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32 views93 pages

Syllabus Modules Complete

Uploaded by

Andre Siahaan

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Curriculum - Syllabus Modules

Surgical Education and Training in Neurosurgery

Royal Australasian College of Surgeons & Neurosurgical Society of Australasia

Clinical Neurology

Syllabus Module Overview

Module Rationale

Neurosurgeons must have a thorough understanding of clinical neurology, the disorders that are
appropriate for surgical treatment, and correlation of imaging findings with clinical signs. Prior to
graduation the trainee is required to be able to:

• take a neurological history, perform a neurological examination, and arrive at a well-reasoned

diagnosis
• recognise the usual neurological disorders and differentiate those amenable to surgical treatment
• make clinical decisions and judgements based on sound interpretations of EEG, EMG and other
techniques of applied neurophysiology

Recommended Readings

Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans.

Desirable • Brain's clinical neurology, Bannister

• Principles of neurology, Adams and Victor

References • Differential Diagnosis of Stupor and Coma, Plum and Posner

Learning Opportunities and Methods

• Trainees are strongly encouraged to attend neurology clinical meetings.

• It is beneficial for trainees to attend electrophysiological sessions with neurologists.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Clinical examination skills are an essential component of Fellowship Examination.

SET1 & SET2 Learning Outcomes

Clinical examination
• Demonstrate an ability to undertake a detailed neurological history and examination.
• Present the relevant examination findings to colleagues in a clear and concise manner.

Altered levels of consciousness

• Discuss the anatomical basis for consciousness.
• Discuss the causes of altered levels of consciousness.
• Demonstrate a relevant neurological examination on the unconscious patient.
• Discuss in detail the diagnosis of brain death and the methods of confirming brain death.
• Describe in detail the structure and application of the Glasgow Coma Scale.

Epilepsy
• Discuss the classification of seizures and epilepsy.
• Explain the neurophysiology of epilepsy.
• Discuss the pharmacology of common anticonvulsants.
• Describe the formal recommendations for driving in patients suffering seizures.
• Describe the physiological basis for the EEG.

Updated 18 January 2007 Page 1 of 4

Copyright © Neurosurgical Society of Australasia
Curriculum - Syllabus Modules
Surgical Education and Training in Neurosurgery
Royal Australasian College of Surgeons & Neurosurgical Society of Australasia

Headache
• Discuss the differential diagnosis of headache.
• Describe the clinical features of migraine and the differentiating features from other common types of
headache.
• Differentiate the features of benign headache from those of significant intracranial pathology.

Peripheral neuropathy
• Classify and describe the causes and clinical features of peripheral neuropathies.

Peripheral electrophysiology
• Discuss the physiology of EMG and nerve conduction studies.

Toxic and deficiency disorders of the nervous system

• Describe the more common vitamin deficiencies.
• Describe the effects of alcohol on the nervous system.
• Discuss the clinical management of alcohol intoxication and alcohol

Paraneoplastic syndromes
• Describe the general concepts of the paraneoplastic syndromes.

Extra pyramidal disorders

• List the spectrum of diseases related to basal ganglia pathology.
• Describe the clinical features, pathogenesis and epidemiology of Parkinson's Disease.
• Discuss the uses and limitations of pharmacological therapy for Parkinson's Disease.

Diseases of muscle
• Describe the structure and physiology of normal muscle.
• Describe the common muscular dystrophies.

SET 3 Learning Outcomes

Clinical examination
• Demonstrate development of a comprehensive differential diagnosis based on focussed clinical history
and examination.
• Altered levels of consciousness
• Discuss the anatomical basis and clinical features of persistent vegetative state, akinetic mutism, and the
locked-in syndrome.
• Discuss abnormalities of breathing, pupillary responses, eye movements, and other signs in various
abnormalities of consciousness.
• Discuss the care of the unconscious patient.

Epilepsy
• Discuss the rationale for epilepsy surgery.
• Discuss the level of risk of seizure for neurosurgical disorders and operative interventions.
• Describe the rationale for prophylactic anticonvulsant therapy in various neurosurgical disorders.
• Describe the normal wave patterns present on an EEG.

Headache
• Discuss the theories of pathophysiology of migraine.
• Discuss the general principles of pharmacological treatment of migraine.
• Discuss common headaches such as muscle contraction headaches and occipital neuralgia.

Updated 18 January 2007 Page 2 of 4

Demyelination
• Describe the pathophysiology, epidemiology and clinical features of multiple sclerosis and other forms of
demyelination.
• Describe the imaging findings in multiple sclerosis.
• Describe the CSF findings in multiple sclerosis.
• Discuss the differential diagnosis of multiple sclerosis.

Peripheral neuropathy
• Describe the pathology and clinical features of herpes zoster infection.

Peripheral electrophysiology
• Describe the findings of EMG and nerve conduction studies in lesions of peripheral nerves.

Toxic and deficiency disorders of the nervous system

• Discuss the pathology of Wernicke's encephalopathy.
• Discuss the pathology of subacute combined degeneration of the spinal cord.

Paraneoplastic syndromes
• Discuss the clinical features and theories of pathogenesis of paraneoplastic syndromes.
• Describe the pathology of Eaton-Lambert syndrome and neoplastic ADH production.

Extra pyramidal disorders

• Discuss other extrapyramidal movement disorders, including chorea, hemiballismus, athetosis, and
dystonias.

Diseases of muscle
• Describe the gross and microscopic pathology of common myopathies.
• Describe the clinical features, epidemiology and natural history of inflammatory myopathies.
• Describe the association between inflammatory myopathy and diseases such as SLE, polyarteritis nodosa,
rheumatoid arthritis, and scleroderma.
• Describe the diagnosis, pathophysiology, investigation and treatment of myasthenia gravis.

