Transcranial Doppler Course

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Transcranial Doppler Course

  1. 1. David Geffen School of Medicine at UCLA Neurosurgery Residency Program Division of NeurosurgeryDavid Geffen School of Medicine at UCLA Box 956901 Los Angeles, California 90095-6901
  2. 2. Table of Contents Message from the Chief The UCLA Division of Neurosurgery has a long rich history of innovation and neurosurgical training. From its inception, the division 1. Message from the Chief has been at the forefront in epilepsy surgery, stereotactic surgery, and the treatment of cerebral aneurysms with embolic materials. Todays division continues to be an innovator in cerebrovascular disease, epilepsy 2. History of the Division surgery, and stereotactic surgery, but has also expanded to make significant contributions to new developments in head trauma, 4. Faculty neuronavigation, and interventional MRI guided surgery. The division is also developing the neurosurgical 5. Clinical and Research Programs technologies of the future including clinical trials in tumor immuno- therapy and intraoperative 7. Neurosurgical Training optical imaging. At UCLA, we are committed 13. Hospitals in Rotation to maintaining the most current neurosurgical equipment and tech- niques as well as actively pursing 20. Additional Information the development of future trends. This environment is perfect for preparing residents to step into the future as practicing neurosurgeons. We are committed, first and foremost, to resident education and have been able to effectively utilize the research and development at UCLA to further this goal. The majority of UCLA Neurosurgery resident graduates go on to either a subspecialty neurosurgical fellowship position or directly into an academic neurosurgical position due to an environment of national experts and cutting edge research. This same environment attracts academically oriented applicants and encourages the pursuit of academic neurosurgery. I am excited to train the neurosurgery leaders of tomorrow and to have the opportunity to lead such a strong program into the Twenty-first Century. Neil A. Martin, MD Professor and Chief, Residency Training Director Division of Neurosurgery David Geffen School of Medicine at UCLA 1
  3. 3. History of the Division Dr. Neil A. Martin became Chief of UCLA Division of Neurosurgery The David Geffen School of in 2001 following a lengthy tenure as a prolific faculty member. He completed Medicine at UCLA Neurosurgery his residency training at the University of California, San Francisco and Residency Training Program began on fellowship training in neurovascular surgery at the Barrow Neurological the main Westwood campus in 1955 Institute. Dr. Martin is a strong advocate for research and academic neuro- with Dr. W. Eugene Stern as the first surgery and has, himself, published over one hundred fifty peer-reviewed chairman. Well regarded as an excellent articles and chapters on topics including neurovascular surgery, neurosurgical clinical training program, UCLA intensive care, and brain trauma. As a faculty member at UCLA and helped pioneer the use of the operative Director of the Neurovascular Surgery Program, Dr. Martin has been microscope, cryothalamotomy, and instrumental in the development of a cerebral blood flow laboratory, the embolization of intracranial nationally recognized UCLA Stroke Center, and a state of the art neurosurgical aneurysms. The university, with strong ancillary facilities, became an early intensive care unit. He has personally been involved in the design of many leader in the surgical treatment of epilepsy and in the development of aspects of the 2004 Westwood Replacement Hospital and a hospital wide microvascular decompression for trigeminal neuralgia. digital record system that allows access to patient records, clinical imaging, and real time ICU vital sign monitoring on personal digital assistant devices. Dr. Donald P. Becker became the Division Since his inception as Division Chief, Dr. Martin has overseen the growth of Chairman in 1985. To develop a the UCLA Spine Program including the recruitment of a minimally invasive Neurosurgery Center of Excellence, Dr. spine surgery expert and the expansion of the Neurosurgery Division to the Becker created a divisional programmatic Santa Monica-UCLA Medical Center for the development of a new Spine approach recruiting sub-specialists from Center. With a new hospital and state-of-the-art the United States and around the world. technology, Dr. Martin is committed to The faculty grew, as did the caseload. This keeping the UCLA Medical Center growth resulted in two residents being Division of Neurosurgery at the accepted into the program each year. In cutting edge of neurosurgical addition to developing a highly academic science and practice. and active clinical service, Dr. Becker also promoted a strong basic research foundation for the division with the purpose of encouraging the training of academic neurosurgeons. Under Dr. Beckers guidance, the program has grown in national prominence to the point of being named the eighth best neurosurgery program in the country in 2002 by the publication U.S. News & World Report.2 3
