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PROGRAM ŠPECIALIZAČNÉHO ŠTÚDIA V ODBORE
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PROGRAM ŠPECIALIZAČNÉHO ŠTÚDIA V ODBORE

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  • 1. PROGRAMME OF SPECIALISED TRAINING STUDY IN THE FIELD OF NEUROSURGERY a) Characteristics of specialised field and the length of specialised training Neurosurgery is an independent field which deals with complex diagnostics and surgical treatment of nervous system including suspensory structures (skull, backbone) as well as other diseases which is possible to influence by surgical procedure on the parts of nervous system. b) Establishing of the level of education, length and content of professional health practice needed for enrolment into specialised training in specialised field The condition for enrolment to specialised study in specialised field neurosurgery is the graduation of university medical study in study field general medicine (MUDr. - MD). c) The scope of theoretical knowledge and practical skills needed for performance of specialised working activities The scope of theoretical knowledge needed for performance of specialised working activities - anatomy of the brain, spinal cord, periphery nerves, supportive structures (skull, backbone) - and surrounding formations including microsurgical anatomy - neurophysiology – normal and also pathological – central and peripheral nervous system, pathophysiology of blood flow of the brain and spinal cord, intracranial pressure, neurophysiologic data for functional neurological operations (epileptosurgery, treatment of movement disorders, surgery of pain, psychosurgery), - pathological – anatomic and pathophysiological background of the diseases of nervous system with practical management of histological picture of the most important diseases, - pharmacotherapy for diseases of the nervous system, - rehabilitation for nervous diseases, - special characteristics of treatments in patients of different age groups (child age, geriatrics), - appropriate legal provisions related to the field of health care. Scope of practical skills and experience needed for performance of specialised working activities Diagnostic procedures: - clinical neurological examination from neurological point of view - examination of thorax, abdomen and blood vessels on extremities
  • 2. Lumbar and chamber puncture: - independent evaluation of pathological changes on scans of native X-ray examination of skull and backbone, brain angiography, perimyelography, computerized tomography (CT) and magnetic resonance (MR), including their following processing by computer techniques and their usage at an operation, - basic evaluation of neuropathological and neuroophthalmologic results, neurootologic, neurophysiologic (EEG, EMG), ultrasonographic and neuroendocrinologic examination, and examination by positron emission tomography (PET) and its diagnostic use in neurosurgery. Therapeutic procedures: - local and regional anaesthesia, resuscitation of breathing and blood circulation including intubation, tracheotomy, - basic approach into skull and spinal channel: trepanation, craniotomy, partial total hemilaminectomy, laminectomy, - decompressive craniectomy and craniotomy, - treatment of impressive fracture, plasty of dura, - evacuation of chronic subdural collection from trepanation, - external drainage of chamber and subdural space, - drainage operation of hydrocephalus, laparotomy, - puncture of cysts and brain abscess, - special approaches to interior of skull and spinal channel: approaches through cranial base (transfenoid approach, combined presigmoid supra-infratentorial approach, orbitozygomatic craniotomy, transfacial approach, front approaches to cervical backbone), - removal of hernia intervertebral disc, - operation of intradural and extradural tumours, - corpectomy and fixation spinal operations, - removal of extracerebral and intracerebral post-traumatic intracranial haematoma and expansive contusion of brain, - fascicular microsuture of injured nerve using transplantate, - deliberation of peripheral nerves at isthmus syndromes, - plastic operations of calva, post-traumatic defects and inborn malformations (dyscrasia), - surgical solution of cleft disorders of backbone, - removal of a tumour from the brain including from functionally important parts of the brain and base of the skull, use of neuronavigation, - surgical treatment basic of aneurysms of brain arteries and arterio-venous malformations, - principles of functional and streotactic neurosurgery (epilepsysurgery, surgery of pain-rizotomy, drezotomy, myelotomy, neurostimulation, surgical performances at neuralgy of head nerves, intrathecal application of medicines, treatment of motoric and psychical disorders), - basic principles of radiosurgery, - assessment activity