SET 5 Learning Outcomes

Clinical examination
• Clearly demonstrate detailed and specific findings, such as fourth nerve palsy, internuclear
ophthalmoplegia, and functional signs.

Altered levels of consciousness

• Discuss the physiology of sleep.
• Discuss abnormalities of sleep, including narcolepsy, cataplexy, and sleep apnoea.

Epilepsy
• Discuss patient selection for epilepsy surgery, including investigations and monitoring techniques.
• Describe the different methods of cortical and depth electrode recording for pre-operative and intra-
operative cases.
• Discuss the issues regarding epilepsy and pregnancy.

Demyelination
• Explain the diagnostic neurophysiological findings in multiple sclerosis, including visual evoked potentials.
• Discuss the treatment of multiple sclerosis.
• Discuss the leukodystrophies.

Updated 18 January 2007 Page 3 of 4

Peripheral neuropathy
• Describe the neurophysiological findings in the different neuropathies.

Peripheral electrophysiology
• Describe the findings of EMG and nerve conduction studies in myopathies.
• Interpret the EMG and nerve conduction studies reports for the common compressive neuropathies.

Toxic and deficiency disorders of the nervous system

• Discuss the treatment of toxic and deficiency disorders of the nervous system.

Paraneoplastic syndromes
• Discuss specific paraneoplastic syndromes, including subacute cerebellar degeneration, spinal cord and
dorsal root ganglia syndromes, and peripheral neuropathy.

Extra pyramidal disorders

• Discuss the surgical treatments for Parkinson's disease, including the indications and the effects of lesions
in different sites.

Diseases of muscle
• Describe the infectious and toxic causes of myopathy.
• Discuss the role of muscle biopsy in the diagnosis of myopathies.

SET 6 Learning Outcomes

Epilepsy
• Describe the different types of epilepsy and the underlying neurophysiology, clinical features, and EEG
findings for each.
• Discuss the use of intra-operative somatosensory evoked potentials, motor evoked potentials, and intra-
operative electrophysiological localisation in neurosurgery.

Demyelination
• Discuss the role of biopsy in demyelinating disease.

Peripheral neuropathy
• Discuss the treatments of peripheral neuropathies.

Peripheral electrophysiology
• Discuss the more specialised neurophysiology findings (such as H-waves).

Toxic and deficiency disorders of the nervous system

• Discuss the neurological effects of metal poisoning.

Extra pyramidal disorders

• Discuss the rationale for lesion generation versus stimulator implantation in movement disorder surgery.
• Discuss the use of cell transplant therapy for Parkinson's Disease.
• Discuss emerging treatment modalities for the surgical treatment of movement disorders.

Diseases of muscle
• Discuss the general principles of mitochondrial diseases.
• Describe the endocrine causes of myopathy.
• Describe the general principles of familial and periodic paralysis.

Updated 18 January 2007 Page 4 of 4

Copyright © Neurosurgical Society of Australasia
Curriculum – Syllabus Modules
Surgical Education and Training in Neurosurgery
Royal Australasian College of Surgeons & Neurosurgical Society of Australasia

Trauma

Syllabus Module Overview

Module Rationale
The trainee should have expertise in all aspects of the management of trauma of the head, spine and
peripheral nerves.
Prior to graduation the trainee is required to be able to:
• directly manage all aspects of appropriate care of patients with head injuries, spinal injuries and
peripheral nerve injuries
• manage multiple system trauma

Recommended Readings
Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or
"Neurological surgery" Youmans.
• Brain Trauma Foundation Head Injuiry Guidelines

Desirable • Head Injury, Pathophysiology and Management of Severe Closed Injury" - Reilly
and Bullock (Chapman and Hall Medical, 1997) Raj Narayan

Learning Opportunities and Methods

• RACS EMST Course.
• Trainees are expected to attend and participate in neuroradiology.
• Trainees are encouraged to attend trauma unit meetings in addition to neurosurgery meetings.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Trauma will be examined during the Fellowship Examination.

SET1 & SET2 Learning Outcomes

Head Injuries
• Discuss the classification of skull and facial fractures and the implications for management.
• Describe the effects of impact and acceleration on the brain.
• Discuss investigations and management of CSF, rhinorrhoea and otorrhoea.
• Describe the indications for surgery in the management of depressed skull fractures.
• Describe the gross and histopathological features of open and closed intracranial injuries including the
following traumatic lesions:
• skull fractures
• entrance and exit gunshot wounds of the skull
• gunshot wounds of the brain
• extradural hematomas
• acute subdural hematomas
• chronic subdural hematomas
• recent and remote cerebral contusions
• traumatic intraparenchymal hemorrhages
• diffuse axonal injury
• traumatic cranial nerve injuries
• spinal cord injuries
• cerebral herniation syndromes
• fat embolization
• CNS trauma in infancy.
• Discuss the injury severity scale for multi trauma.
• Discuss the principles of initial resuscitation and assessment (EMST).
• Discuss the principles for managing head injury in remote locations.

Updated 18 January 2007 Page 1 of 3

• Demonstrate the systematic assessment of multiple system trauma.