  4. 4. Neurosurgery Faculty Clinical and Research Programs Ulrich Batzdorf, MD Daniel F. Kelly, MD Skull Base Surgery Professor Associate Professor Director, Spinal Disorder Program Director, Pituitary Program The Benign and Skull Base Tumor Program focuses on resection of tumors at the skull base and makes use of advanced image guidance, minimally invasive Donald P. Becker, MD Larry T. Khoo, MD techniques, evoked potential monitoring, and intraoperative MRI. Over 2000 Professor Assistant Professor cases have been done in the last decade. Director, Brain Tumor Program Co-Director, Comprehensive Spine Program Director, Benign & Skull Base Tumor Program Jorge Lazareff, MD Surgical Epilepsy Marvin Bergsneider, MD Associate Professor Associate Professor Director, Pediatric Neurosurgery Program The Epilepsy Surgery Program is a key component of the UCLA Director, Hydrocephalus Program Comprehensive Epilepsy Program having treated intractable lesional and Director, iMR Program Co-Director, Neuroendoscopy Program Stefan Lee, PhD non-lesional epilepsy over the past thirty years. Invasive electrode monitoring Assistant Professor and pinpoint accuracy using functional MRI and brain stimulation permits a Co-Director, Neurotrauma Laboratories Antonio De Salles, MD, PhD high cure rate and high quality of life measures. Professor Director, Stereotactic, Radiosurgery, Linda Liau, MD, PhD & Functional Program Associate Professor Director, Malignant Brain Tumor Program Cerebrovascular Surgery Over the last fifteen years, UCLA neurovascular surgeons, along with Fredric I. Edelman, MD Associate Clinical Professor Neil A. Martin, MD colleagues in interventional neuroradiology and stereotactic radiosurgery, Director, Peripheral Nerve Program Professor & Chief have treated more than 4000 aneurysms, arteriovenous malformations, cervical Program Director, Residency Training Program Director, Neurovascular Program and intracranial atherosclerosis. The use of awake carotid endarterectomy, Avner L. Feldman, MD Co-Director, UCLA Stroke Center image-guided stereotaxis, neuro-endoscopy, intraoperative angiography, and Associate Clinical Professor Director, Clinical Education Program intraoperative MRI permits minimally invasive surgery with unsurpassed Gary W. Mathern, MD results. Assistant Professor John G. Frazee, MD Co-Director, Pediatric Neurosurgery Clinical Professor & Seizure Disorder Program Director, NeuroEndoscopy Program Pediatric Neurosurgery Duncan Q. McBride, MD Pediatric Neurosurgery is a multidisciplinary program providing compre- Itzhak Fried, MD, PhD Associate Professor hensive services to children suffering from epilepsy, brain tumors, hydro- Professor Chief, Harbor/UCLA Dept. of Neurosurgery Director, Adult Epilepsy Program cephalus, spinal malformations, neurovascular disorders, and craniofacial Co-Director, Seizure Disorder Program disorders. Val Nenov, PhD, PhD Associate Professor Christopher Giza, MD Director, Brain Monitoring Assistant Professor & Modeling Laboratory Functional Neurosurgery and Stereotactic Radiosurgery Pediatric Neurosurgery and Neurology UCLA is the first center in the United States to use a dedicated Novalis Tien Nguyen, MD Varian SR600 unit for Shaped Beam Surgery, stereotactic radiosurgery, and Fernando Gomez-Pinilla, PhD Assistant Professor Associate Professor Harbor/UCLA Dept. of Neurosurgery radiotherapy. This permits much less radiation to surrounding normal tissue Neurotrophic Factor Research than other methods. We have over ten years of experience with deep brain stimulation and other techniques for Parkinson’s disease and other move- Langston Holly, MD Paul M. Vespa, MD ment disorders. Assistant Professor Associate Professor Comprehensive Spine Program Director, Neurocritical Care Program Spinal Surgery David A. Hovda, PhD The Comprehensive Spine Program uses minimally invasive techniques Professor Director, Brain Injury Research Center Program like endoscopic laminectomy, as well as complex reconstructive spinal instrumentation, to treat cervical, thoracic, lumbar, and sacral spine due to degenerative, congenital, traumatic, neoplastic or infectious origins. We feature a thirty-year experience in treating syringomyelia, spinal cord tumors, arteriovenous malformations, and other complex spinal disorders.4 5
