Clinical Objectives
- Develop a comprehensive understanding of the underlying disease state and its non-surgical management
- Comprehend the key criteria for proceeding with surgery
- Technical mastery of the surgery and an expansive knowledge of the literature describing surgical options
- Knowledge and comfort with avoiding and managing potential complications
- Ability to work closely with related clinical specialties, especially Neurology, Pain Management, and Psychiatry
Technical and procedural areas of training include:
- Deep brain stimulation
- MRI-guided focused ultrasound
- Radiofrequency lesioning
- Spinal cord stimulation
- Microvascular decompression
- Stereotactic radiosurgery
- Frame-based stereotactic techniques
- Robotic stereotactic techniques
- Neurophysiology (including MER, ECOG, SSEP)
- Cortical and subcortical stimulation mapping
- Stereoencephalography
- Subdural grid/strip placement
- Responsive neurostimulation
- Laser ablation
- Lobar resection
- Functional hemispherotomy
- Intrathecal therapy
- Cordotomy, tractotomy, myelotomy, dorsal root entry zone lesioning
Surgical Procedure Participation
In a typical 12-month fellowship, the fellow can expect to participate in approximately 350-400 surgical procedures. Each fellow’s experience will differ based on his/her emphasis, but rough numbers of index cases are as follows:
Movement Disorders
- DBS (new implants): 75
- MRgFUS: 15
Epilepsy
- Diagnostic intracranial implants: 20
- Resection surgeries: 20
- Neuromodulation implants: 30
Pain
- SCS (new implants): 30
- IT pumps (new implants): 30
- Facial pain procedures: 20
Psychiatric
- DBS (new implants): 10
- Lesion procedures: 5
Research
Early within the fellowship year, fellows develop an area of scientific focus in collaboration with faculty. Faculty will help identify one to two specific projects and set a timetable of achieving milestones towards the completion of those projects, including literature review, experimental design, data collection and analysis and manuscript production. Fellows are provided ample time to pursue these research interests. The expected goal is to have a body of research that can be presented at a national meeting and that will be publication-ready by the end of the fellowship year.
Hospitals
Fellows have the opportunity to see patients and perform stereotactic/functional cases within the following hospitals affiliated with BCM:
- Baylor St. Luke's Medical Center
- Texas Children’s Hospital
- M.D. Anderson Cancer Center
- Michael E. Debakey Veterans Affairs Medical Center
- Ben Taub Hospital
Clinical Responsibilities
Fellows are expected to attend the neurosurgical procedures and outpatient clinics to which they are assigned. These assignments are made on a monthly basis in consultation with the fellow. They are also expected to round daily on the inpatients with whom they have been involved. In all of these settings, they are under the ultimate supervision of the faculty member responsible for the respective patient.
Resident Training
Neurosurgical resident training is the educational priority of the Department, and fellows enrich the resident training experience. The Neurosurgery Residency Program at Baylor College of Medicine has 23 residents in 2020-2021 and is expected to grow to 28 over the next years, whereas there is a single Stereotactic/Functional fellow. Case assignments are the responsibility of the chief resident of each hospital rotation. The fellow’s role for each surgical procedure depends on the technical aspects of the procedure and the experience level of the resident assigned to the case (if one is assigned). This arrangement ensures both that the resident receives appropriate experience and that the fellow continues developing supervisory experience. A significant portion of the fellow's education occurs outside the operating room - in surgical management conferences, clinic, and in planning cases - arenas in which residents typically are not present.
Conferences
Fellows are expected to attend clinical conferences devoted to the management of stereotactic/functional patients, including Epilepsy Conference (weekly), Movement Disorders Conference (monthly), and Psychiatric Neurosurgery Conference (periodically). They are also invited to attend research/scientific conferences and lab meetings based on their interests.