• Discuss the principles of resuscitation of multiple system trauma patients, including appropriate fluid
resuscitation.
• Discuss in detail the appropriate fluid and electrolyte management in trauma patients.
• Discuss ventilation parameters for patients with head injury.
• Describe basic principles of nutritional management in neurosurgical critical care.
• Discuss the risk factors for post traumatic seizures.
• Independently perform the insertion on an ICP monitoring devices and fiberoptic or miniaturized strain
gauge devices.
• Prepare and position a patient for a trauma craniotomy including marking of the flap.
• Demonstrate elective intubation patients and describe the indications for emergency and elective
situations and the use of medications.
• Discuss in detail the options for airway management of an unconscious patient.
• Demonstrate emergency vascular access including central line.
• Discuss the classification and pathogenesis of acute traumatic haematomas.
• Discuss the pathogenesis of chronic subdural haematoma.
• Discuss the management options for chronic subdural haematoma.
• Demonstrate twist-drill or burr-hole drainage of subdural fluid collections.
• Demonstrate the formal assessment of brain death.
• Discuss the prognostic factors associated with head injury.
• Describe outcome measures following head injury and their limitations.
• List the principles of rehabilitation of head injured patients.
• Define post traumatic amnesia.
• Discuss in detail the management of post-traumatic seizures and discuss prediction of risk factors.
• Describe the management of status epilepticus.
• Discuss in detail post traumatic CSF fistulae, its diagnosis and investigation.
• Discuss the initial management and investigations of penetrating head injuries.
• Describe the classification of traumatic vascular injuries and their presentation.
• Discuss the pathophysiology of head injury and the relationship to ICP.
• Discuss the methods of ICP monitoring.
• Discuss the Brain Trauma Foundation guidelines for head injury management.

Spine Injury (refer also to Spine Module - Trauma Unit)

• Identify normal anatomy and features of vertebral column injury on plain Xrays and CT scan.
• Describe the common classification of vertebral column injury.
• Describe the common spinal cord injury severity scales.
• Discuss the physiological consequences of acute spinal cord injuries.
• Discuss the acute resuscitation of acute spinal cord injuries.
• Describe the clinical patterns of incomplete/complete injuries and the pathophysiology including the
specific patterns.
• Demonstrate the application of cervical traction and describe the management in terms of nursing care
and recommended weights for management of cervical subluxation.
• Demonstrate the application of a halo-thoracic brace

SET3 & SET4 Learning Outcomes

Head Injuries
• Discuss the biochemical subcellular process in brain trauma.
• Discuss the pathophysiology of brain swelling and raised ICP.
• Discuss the principles of head injury protection.
• Discuss the management of craniofacial fractures.
• Discuss the pathophysiology of intracranial hypertension and its management, including arguments for
and against various treatments.
• Provide advice to the local surgeons/retrieval team on early management, including indications for onsite
surgery/retrieval.
• Discuss the indications, advantages and risks for various haemodynamic monitoring tools (e.g.
pulmonary artery catheters, indwelling arterial lines) used in critically ill patients.
• Discuss the pathophysiology and management of coagulopathy after head injury.

Updated 18 January 2007 Page 2 of 3

• Demonstrate a trauma craniotomy for intracranial haemorrhage.

• Discuss the risks and management of CSF fistula.
• Describe in detail surgical options including approaches and timing for treatment of CSF fistulae.
• Discuss the surgical techniques used for exploration, debridement and repair of penetrating head injuries.

Spine Injury (refer also to Spine Module - Trauma Unit)

• Describe the long term complications associated with spinal cord injury.
• Describe the principles of reduction and stabilisation of spinal instabilities.
• Discuss the options for reduction of cervical subluxation with jumped facets.
• Define the named fracture types involving C1 and C2, and the treatment options available for each.

SET5 Learning Outcomes

Head Injuries
• Discuss the epidemiology and prevention of head injury in Australia .
• Discuss in detail the options for cranioplasty.
• Discuss the principles of trauma care systems.

Spine Injury (refer also to Spine Module - Trauma Unit)

• Discuss the management and surgical treatment of the spinal cord injured patient.
• Discuss the management of post traumatic syringomyelia and the rationale for surgery.

SET6 Learning Outcomes

Head Injuries
• Discuss the interventions (actual or possible) aimed at the subcellular biochemical processes in the brain.
• Discuss the evidence for decompressive craniectomy in the management of severe closed head injury.
• Discuss the uses, problems and alternatives for surgery in non-neurosurgical centres.
• Demonstrate the surgical repair of an anterior fossa CSF fistula.
• Discuss the role of endoscopic sinus surgery in the repair of CSF fistulae.

Updated 18 January 2007 Page 3 of 3

Statistics

Syllabus Module Overview

Module Rationale
The neurosurgical trainee should understand the principles of analysis of data and assessment of
outcome so that a critical appraisal can be made of reports in the literature.
Prior to graduation the trainee is required to be able to:
• efficiently collect and interpret medical data relevant to proposed research studies

Recommended Readings

Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans.

Desirable • Evidence-based medicine: how to practice and teach EBM (Sackett DL, Straus
SE, Richardson WS, Rosenberg W, Haynes RB). 2 nd Edition. 2000. Churchill
Livingstone, Edinburgh.

Learning Opportunities and Methods

• Trainees are encouraged to attend the RACS CLEAR Course.
• Regular attendance at formal journal club meetings is expected.
• Participation in research projects during training is expected.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Statistics may be examined during the Fellowship Examination.

SET1 & SET2 Learning Outcomes

Fundamental epidemiological and biostatistical principles

• Define levels of evidence.
• Discuss the principles of evidence based medicine.
• Define phase 1, 2 and 3 studies.
• Define the types of biostatistical data including nominal, interval, ordinal and ratio.
• Define a normal distribution.
• Discuss confidence intervals and population parameters.
• Discuss simple statistical tests such as univariate analysis.
• Discuss different study designs including randomised controlled trial, cohort studies and clinical trials.
• Discuss the options for obtaining evidence from the literature eg. Medline search techniques and
Cochrane collaboration.

SET3 & SET4 Learning Outcomes

Fundamental epidemiological and biostatistical principles

• Discuss the evaluation of articles regarding effectiveness of therapy and risks
• Define the magnitude of treatment effect
• Define odds ratios and relative risk
• Define Type I and Type II error.
• Discuss statistical versus clinical significance
• Discuss the concept of the number needed to treat (NNT) and the number needed to harm.
• Discuss complex statistical tests including multivariate analysis, multiple regression and factor analysis.