  5. 5. Clinical and Research Programs (cont.) Neurosurgical Training The rotations of the UCLA neurosurgery residency have been designed and organized to maximize resident education while providing Peripheral Nerve Surgery enough flexibility for the individual resident to explore specific neurosurgical The Peripheral Nerve Surgery program boasts a twenty five-year experience in interests. The rotation schedule is built around a set progression of four to treating surgical disorders of the brachial plexus, lumbosacral plexus, and six-month clinical neurosurgical rotations. The sequence of rotations has been peripheral nerves that originate from injuries, compression syndromes, and tumors. MR neurography, endoscopic surgery, outpatient surgery, and directed developed to allow the resident gradually increasing levels of responsibility nerve blocks are a few of the advanced treatments available. and technical skill in various clinical situations. Following the second year, the two to three residents in the same class are staggered by four to six months, with one following the other in clinical neurosurgical rotations, so the exact Brain Trauma and Neurocritical Care time in which each resident does each rotation may vary by four to six months. The UCLA Brain Injury and Neuro-critical Care Program provides comprehensive care for brain trauma, subarachnoid and stroke patients. We feature a state-of- the-art neuro-intensive care, continuous EEG and TCD monitoring, brain oxygen First and Second Years monitoring, and positron emission tomography. An internationally recognized program in basic and clinical research has focused on development of new The rotation schedule begins with the internship year. This year is treatments for brain injuries for the past fifteen years. important in developing basic patient care concepts and surgical skills that apply across multiple subspecialties as well as introducing the trainee to the expectations and responsibilities accompanying surgical training. Each intern Malignant Brain Tumor Program rotates on several general surgery and surgery subspecialty services. Of special The Malignant Brain Tumor Program offers a thirty-year experience in the interest to the neurosurgical intern are the two neurosurgery rotations, one at comprehensive, multidisciplinary approach to malignant brain tumors. A team UCLA and one at the VA. The UCLA rotation is important in learning the care of neurosurgeons, neuro-oncologists, radiation oncologists, neuropathologists, of neurosurgery inpatients and understanding the organization and culture of and interventional neuroradiologists conducts advanced treatment plans and the service. The VA rotation is an research protocols. opportunity to gain more neuro- surgery operative experience. The Neuro-endoscopy other notable intern rotation is Neuro-endoscopy utilizes small endoscopes to perform many microsurgical trauma surgery during which the operations on the brain and spine. Disorders such as hydrocephalus, third neurosurgery intern gains skills ventricular tumors, intracerebral hemorrhage, herniated discs, and pituitary and knowledge concerning the tumors have been treated using endoscopy at UCLA for the past ten years. trauma suite and care of the trauma patient that will serve h/him well Pituitary Surgery in h/his second year. The intern call schedule is in-house Q3 to Q6 The UCLA Pituitary Tumor and Neuroendocrine Program features minimally depending on the rotation. invasive techniques to treat pituitary tumors. A fifteen-year experience has molded a diverse team of specialists in Neurosurgery, Endocrinology, Radiosurgery, Neuro-Ophthalmology, and intraoperative MRI to treat pituitary The second year is devoted entirely to the neurosurgery service tumors. at the Westwood Campus. During this year, the neurosurgery resident shares responsibility with the attending surgeon for the intensive care unit patients, consults (including trauma and other emergency room consult), and the pediatric patients. Residents also gain a great deal of operative experience in this year. It is common for second year residents to operate most or all working days of the week. A resident will typically participate in over 300 cases in the second year with gradually increasing involvement in each case until the resident, working under the attending surgeon, is in charge of the majority of trauma patients and [other] straightforward cases. To insure that this does not detract from the important critical care and6 7