  • 3. Minimal numbers of required procedures: Adults Head injuries 47 Trepanation opening, chamber drainage /ICP monitoring/ reservoir 15 Chronic subdural haematoma 10 Craniotomy– epidural /subdural/intracerebral haematoma/ contusion 10 Impressive fracture of calva 5 Cranial base plasty (liquorea) 2 Cranioplasty 5 Supratentorial tumours and other expansive processes (except stereotactic procedure) 40 Intracerebral tumours – primary/metastatic 30 Meningiomata 8 Other benign lesions (epidermoids, arachnoidal cysts etc.) 2 Lesions of posterior cranial fossa 7 Primary and metastatic tumours 3 Chiari malformation 2 Other benign lesions (epidermoid, arachnoidal cyst, Hypple Lindau etc.) 2 Infections (cranial – spinal) 8 Absces/subdural empyema 8 Vascular diseases 10 Cavernous malformation 2 Haematoma (spontaneous intracerebral/intracerebral) 8 Hydrocephalus (over 15 years) 42 Drainage operation, initial 20 Revision of drainage system 10 Endoscopic fenestration 2 External chamber drainage 10 Backbone 92 Hernia of cervical disc/spondylosis : front decompression/foraminotomy 15 Cervical instrumentation (anterior/posterior) 3 Lumbar discopathy /spondylosis : diskectomy 50 Lumbar discopathy /spondylosis: laminotomy/laminectomy for spondylosis 10 Lumbar discopathy/spondylosis: lumbar instrumentation 5 Spinal tumours: extradural 3 Spinal tumours: intradural extramerular 3 Spinal trauma: decompression/instrumentation 3 Trigeminal and other neuralgies 7 Injections/electrocoagulation 5 Microvascular decompression 2
  • 4. Stereotactic and functional neurosurgery 5 Stereotactic biopsy of tumour 5 Periphery nerves 30 Compressive syndromes/transposition 30 Performance with neuronavigation and neurophysiologic monitoring (no operations) 10 Basic techniques – approaches to inracranium Supratentorial craniotomy 60 Intratentorial craniotomy 8 Children under 15 years Hydrocephalus and inborn malformations 7 External chamber drainage 5 Drainage operations 2 Performance at which the applicant has to assist or perform them partially Craniopharyngeom 5 Adenoma of hypophysis (transsphenoidal and transcranial operations) 10 Vestibular schwanom 10 Complicated menigiomata of cranial base/posterial cranial fossa 10 Aneurysm treated from craniotomy 12 AVM treated from craniotomy 5 Endarterectomy 3 Hernia of thorasic disc 3 Intramedular tumours 3 Talamotomy, palidotomy/stimulating techniques 5 Implantation of intrathectal pump 5 Craniostenosis of one cranial suture 2 Tumours of posterior cranial fossa in children 2 Meningo/meningomyelocele 5 Syndromes of fastening spinal cord 2 Sutures of peripheral nerves (with nervous grafts) 3 d) Organizational form of specialised study Specialised study in specialised field neurosurgery lasts 6.5 years. The forms of tuition are theoretical and practical part. Specialised study is finished by specialised examination, the part of which is defence of written work. e) Scope and specialisation of professional health practice done at particular workplaces; its minimal length and schedule
  • 5. Practice involves: 54 months of clinical neurosurgery at neurosurgical teaching workplace of health centre, 3 months of neurointensive care at the workplace of anaesthesiology and intensive medicine, 6 months of general surgery, 3 months of traumatic surgery or orthopaedics, 3 months of other surgical fields and cross-boundary disciplines with neurosurgery (ORL, stomatosurgery, anaplasty), 3 months of clinical neurology, 3 months of other disciplines oriented to diagnostics of nervous system systems (neurophysiology, neuroradiology, neuropathology), 1 month of gynaecology and obstetrics, 2 months of internal medicine.
  • 6. Practice involves: 54 months of clinical neurosurgery at neurosurgical teaching workplace of health centre, 3 months of neurointensive care at the workplace of anaesthesiology and intensive medicine, 6 months of general surgery, 3 months of traumatic surgery or orthopaedics, 3 months of other surgical fields and cross-boundary disciplines with neurosurgery (ORL, stomatosurgery, anaplasty), 3 months of clinical neurology, 3 months of other disciplines oriented to diagnostics of nervous system systems (neurophysiology, neuroradiology, neuropathology), 1 month of gynaecology and obstetrics, 2 months of internal medicine.