Updated 18 January 2007 Page 1 of 2

SET5 Learning Outcomes

Fundamental epidemiological and biostatistical principles

• Discuss the critical appraisal of published articles including study design, population, sampling, size and
power calculation, measurement and effect size, randomisation, control of confounding variables,
analytical procedures and statistical significance.

SET6 Learning Outcomes

Fundamental epidemiological and biostatistical principles

• Discuss the ethics of clinical trials.

Updated 18 January 2007 Page 2 of 2

Spinal Surgery

Syllabus Module Overview

Module Rationale
The management of spinal conditions is a major part of neurosurgical practice.
Prior to graduation the trainee is required to be able to:
• investigate and accurately diagnose patients with spinal disorders
• perform appropriate therapeutic procedures and manage all spinal conditions
• communicate information about procedures and risks associated with spinal surgery to patients
(and/or their family) in ways that encourage their participation in informed decision making

Recommended Readings
Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or
"Neurological surgery" Youmans.

Desirable • Operative Neurosurgery" A Kaye & P McL Black Churchill Livingstone

• Operative neurosurgical techniques" Schmidek and Sweet
• The Spine" Rothman and Simeone.

Learning Opportunities and Methods

• Regular attendance at xray conferences and spine meetings is required.
• Close involvement with orthopaedic spinal surgeons and orthotists is encouraged.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Spinal Surgery may be examined during the Part 2 Examination.

SET1 & SET2 Learning Outcomes

General
• Demonstrate history acquisition and physical examination on patients with spinal disorders.

Biomechanics and kinematics of the spine

• Describe in detail the normal movements of the vertebral column at each level.
• Describe the normal alignment of the vertebral column.

Anatomy
• Refer to the spinal anatomy section of the curriculum.

Degenerative and inflammatory disorders

• Describe in detail the clinical features of neurological compression syndromes of the spine including
radiculopathy, myelopathy, cauda equina compression and neurogenic claudication.
• Discuss the importance and relative urgencies of the various compressive syndromes especially cauda
equina syndrome.
• Discuss the differential diagnosis of cervical, thoracic, and lumbar pain.
• Discuss the effects of rheumatoid arthritis on the spine.

Trauma
• Describe in detail the clinical features and pathophysiology of spinal cord injury including complete and
incomplete injury, anterior cord injury, central cord injury, Brown-Sequard injury, cruciate paralysis,
conus syndrome and sacral sparing.

Updated 18 January 2007 Page 1 of 5

• Describe the early management of spine and spinal cord injured patients including immobilization,
traction, reduction, appropriate radiographic studies and medical management.
• Discuss in detail the definitions of spinal stability.
• Describe the named fractures in the cervical spine. - check level radiology

Neoplasia
• Describe the clinical and radiological features of intra-axial and extra-axial spinal tumours.

Infection
• Discuss the pathogenesis and bacteriological features of spinal infections.
• Discuss the clinical and radiological features of discitis.
• Discuss the clinical and radiological features of epidural abscess.

Congenital and developmental

• Discuss the embryology and anatomy of spinal dysraphism.

Principles of spinal fusion and stabilisation

• Discuss the biology of bone healing.
• Discuss the concepts of stabilisation, instrumentation and fusion.

SET3 & SET4 Learning Outcomes

General
• Discuss the management of postoperative complications of spinal surgery including:
• hematoma;
• infection;
• spinal fluid leak;
• new neurologic deficit.
• Define the terms spondylosis, spondylolysis and spondylolisthesis.
• Describe the clinical assessment and differential diagnosis spinal pain.

Biomechanics and kinematics of the spine

• Discuss the factors responsible for stability of the spinal column.
• Discuss the biomechanics of the craniocervical junction, cervical spine and thoracolumbar and lumbar
spine.
• Discuss the concepts of motion of the vertebral column including instantaneous axis of rotation.

Anatomy
• Refer to the spinal anatomy section of the curriculum.

Degenerative and inflammatory disorders

• Discuss the theories of spinal stability eg Punjabi and White, Denis and AO classification.
• Discuss the indications for cervical, thoracic and lumbar discectomy.
• Compare and contrast indications for anterior and posterior approaches to the cervical spine for the
treatment of herniated cervical discs, spondylosis, and instability.
• Compare and contrast the indications for anterior cervical discectomy with and without anterior interbody
fusion.
• Describe the pathological and radiological features of OPLL and DISH.
• Discuss the management options of degenerative lumbar spondylolisthesis in association with canal
stenosis.
• Discuss the clinical features, pathological findings and management of osteoporosis.
• Discuss the appropriate radiological investigations for patients with degenerative spine disease.

Trauma

Updated 18 January 2007 Page 2 of 5

• Compare to the trauma section

• Classify fractures, dislocations, and ligament injuries of the craniocervical region, subaxial cervical spine,
thoracic, thoracolumbar junction, lumbar and sacral spine.
• Discuss the indications for surgical management of spinal instability.
• Discuss briefly the concept of grading schemes for spinal cord injury and myelopathy.
• Discuss the indications, uses and relative effectiveness of common spinal orthoses.
• Discuss the degree of segmental and regional immobilization different spinal orthoses provide.
• Discuss the management principles for penetrating wounds to the spine.
• Discuss non-operative and operative treatment options for fractures and dislocations affecting the atlas
and axis.
• Compare and contrast the indications for non-operative treatment, anterior approaches and posterior
operative approaches for the treatment of fractures and dislocations of the subaxial cervical spine.
• Discuss the appropriate radiological investigations for patients with spinal trauma.

Neoplasia
• Discuss the diagnosis and management of primary spinal tumours, spinal cord tumours, and spinal
metastatic disease.
• Describe the most common types of spinal tumours in the following categories:
• intradural/intramedullary;
• intradural/extramedullary;
• extradural.
• Discuss the appropriate radiological investigations for patients with spinal neoplasia

Infection
• Discuss the management principles for epidural abscess and discitis.
• Discuss the factors contributing to post operative spinal infections.