  6. 6. trauma education, there are daily neuro critical care rounds and weekly neurosurgery trauma rounds. The second year call schedule is in-house Chief Years Q3 – Q4. There is a six-month block for non-neurosurgical rotations, research, On a rotational basis, each second-year resident, with direct attending or elective rotations after the senior year. This block is followed by the three oversight, has sole responsibility for the neurosurgery pediatric/spine/ chief rotations at the VA, Harbor and UCLA and usually with a break of six functional services, the tumor/epilepsy services, and the vascular service. This months. The chief resident rotation at the VA is much like a private practice. period of time in the second year is specifically for learning neurosurgical and The chief has one intern and is solely responsible for running the service patient care skills in each of these neurosurgery subspecialty services. providing the first opportunity for independent decision-making concerning patient care and the indications for surgery. The chief resident under the Third and Fourth Years guidance of the attending staff makes decisions for clinic patients and inpatients and is the primary surgeon under the attending surgeon in almost The third, and sometimes half of the fourth, year is spent on non- all of the cases. The chief resident at the VA is first back-up call from home neurosurgical rotations or research. These non-neurosurgical rotations and for the entire six-month period, but calls are infrequent and emergencies are the research opportunities at UCLA will be discussed later. Every attempt is rare. made to place the residents in non-neurosurgical rotations immediately after the second year rather than directly into a research rotation so that the residents The chief resident at Harbor has similar responsibilities as the VA have time to develop research project proposals and apply for grants if chief resident but with some key differences. The neurosurgical team is larger, applicable. This is resident dependent and can be negotiated by residents the hospital is a level one trauma center so it is usually a busier service, and who are industrious in research planning during the second year. The resident the chief resident has responsibility for teaching the senior neurosurgery will typically have responsibility for Q6 in-house call during six months of resident on h/his service both surgical techniques and patient care. At this this period. point, the chief residents level of proficiency allows h/him to do the most complex cases with guidance from the attending surgeon and to take the The fourth year or half of fourth and fifth years are spent in two senior resident through cases appropriate to the senior level. The chief resident senior rotations of six months each, first at Harbor and then at UCLA. At is second back-up call from home two of three nights and first back-up call Harbor, the senior works closely in a team with the chief resident supervising the third night. The chief resident typically becomes involved any time a two interns and running the neurosurgery service. During this rotation, the patient goes to the operating room. senior resident is in the operating room on three scheduled days a week and, under the supervision of the attending surgeon, participates on all emergency The chief resident rotation at UCLA is the final rotation. During this surgical procedures together with the chief resident. The senior resident rotation, the chief resident has the opportunity to lead a large team at a major gains more operative skills and learns how to supervise lower level trainees medical center including neurosurgery residents at the senior and junior levels, in an environment that is not as busy as UCLA. As senior resident at UCLA, two surgical interns, nurse practitioners, ICU fellows, and rotating medical the resident is in the operating room almost every day and is responsible, students. At this point, the chief resident is able to fine tune his surgical skills together with the junior resident, for reviewing every consult with the attending and obtain experience in surgeries only seen at a tertiary medical center with surgeon. The senior resident at UCLA is the first assistant surgeon, working a large regional referral base. With rare exceptions, the chief resident is the directly under the attending surgeon, in the majority of cases in which s/he first assistant to the attending surgeon on all cases in which he or she partici- participates, and s/he teaches the junior residents basic neurosurgical pates. Teaching responsibilities at this level include medical student, intern, techniques including trauma surgery. This rotation can be busy but is essential and junior resident teaching during rounds and teaching the junior residents in making the transition to mature decision-making and proficiency in surgical basic opening