Program Goals and Objectives
The functional neurosurgery fellowship has been designed to train neurosurgeons in all aspects of neuromodulation including spinal cord stimulation, intrathecal pumps, deep brain stimulation, and focused ultrasound. At the conclusion of the program, the fellow should feel comfortable establishing his/her own center in an academic and/or non-academic setting. The fellow should be able to care for neuromodulation patients pre-, intra-, and postoperatively.
The fellow will achieve competence in the following specific areas:
1. Indications for surgery, and preoperative neurologic evaluation, in patients with Parkinson’s disease, dystonia, tremor, chronic pain, and spasticity.
2. Interpretation of preoperative data including neuropsychological evaluation, ON/OFF testing, trial films and data.
3. Collaboration with referring MDs, neurologists, psychologists, trialing physicians, and device representatives.
4. Preoperative planning for surgery including MRI-based target localization for DBS surgery, determination of “sweet spot” for spinal cord stimulation surgery and selection of proper dosing for pump placement, pain management in collaboration with anesthesiologists.
5. Use of physiological localization (microelectrode recording/macrostimulation) in the thalamus, subthalamic nucleus, and globus pallidus internus for DBS; use of somatosensory evoked potentials and motor-evoked potentials for SCS.
6. Use of image-guided DBS (MER/MRI).
7. Placement of neuromodulation hardware and management of hardware-related complications.
8. Collaboration with residents, midlevel providers, nursing staff, radiology staff, and laboratory personnel.
9. Programming of neuromodulation hardware and management of hardware-related complications.
10. Pathophysiology of the basal ganglia in movement disorders and theoretical basis for lesioning and chronic electrical stimulation in movement disorders; pathophysiology of spinal cord stimulation.
11. Demonstrate competency in sentinel literature of neuromodulation through manuscript/presentation preparation and review.
The fellow will understand the basic elements of translational research, including idea generation, IRB/ACUP approval, data collection/analysis, and manuscript preparation. The fellow will have full access to the research group of University of Arizona College of Medicine, which includes a grant writer, clinical research coordinators, biostatisticians, and contract coordinators.
The fellow will generate at least one publication in the area of neuromodulation for the neurosurgery, neurology, or translational neuroscience literature. S/he will present this work to the faculty of the department as a Grand Rounds lecture. It is expected that the fellow will contribute in a meaningful fashion to at least two other publications.
The fellow will have a thorough exposure to human neurophysiology in movement disorders, pain, and spasticity. S/he may opt to spend time in the swine laboratory on a specific project. The fellow will be exposed to, and participate in, active clinical trials. The stereotactic and functional neurosurgery fellow will be expected to have a productive research year, contributing to the existing literature in this field, in addition to his/her clinical and didactic activities.