Congenital and developmental

• Discuss the signs, symptoms and management options in the treatment of the adult tethered cord
syndrome and syringomyelia.

Principles of spinal fusion and stabilisation

• Discuss the principles of bone grafting in spinal surgery.
• Discuss the materials available for fusion.

Spinal vascular conditions

• Discuss the aetiology, presentation, classification and natural history of spinal AVMs.
• Discuss the treatment options for spinal AVMs.
• Describe the risks and indications of spinal angiography.
• Describe the clinical presentation, epidemiology, radiological features, pathology and natural history of
vertebral haemangioma.

SET5 Learning Outcomes

General
• Discuss the indications for, and physiology of, intraoperative spinal cord monitoring.
• Describe the management options for intraoperative and postoperative cerebrospinal fluid leaks.

Biomechanics and kinematics of the spine

• Discuss the concepts of load bearing relative to each section of the vertebral column.

Anatomy
• Refer to the spinal anatomy section of the curriculum.

Updated 18 January 2007 Page 3 of 5

Degenerative and inflammatory disorders

• Discuss the role of corpectomy in the management of cervical disorders.
• Discuss the management of rheumatoid cervical disease and describe factors which make it different
from the management of non-rheumatoid disease.
• Discuss the clinical features and management of ankylosing spondylitis.
• Compare and contrast the various approaches to a herniated thoracic disc.
• Discuss the indications for lumbar fusion for iatrogenic disease and degenerative disease.
• Discuss the controversies surrounding the management of asymptomatic radiological cord compression
from degenerative disease.

Trauma
• Discuss the implications for the management of trauma in the presence of ankylosing spondylitis.
• Discuss the pathogenesis, clinical presentation and management options for post traumatic
syringomyelia.
• Demonstrate the placement and management of cranial traction devices for reduction and immobilization
of the unstable cervical spine.
• Demonstrate the application and management of a halo-thoracic brace.
• Demonstrate the application and management of cervical traction for instability.

Neoplasia
• Discuss the indications for dorsal decompression and ventral decompression of acute neoplastic spinal
cord compression at various levels.
• Discuss the options for spinal fixation of neoplastic disease.
• Discuss the options of surgery and radiotherapy for acute neoplastic spinal cord compression.

Infection
• Discuss the management options for infected post operative stabilisation procedures.

Congenital and developmental

• Discuss the pathological significance and management options for Tarlov cysts and arachnoid cysts.

Principles of spinal fusion and stabilisation

• Discuss the indications and techniques for anterior and posterior cervical spinal internal fixators.
• Discuss the properties of various grafting materials eg osteoconductive, osteoinductive and osteogenic.
• Discuss additional measures to enhance fusion.
• Compare and contrast the indications for anterior or posterior lumbar interbody fusion and
intertransverse fusion for lumbar disease.
• Discuss the indications and options for internal fixation in association with lumbar fusion.

Spinal vascular conditions

• Demonstrate surgery on a spinal dural AVM.
• Discuss the role of endovascular procedures in the management of spinal disorders.

SET6 Learning Outcomes

General
• Discuss the role of rehabilitation in patients with spinal disorders.
• Describe the technical aspects and limitations of intraoperative spinal cord monitoring.

Biomechanics and kinematics of the spine

• Discuss the effects of abnormal loading on individual spinal components such as vertebrae, discs and
ligaments.
• Discuss the biomechanical consequences of common procedures such as laminectomy.

Updated 18 January 2007 Page 4 of 5

Anatomy
• Refer to the spinal anatomy section of the curriculum.

Degenerative and inflammatory disorders

• Discuss the controversies surrounding kyphoplasty and vertebroplasty.

Trauma
• Discuss the indications and techniques for complex internal fixation for spinal trauma.
• Discuss current theories of spinal cord regeneration.
• Discuss the controversies surrounding the management of compression fractures.
• Describe the controversies surrounding the management of odontoid fractures.
• Discuss the controversies surrounding and evidence relating to the use of steroids in spinal injury.
• Discuss controversies and risks associated with dynamic Xrays in acute spinal trauma.
• Discuss controversies regarding chronic musculoligamentous spinal injuries (including "whiplash").

Neoplasia
• Discuss controversies regarding surgery for intra-axial spinal tumours. Check operative surgery
• Discuss the controversies surrounding the extent of surgical vertebral column.

Principles of spinal fusion and stabilisation

• Discuss the controversies surrounding the role of fusion associated with discectomy.
• Discuss the various hardware systems available for internal fixation.
• Discuss arthrodesis versus arthroplasty in the spine.

Spinal vascular conditions

• Describe in detail surgery of a spinal cord AVM.

Updated 18 January 2007 Page 5 of 5

Psychiatry and Neuropsychology

Syllabus Module Overview

Module Rationale
All neurosurgical conditions have associated psychological factors, and some have coexisting psychiatric
factors. It is vital to recognise that all neurosurgical conditions are viewed and treated in this context.
Prior to graduation the trainee is required to be able to:
• differentiate between psychiatric disorders according to their classification and identify the methods
used for neuropsychological testing
• manage patients in ways that demonstrate sensitivity to their psychological needs

Recommended Readings
Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or
"Neurological surgery" Youmans.

Desirable • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans.

References • Neuropsychology [Link]

• [Link]
• [Link]
• Abnormal Illness Behaviour, Issy Pilowsky, ISBN: 0-471-96573-1
• Waddell: [Link]

Learning Opportunities and Methods

• Trainees are encouraged to engage in discussions with neuropsychologists.

Assessment and Examination

• Trainees will undergo regular onging assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Neuropsychiatry and neuropsychology may be examined during the Fellowship Examination.