and closing skills in the operating room. Graduating chief skills required of a chief resident. The senior resident will typically participate residents have typically completed over one thousand cases during their in over one hundred surgical cases at Harbor and around two hundred cases residency. The chief resident is second back-up call for the four-month at UCLA. The residents in-house call responsibilities for the entire residency rotation, but is seldom called unless there is an interesting case in which he or are completed by the time the senior rotations begin. The senior resident at she may want to participate. Harbor is first back-up call from home two out of three nights; and, the senior resident at UCLA is first back-up call from home for the entire six-month rotation except for days off.8 9
  7. 7. Non-Neurosurgical Clinical Rotations brain tumor immunotherapy, now in clinical trials, was developed. There is an active cerebral blood flow laboratory with ongoing projects in subarachnoid There are several clinical rotations required or recommended for hemorrhage and ischemia. Clincal and basic science studies of epilepsy board certification that are included in the residents schedule between the include cerebral microdialysis during phase two monitoring and seminal neurosurgical rotations outlined above. These rotations are a three-month studies of hippocampal physiology using animals and human surgical neurology rotation, two months of neuroradiology, and two months of neuro- specimens. The neuroendocrine program is actively investigating the impact pathology. There is also a two-month rotation in radiosurgery, stereotactic, of head trauma on pituitary function. and functional neurosurgery including experience in surgery for movement disorders and pain. This is a neurosurgical rotation but is scheduled indepen- Two new state of the art laboratories have been developed with the dently from the other neurosurgical rotations because many of the procedures collaboration of industry. Within the Division of Neurosurgery, the skull base occur at the UCLA Outpatient Center allowing for more focused learning of and spine laboratory has all the equipment of a full operating room including these techniques by the resident. BrainLAB neuronavigation. This laboratory has been used for investigation of novel cranial base approaches, endoscopy research, and research of the use of neuronavigation for spinal instrumentation. The laboratory is currently Research being equipped for research on minimally invasive spine surgery. The Department of Surgery has recently opened a new laboratory dedicated to Residents have a minimum of one year of research time either in one research and training of minimally invasive and robotically assisted surgery. block or split into two six-month periods. Individual residents may choose to do more research time by utilizing non-clinical elective rotations in the later The UCLA Brain Research Institute is a multidisciplinary research years for research. The research block typically occurs after the second year. institute interested in normal and pathologic brain development and function. Opportunities exist for residents, with a well-developed research plan, to Residents are encouraged to explore their individual research collaborate with the Brain Research Institute or virtually any department in interests during this time. Each resident is required to write a formal research the university for their research time. proposal prior to the start of the project and submit a minimum of one paper to a national peer-reviewed journal following the rotation. Residents are encouraged to apply for research Elective Rotations grants; however, obtaining a research grant is not required for There is usually a six-month rotation, not specifically designated for doing the research rotation. one of the rotations outlined above, within each residents rotation schedule. The resident has the opportunity to select a specific educational opportunity There are several research pro- for this time period as long the goals and responsibilities of the six-months grams with total funding by the are explicitly outlined in writing. Usually, residents use this time to continue NIH and other sources of millions working on a successful research project or to do clinical work with an of dollars within the Division of individual attending or group of attendings in a specific subspecialty of inter- Neurosurgery. Many opportunities est. Additionally, this has been a time when residents have done an elective to collaborate with other laboratories rotation at Santa Monica-UCLA Medical Center in spine surgery and spinal throughout UCLA, an institution instrumentation. Because the