of the ventricular system and pineal: including surgical approaches to the third ventricle and pineal; transfrontal transventricular excision of intraventricular tumours and cysts; transcallosal transventricular excision of lesions of the third ventricle and foramen of Munro
- Brainstem tumours: including the management options for intrinsic brainstem tumours; stereotactic biopsy of accessible lesions
- Radiosurgery and stereotactic radiotherapy: including the principles of radiosurgery and stereotactic radiotherapy and the indications for their use as adjunctive and/or primary treatment modalities.
Functional neurosurgery
Trainees with a special interest in functional neurosurgery will develop additional expertise as follows:
- Surgical management of pain: including the implantation of spinal cord stimulators; the insertion of intrathecal drug delivery systems; knowledge of ablative surgical treatment for pain including DREZ lesioning, cordotomy and myelotomy and of neuromodulatory techniques including peripheral nerve, motor cortex and deep brain stimulation.
- Neurovascular compression syndromes: including microvascular decompression of the trigeminal nerve; microvascular decompression of the facial nerve; percutaneous trigeminal rhizotomy
- Spasticity: including an in-depth understanding of medical and surgical treatments for spasticity; implantation of intrathecal drug delivery systems; knowledge of other surgical treatments for spasticity including phenol blocks, neurectomies and rhizotomy.
- Epilepsy: including the multidisciplinary assessment and preparation of patients for epilepsy surgery; stereotactic placement of depth electrodes and placement of subdural electrode grids; temporal lobectomy; selective amygdalohippocampectomy; callosotomy; insertion of vagal nerve stimulators; hemispherectomy; multiple subpial transections
- Movement disorders: including the multidisciplinary assessment and selection of patients with movement disorders e.g. Parkinson's disease and dystonia; selection, targeting and placement of deep brain stimulation electrodes; management of neuro-stimulators; radiofrequency lesioning
Neurovascular surgery
Special interest training will take place in units with extensive experience in the multi-disciplinary management of all common intracranial vascular disorders. These units should manage a minimum of 120 aneurysmal subarachnoid haemorrhages a year. Trainees with a special interest in neurovascular surgery will develop additional expertise in:
- Intracranial aneurysms: including surgical and endovascular strategies for the management of ruptured and unruptured intracranial aneurysms; surgical treatment of ruptured aneurysms of the anterior circulation; principles of microvascular reconstruction and bypass for complex aneurysms
- Intracranial vascular malformations: including surgical, endovascular and radiosurgical strategies for the management of arteriovenous malformations; surgical treatment of superficial cortical arteriovenous malformations, surgical and endovascular treatment of dural arteriovenous fistulae, image-guided resection of cavernomas
- Other vascular disorders: including the management of primary intracerebral haematomas; the management of venous occlusive disorders
- Acute and chronic cerebral ischaemia: including the medical, surgical and endovascular management of extracranial arterial occlusive disease
Skull-base surgery
Special interest training in skull base surgery will take place in units with extensive multi-disciplinary experience in the management of all common skull-base disorders. Trainees with a special interest in skull-base surgery will develop additional expertise as follows:
- Skull-base and craniofacial surgical access: including standard variations of fronto-basal, fronto-orbital, trans-zygomatic, infratemporal, transtemporal, far-lateral, transphenoidal and transmaxillary approaches
- Cranial base meningiomas: including resection of anterior fossa (olefactory groove and suprasellar) meningiomas; tentorial and petrous temporal meningiomas; petroclival meningiomas
- Pituitary and sellar tumours: including microsurgical and endoscopic transphenoidal resection of pituitary tumours; pterional, subfrontal, interhemispheric and transventricular approaches to suprasellar tumours
- Acoustic neuromas: including retrosigmoid, translabyrinthine and middle fossa resection of acoustic neuromas
- Other skull-base tumours: including the management of other cranial nerve schwannomas, glomus tumours and malignant primary and secondary tumours of the skull-base
- Management of cranio-facial trauma: including multi-disciplinary management of fronto-orbital disruption
- Repair of CSF fistulae: including the management of post-operative CSF fistulae; indications for endoscopic repair of basal CSF fistula; techniques for open repair and skull-base reconstruction
Spinal surgery
On completion of a special interest fellowship in spinal surgery trainees will be competent in all aspects of the emergency and urgent operative care of patients with spinal disorders. They will develop additional expertise as follows:
- Spinal trauma: including reduction and internal stabilisation of atlanto-axial, sub-axial and thoraco-lumbar fractures and dislocations
- Metastatic disease of the spine: including posterior decompression and stabilisation using pedicle screw, hook and sub-laminar wire constructs; corporectomy and instrumented reconstruction of the anterior column
- Primary tumours of the spine: including techniques for local ablation of benign lesions and en bloc resections of malignant tumours
- Intradural tumours: including the radical resection of intradural, extra-medullary tumours; biopsy and optimal resection of intramedullary tumours
- Syringomyelia and hind brain anomalies: including foramen magnum decompression, syringostomy, syringopleural shunting, detethering and duroplasty
- Advanced surgery of the ageing and degenerative spine: including the management of osteoporotic collapse, vertebroplasty, kyphoplasty; stabilisation of the osteoporotic spine; operative management degenerative spondylolisthesis and scoliosis
- The rheumatoid and ankylosed spine: including the management of atlanto-axial subluxation; cranial settling and odontoid migration; sub-axial degeneration; cervico-dorsal kyphosis
- Spinal deformity: including the multidisciplinary management of patients with spinal dysraphism, diastematomyelia etc
Click on Workplace Based Assessments to view the assessment forms including DOPS and PBAs