SET1 & SET2 Learning Outcomes

Abnormal Illness Behaviour

• Describe the features of abnormal illness behaviour (including not only the problems of patients with
bodily symptoms for which no adequate organic cause can be found, but also those who deny the
presence of disease which is obvious to others).
• Define acute confusional state.
• Discuss the assessment, differential diagnosis and investigation of an acutely confused patient.
• Define dementia.
• Discuss the assessment, differential diagnosis and investigation of a patient with dementia.
• Identify treatable causes of dementia.

Principles of Neuropsychological Testing

• Discuss the use of neuropsychological testing and its application to the following areas:
• General intellectual ability
• Reasoning and problem solving ability
• Receptive and expressive language ability
• Visuoperceptual and visuoconstructional ability
• Speed of information processing
• Attention and concentration

Updated 18 January 2007 Page 1 of 3

• Memory and learning

• Executive functioning (i.e. problem identification, goal formulation, generation of alternative responses,
choosing and initiating responses, planning and organising, monitoring and regulating responses)
• Describe the testing instruments that can be used to assess a patient's cognitive functioning.
• Describe the testing instruments that can be used in neuropsychological testing.

Psychiatric Evaluation
• Describe the principles of a psychiatric evaluation and formulation of a diagnosis.
• Discuss the clinical uses of sedative drugs, particularly benzodiazepines (uses, limitations and
dependence.)
• Discuss the uses, indications and classification of psychotropic drugs.
• Discuss features and management of drug dependency.

Psychosurgery
• Discuss the history of psychosurgery.
• Discuss the impact of Egas Moniz in neurosurgery.

SET3 & SET4 Learning Outcomes

Abnormal Illness Behaviour

• Define and discuss the commonly used terms including somatisation, hypochondriasis, hysteria,
conversion disorder, malingering, chronic fatigue syndrome.

Psychiatric Evaluation
• Discuss the application of the DSM IV. Describe the general structure of this text.
• Describe the Multiaxial Assessment Classification (Axis I-V) and clinical application of the DSM IV system.

SET5 Learning Outcomes

Abnormal Illness Behaviour

• Describe in detail the bio-psycho-social model of abnormal illness behaviour.
• Describe in detail how the features of abnormal illness behaviour impacts on the management of chronic
pain.

Principles of Neuropsychological Testing

• Describe examples of neuropsychological sequelae that commonly occur after brain injury.

Psychosurgery
• Describe the anatomical lesions for different psychiatric conditions.
• Discuss the effectiveness of surgery in the treatment of depression.

SET6 Learning Outcomes

Abnormal Illness Behaviour

• Describe medicolegal implications of abnormal pain behaviour and incorporate this in a meaningful and
constructive way in medical assessments and reports.

Psychiatric Evaluation
• Define the following conditions:
• Depressive Disorders
• Anxiety Disorders (including post traumatic stress disorder)
• Conversion Disorder

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• Somatoform Disorders
• Personality Disorders
• Pain disorder
• Adjustment disorders
• Psychological Factors Affecting Medical Condition
• Discuss pharmacology of antidepressant medication. Describe indications and side effects of tricyclics,
MAO Inhibitors and serotonin selective reuptake inhibitors (SSRIs)
[Link]

Psychosurgery
• Discuss in detail local legislation regarding psychosurgery.

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Peripheral Nerve Disorders

Syllabus Module Overview

Module Rationale
Prior to graduation the trainee is required to be able to:
• apply their extensive knowledge of the anatomy, physiology, pathophysiology, and presentation of
peripheral nerve disorders in order to accurately diagnose and treat peripheral nerve disorders

Recommended Readings

Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans .

Desirable • Henry's Extensile Exposure

Peripheral Nerve Examination (British)
Kline's textbook

Learning Opportunities and Methods

• Trainees are encouraged to participate in outpatient clinic and preoperative assessment.
• Clinical examination skills should be developed throughout the training programme.
• Trainees are encouraged to attend workshops and skills laboratories and to closely liaise with
neurologists, particularly for instruction on electrophysiological examination.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Peripheral nerve lesions are common clinical cases examined during the Fellowship Examination.

SET1 & SET2 Learning Outcomes

Peripheral nerve injuries and entrapment neuropathies

• Discuss the classifications of peripheral nerve injury.
• Expertly demonstrate clinical examination of common peripheral nerve lesions.
• Describe the symptoms and signs of common entrapment neuropathies.
• Describe the surgical treatment of carpal tunnel syndrome and ulnar nerve entrapment at the elbow.
• Describe Wallerian degeneration.
• Describe the rating scale of motor power.
• Describe nerve regeneration.

Autonomic nervous system disorders

• Discuss the clinical features of a patient with hyperhidrosis.

Neoplasms of peripheral nerves

• Describe the classification of peripheral nerve tumours and their relationship to neurofibromatosis.
• Describe the clinical presentation, epidemiology and natural history of peripheral nerve tumours.
• Demonstrate the clinical assessment of a patient with peripheral nerve tumour.

SET3 & SET4 Learning Outcomes

Peripheral nerve injuries and entrapment neuropathies

• Discuss the differential diagnosis and investigation of entrapment neuropathies.
• Discuss the operative and non-operative treatment of entrapment neuropathies.

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• Describe the procedure of peripheral nerve. electrophysiological studies.

• Describe the uses and limitations of electrophysiological studies in peripheral nerve lesions.
• Describe in detail the surgery of the common sites of peripheral nerve entrapment.
• Describe stretch injury, missile injury and avulsion injury: definition, non-operative management and
indications for surgery.
• Discuss the optimal timing of surgery for peripheral nerve injuries.
• Discuss non-surgical peripheral neuropathies e.g. brachial plexopathy, mono and polyneuropathies.

Autonomic nervous system disorders

• Describe the various conditions for which sympathectomy could be considered therapeutic.
• Discuss the risks and complications of sympathectomy.