Division of Neurosurgery at UCLA has nation- known for its cutting edge neuro- ally recognized experts in nearly every neurosurgical subspecialization, science, also exist. The Brain Injury fellowship rotations at outside institutions are not encouraged. However, the Research Center is the largest research program within the Division of division recognizes that individual residents may want to gain an outside Neurosurgery. This research program has robust funding and many basic perspective on a surgical subspecialty; therefore, residents who obtain their science and clinical investigators. There are both clinical and basic science research projects that include topics of post-concussive hyperglycolysis and own funding for this period are usually granted permission to do a six-month excitotoxicity. rotation in a nationally recognized subspecialty fellowship. The division has an active brain tumor research laboratory in which10 11
  8. 8. Operative Experience Conferences UCLA and its’ affiliated hospitals provide the neurosurgical Wednesdays are set aside for conferences. The residents typically residents with more than a sufficient number of cases for their training. With operate in the morning, and then leave surgery in the afternoon to attend a strong community and referral base of unique and interesting cases, the conferences. Mandatory weekly conferences include a morning clinical operative experience continues to grow. The graph below demonstrates the conference in which cases and operations are presented and discussed, neuro- number of major operative neurosurgery cases at UCLA and affiliated hospitals. trauma/neuro critical care conference, and clinical ward teaching rounds. 2500 2000 Number of Cases 1500 Santa Monica VA Harbor 1000 UCLA 500 Following these conferences, there are a variety of other mandatory weekly 0 conferences including neuroradiology, neuropathology, basic science neuro- 1998 1999 2000 2001 2002 Academic Year surgery board preparation course, clinical specialty conference, and journal club. In addition, visiting professors are invited to the division several times a year for a Clinical Neurosurgery Symposia. Typically two talks are given and clinical cases discussed with the residents over the course of the day. Quality The following graph is a breakdown of a recent graduates residency Assurance Conference is held once a month during the morning conference operative caseload. Of these cases, the resident claimed 75% as primary time. surgeon. This case distribution and level of involvement is exemplary of the experience gained by UCLA neurosurgery residents. Resident Evaluations The faculty evaluate the residents two times a year. Each faculty 7% Spine member completes an independent, written evaluation of each resident. A 3% 1% 4% 30% Tumor group of three faculty members, including the division chief, review all the 6% Vascular evaluations and compile them into a single statement that is discussed with Pediatric the resident during a biannual meeting with the residency director. Trauma CSF Shunt The residents anonymously review the program and faculty annually 8% Epilepsy following a written format. The residents participate in a retreat once or Stereotactic twice a year to provide feedback about the program in a group format. This 8% 21% Peripheral Nerve retreat is conducted to continually improve the learning environment in the 12% Other division.12 13
  9. 9. Hospitals surgeries. The spine program is involved in all aspects of operative spinal pathology including spinal instrumentation and minimally invasive spinal surgery. In addition, UCLA has very active pediatric neurosurgery, neuro- David Geffen School of Medicine at UCLA endoscopy, hydrocephalus, and pain surgery programs to round out the resident education. UCLA is a Level-One Trauma Center and a major center for neuro- trauma research with significant funding from the N.I.H. and the State of California. Because of strict regional trauma center territories, this does not translate into a greater volume of head trauma, but it does mean that there is better care for the head trauma patient and more support available to the residents in caring for the head trauma patient. UCLA Replacement Hospital The David Geffen School of Medicine at UCLA main campus is located in the beautiful community of Westwood, contiguous with the UCLA main campus. The 644 bed medical center is a major tertiary referral center for the West Coast. U.S. News & World Report has rated UCLA as "Best in the West" among major medical centers and fifth in the country for overall medical and surgical subspecialty programs. All major neurosurgical subspecialties are well represented at the main campus. The medical center has all the latest advances in neurosurgical technology including two intraoperative MR suites, BrainLAB neuronavigation, and Novalis stereotactic radiosurgery equipment allowing the residents to be trained in cutting edge technology. UCLA has developed a regional stroke center that takes a multi- disciplinary approach to neurovascular disease, incorporating neurovascular Following the 1994 Northridge earthquake, UCLA was given a state surgery, world-class interventional neuroradiology, and neurology. Numerous mandate as well as state and federal funds for building a new hospital. The skull base procedures are performed, sometimes in coordination with 2004 UCLA Westwood Replacement Hospital across the street from the colleagues in head and neck surgery and opthomology. There are several original hospital is a state-of-the-art facility that incorporates the most clinical and research programs dealing with malignant, benign, pituitary, and advanced concepts in inpatient care. The hospital is designed for 590 beds, metastatic brain tumors within the division. each in a private room. Almost all of the rooms are able to be converted into an ICU, monitored, or unmonitored inpatient bed as hospital needs change The epilepsy surgery program has a strong foundation in both adult on a daily basis. There is an invasive floor that integrates the operating and pediatric populations spanning decades of experience and including rooms, including an interventional MR operative suite and interventional multiple N.I.H. funded research projects. Many stereotactic surgeries are radiology suites. The new computerized medical record system is accessible performed at UCLA including stereotactic radiosurgery and movement disorder to handheld personal digital assistant devices.14 15
  10. 10. resident. Several unique disease entities are encountered at Harbor not seen Harbor - UCLA Medical Center as often at other institutions; one such pathology is central nervous system involvement by cysticercosis. Treatment of these patients is often complex and frequently requires neuroendoscopy or other innovative techniques in their management. West Los Angeles V.A. Medical Center Residents receive excellent training in a county hospital environment at Harbor-UCLA Medical Center, a 530 bed hospital located in the South Bay community of Torrance, 22 miles south of the main UCLA Medical Center. Approximately 200-400 operations and 100-300 procedures are performed annually at Harbor. This caseload is quite diverse as to the types of cases with approximately 50% intracranial, 40% spine, and 10% shunts, peripheral nerve, etc. Longitudinal patient care is an advantage of the Harbor rotation The West Los Angeles Veterans Administration Medical Center is a since residents evaluate patients pre-operatively in the clinic or the emergency 288 bed hospital located two miles west of the main UCLA Medical Center room, make the diagnosis, participate in the surgery and inpatient hospital and is the southwest referral center in neurosurgery for the Veterans care, and follow-up post-operatively in clinic to evaluate the patients Administration. Cases are referred from around Southern California and progress. occasionally from out of state. The medical center has active clinical trials in the treatment of movement disorders with deep brain stimulation. Residents receive strong training in neurovascular surgery, neuro- endoscopy, and spinal instrumentation. There is particularly strong training The six-month period as chief resident at the Veterans in intracranial aneurysm surgery. Neurosurgery actively collaborates with the Administration Hospital helps the resident hone skills in spine surgery, endocrine division in the treatment of pituitary tumors giving residents a firm including complex spinal instrumentation. Approximately 60% of the 150- foundation in the transnasal transsphenoidal approach. Head injury protocols 350 surgical procedures performed annually at the V.A. are spine cases. The are coordinated with the main UCLA campus as part of the N.I.H. funded generally older patient population of the V.A. gives additional experience in clinical research. The head trauma experience is plentiful without being over- the difficult management of chronic back problems, degenerative disk disease, whelming. As Harbor is a Level-One Trauma Center, the responsibility of and movement disorders. trauma patient care is shared with a dedicated trauma surgery team from the Harbor General Surgery Residency Program. Neuroendoscopy also has had an important role in the training program at the V.A. Residents obtain experience in endoscopic navigation The county hospital environment also develops decision-making from intraventricular exploration in hydrocephalus to transnasal trans- skills and autonomy by helping to season residents in their six-month senior sphenoidal exploration during pituitary adenoma resection. rotations, and by polishing their skills during their six-month rotation as chief16 17