Neoplasms of peripheral nerves

• Describe the gross and microscopic pathological features of peripheral nerve tumours.
• Identify the diagnostic radiological features for peripheral nerve tumours.

SET5 Learning Outcomes

Peripheral nerve injuries and entrapment neuropathies

• Discuss diagnostic features of the uncommon entrapment neuropathies.
• Expertly demonstrate the clinical examination of uncommon peripheral nerve lesions.
• Describe the symptoms and signs of uncommon entrapment neuropathies.
• Describe in detail the surgery of the uncommon sites of peripheral nerve entrapment.
• Describe the exposure of the brachial plexus.
• Describe the uses and limitations of intra-operative electrophysiological nerve evaluation.
• Discuss the techniques of nerve repair and grafting.

Autonomic nervous system disorders

• Describe the surgical approaches for an upper thoracic sympathectomy.

Neoplasms of peripheral nerves

• Describe the operative and non-operative management of a patient with a peripheral nerve tumour.
• Demonstrate the exposure of a peripheral nerve tumour.

SET6 Learning Outcomes

Peripheral nerve injuries and entrapment neuropathies

• Discuss in detail the surgical options for decompression of the ulnar nerve at the elbow.
• Interpret electrophysiological studies of the common entrapment neuropathies.
• Independently perform decompression of entrapment neuropathies.
• Demonstrate exposure of the brachial plexus.
• Demonstrate nerve repair techniques and nerve grafts.

Autonomic nervous system disorders

• Demonstrate an upper thoracic sympathectomy.

Neoplasms of peripheral nerves

• Independently perform the resection of a peripheral nerve tumour with appropriate reconstruction.
• Discuss the treatment options for a malignant peripheral nerve tumour.

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Perioperative Care

Syllabus Module Overview

Module Rationale
Perioperative care is an integral part of the performance of surgery and is the responsibility of the
surgeon.
Prior to graduation the trainee is required to be able to:
• identify post-operative risk factors for the patient
• communicate information about procedures and potential risks associated with spinal surgery to
patients (and/or their family) in ways that encourage their participation in informed decision making
• effectively and efficiently conduct the pre-operative workup and post operative care of neurosurgical
patients

Recommended Readings
Essential The relevant chapter of one of the following:
• •Robert, H., M.D. Wilkins, S. Settis and M. D. Rengachary (1996) Neurosurgery .
New York : McGraw-Hill, Health Professions Division.
• Julian R. and M.D. Youmans (2004) Neurological Surgery . 5 th Edition. W. B.
Saunders & Co. CD-ROM.

Desirable • Greenberg operative neurosurgery

Talley and O'Connor

References • CCrISP Course Manual - RACS

Learning Opportunities and Methods

• The RACS CCrISP course is identified as an essential learning resource in perioperative care.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Programme including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Periopoerative care will be examined during the Fellowship Examination.

SET1 & SET2 Learning Outcomes

History Examination
• Consistently demonstrate complete history examination and appropriate pre operative workup of all
patients, taking into account all body systems and relevant personal and family history.
• Consistently demonstrate complete and thorough history and examination of neurological patients
presenting for surgery.

Blood coagulation and transfusion

• Demonstrate a knowledge of the coagulation pathways.
• Describe the indications and complications of a blood, platelet and plasma protein transfusion.
• Describe the clinical principles for safe transfusion including appropriate laboratory testing.

D.V.T. and pulmonary embolism

• Describe the pathophysiology of venous thrombosis and the general predisposing factors for a DVT.
• Discuss the specific risk factors in neurosurgical patients.
• Describe in detail the clinical features and appropriate diagnostic test and treatment of a DVT and
pulmonary embolism.
• Discuss the clinical indications and trials for DVT Prophylaxis as it relates to neurosurgery.

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Fever in neurosurgical patients

• Discuss in detail causes and appropriate investigations for neurosurgical patients.
• Discuss in detail causes of fever in neurosurgical patients and how to diagnosis a CNS.
• Discuss the appropriate investigations of a patient with a fever and common organisms in neurosurgical
infection.
• Discuss of the major class of modern antibiobiotic, antimicrobial spectrum and the associated side
effects.
• Discuss the use of CSF penetration of the above antibiotics.
• Discuss the use of universal precautions in preventing infection.

Acute Confusion in the Peri Operative Patient

• Discuss indication and risks associated with medical therapy in an agitated patient.
• Demonstrate a knowledge of the appropriate pharmacological agents to manage a patient who is
agitated.
• Discuss the examination and appropriate investigations of the causes of confusion.
• Demonstrate an ability to perform a neurological examination in a confused patient.

Perioperative Seizers
• Discuss the incidence and etiological factors of seizures following a craniotomy.

Informed consent and medico-legal aspects

• Discuss in detail the concept of informed consent.
• Demonstrate an ability to obtain informed consent.
• Demonstrate an ability to maintain accurate medical records.

Persistent headache after craniotomy

• Demonstrate an ability to perform a neurological examination of a patient with a head ache following a
craniotomy.
• Discuss the appropriate investigation in a patient with a postoperative headache.

Benign Intracranial Hypertension

• Describe the pathophysiology of BIH.
• Demonstrate an understanding of the clinical manifestation of BIH.
• Demonstrate an ability to perform a neurological patient with BIH.

Epilepsy after craniotomy

• Describe the classification of seizures.
• Discuss the knowledge of the common anti-epileptic medications and their side effects.
• Management of a postoperative seizure

Management of peri operative fluid, electrolyte and circulatory status

• Demonstrate the management and diagnosis of circulation disorders.
• Describe the pathophysiology of hypertension.
• Discuss the etiological causes of hypertension.
• Demonstrate a detailed knowledge of hemodynamic monitoring.
• Demonstrate detailed understanding of water and electrolyte including fluid balances and losses.
• Discuss why sodium, magnesium and t water balance are particularly important.
• Demonstrate a knowledge of the physiology of the hypothalamic - pituitary axis.
• Discuss the principle physiology/pathophysiology of water balance.