  11. 11. Santa Monica - UCLA Replacement Hospital Santa Monica - UCLA Medical Center In a similar situation to the Westwood Campus, UCLA received a Santa Monica-UCLA Medical Center is a 337 bed, acute care medical state mandate as well as state and federal funds to replace the Santa Monica center located four miles west of the main UCLA Medical Center. In 1995, Hospital after the Northridge earthquake. The result is the 2005 Santa UCLA Healthcare acquired the medical center; and, today it serves as the Monica-UCLA Replacement Hospital, a 266 bed hospital constructed on cornerstone of UCLA Healthcares Primary Care Network, providing high- the same site as the original Santa Monica-UCLA Medical Center. This hospital quality primary and specialty care to the Westside community. will function in collaboration with the Los Angeles Orthopaedic Hospital that will relocate its inpatient services to Santa Monica-UCLA Medical Center. With In 2000, the Division of Neurosurgery at UCLA began shifting some a combination of orthopaedic and neurosurgical services, Santa Monica-UCLA of its spine surgery practice to Santa Monica-UCLA Medical Center. This was Medical Center is the headquarters of UCLAs developing multidisciplinary done to expand the program and facilitate access to more patients in the spine surgery program. Westside community. Currently, the division does over sixty cases a year at the Santa Monica-UCLA Medical Center including basic spine surgery, spinal instrumentation, and minimally invasive spine surgery. This number continues to grow. Resident involvement typically occurs during a clinical elective rotation block during which a resident may choose to gain more focused experience in spine surgery.18 19
  12. 12. Questions / Further InformationAdditional Information Recreation Los Angeles is conveniently located near a variety of sports, recre- For further information regarding the residency program, please contact: ation, and cultural opportunities. Big Bear Mountain, a two-hour drive from L.A., offers excellent conditions for skiing or snowboarding. The Pacific Administrative Director Ocean, five miles west of the UCLA campus, offers opportunities in a wide Division of Neurosurgery Education Program variety of water sports. Weekend trips to Santa Barbara, Catalina Island, David Geffen School of Medicine at UCLA Palms Springs, and Mexico are very short drives. There are year-round con- Box 957039 certs at the Dorothy Chandler Pavilion, the New Disney Concert Hall, and Los Angeles, California 90095-7039 UCLAs Royce Hall and seasonal outdoor concerts at the Hollywood Bowl. Numerous amusement parks, movie studios, and sporting events are also Telephone 310.794.7362 close by for entertaining visiting family and friends. FAX 310.267.2707 Housing Low rent, university owned housing is available for house staff and faculty. The Westwood neighborhood in which UCLA is located and the entire west side of Los Angeles remain some of the nicest neighborhoods in the Los Angeles region. There are many apartments within walking distance of the university and medical center. Miscellaneous Residents are given four weeks of vacation per year except in the second and third years in which they receive two and six weeks of vacation respectively. Contingent on the yearly budget, the division has traditionally provided the individual incoming junior residents with a gift of operative magnification loupes. Also, the division has generously provided residents with a holiday gift of book funds to be used to build each resident’s personal neurosurgical library. Residents begin taking the American Board of Neurological Surgery written exam for self-assessment in their third year and usually take the exam for credit in their fifth year. The division typically sends each resident to a formal board preparation course on the year that s/he takes the written neu- rosurgery board exam for credit. Almost all of the residents from the UCLA Division of Neurosurgery have obtained scores well above the fiftieth per- centile on the national neurosurgery board exam in the year that they took it for credit. The majority of resident graduates from the UCLA Division of Neurosurgery have gone into academic practices. There is a concentration of resident graduates in California, but many graduates have taken positions in communities throughout the United States and some internationally. 21

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