Principles of Discharge Planning and Rehabilitation

• Demonstrate appropriate forward planning in all patients.
• Discuss in detail the principles of planning and post operative care as it relates to discharge planning and
continuity of care.
• Discuss the general principles of rehabilitation.

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• Discuss in detail the neurobiological process underlying functional brain recovery.

• Describe the principles of head injury rehabilitation.

Diagnosis of brain death

• Discuss the indications for brain death.
• Demonstrate the formal assessment of brain death.

SET3 & SET4 Learning Outcomes

Blood coagulation and transfusion

• Demonstrate knowledge of the congenital/abnormalities for coagulopathies.
• Discuss the indications and mechanisms and risks for intra-operative blood salvage.
• Discuss the indications and contra-indications for anti coagulation and anti platelet usage in neurosurgical
patients.
• Describe the diagnosis and treatment of disseminated common or severe coagulations (ie DIC).

Informed consent and medico-legal aspects

• Demonstrate an ability to interact effectively with a patient and family members following a surgical
complication.

Persistent headache after craniotomy

• Discuss the incidence and etiological factors of headaches following a craniotomy.
• Discuss the knowledge of the common analgesic medication and their side effects to manage a patient
with a postoperative headache.

Benign Intracranial Hypertension

• Demonstrate an understanding of the appropriate investigation to diagnosis with BIH.
• Demonstrate the treatment options of BIH.
• Discuss the common conditions that cause sodium abnormalities.
• Demonstrate a knowledge of the various classes of antihypertensive drugs.

Epilepsy after craniotomy

• Discuss the role of prophylactic antiepileptic medication.

Management of peri operative fluid, electrolyte and circulatory status

• Demonstrate knowledge of the etiological cause of DI.
• Demonstrate an ability to diagnosis DI.

Peri Operative Steroid Use

• Discuss the indications, benefits and risks for perioperative steroid use.

Principles of Discharge Planning and Rehabilitation

• Describe the principles of spinal injury rehabilitation and stroke rehabilitation

Diagnosis of brain death

• Discuss the differences in regional and international legislations relating to brain death.
• Demonstrate an ability to examine a patient to determine brain death.
• Demonstrate ability to interpret ancillary criteria fro brain death.

Updated 18 January 2007 Page 3 of 4

SET5 Learning Outcomes

Informed consent and medico-legal aspects

• Discuss the importance of tracking morbidity, mortality and patient outcomes.
• Discuss the common causes of medical malpractice and effective measures to reduce risk.

Epilepsy after craniotomy

• Discuss the role and controversies associated with prophylactic medication.

Principles of Discharge Planning and Rehabilitation

• Demonstrate an ability to develop patient focused rehabilitation goals and program planning.
• Demonstrate an ability to lead a multidisciplinary rehabilitation team

SET6 Learning Outcomes

Informed consent and medico-legal aspects

• Demonstrate an ability to maintain a personal patient morbidity/mortality outcome database.
• Discuss current medico legal aspects of informed consent.

Benign Intracranial Hypertension

• Discuss the treatment options in a patient with a failed LP shunt.
• Demonstrate an ability to perform a subtemporal decompression.

Epilepsy after craniotomy

• Demonstrate the diagnosis of pseudoseizures and discuss the use and limitations of EEG's.

Diagnosis of brain death

• Demonstrate an ability to oversee junior medical staff in the diagnosis of brain death.
• Discuss the issues associated with the removal of life support.
• Discuss potential perceived conflicts of interest for neurosurgeons being involved in organ donation and
brain death including morale issues.

Updated 18 January 2007 Page 4 of 4

Pain

Syllabus Module Overview

Module Rationale
The management of acute and chronic pain conditions is an integral part of neurosurgical practice. Prior
to graduation the trainee is required to be able to:
• recognise, classify, and describe the variety of specific pain conditions, and define organic and other
factors relevant to the condition and its management
• prescribe for and effectively manage treatment regimes for patients experiencing pain

Recommended Readings

Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans.

Learning Opportunities and Methods

• Trainees are encouraged to attend multidisciplianary pain clinics when possible.
• Faculty of Pain Medicine could be contacted for additional resources.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Pain syndromes will be examined during the Fellowship Examination.

SET1 & SET2 Learning Outcomes

Pathophysiology of pain
• Describe the anatomy of pain pathways within the peripheral and central nervous systems.
• Describe the physiology of nociception.
• Describe the clinical features of the basic pain syndromes, including:
• acute
• chronic
• nociceptive
• neuropathic (including complex regional pain syndromes)
• musculofascial
• malignant

General and psychosocial factors in pain management

• Discuss the interaction of physiological, pathological and psychosocial components of pain.
• Explain the rationale for multidisciplinary management of pain disorders.
• Discuss controversies associated with pain management following intracranial and spinal surgery.

Analgesics and pain relief

• Describe the major classes of medications commonly used for pain treatment eg. opioids, nonsteroidals
and paracetamol, antidepressants, anticonvulsants.
• Describe the pharmacology of local anaesthetic agents (e.g., lignocaine, marcain) and the use of
adrenaline with local anaesthetic agents.

Facial pain including trigeminal neuralgia

• Describe in detail the surgical anatomy of the trigeminal nerve.
• Describe the clinical features of trigeminal neuralgia, trigeminal neuropathic pain, and atypical facial pain.
• Discuss the medical management of trigeminal neuralgia.

Updated 18 January 2007 Page 1 of 4

Glossopharyngeal neuralgia
• Describe the clinical syndrome and differential diagnosis of glossopharyngeal neuralgia.

Hemifacial spasm
• Describe the clinical syndrome and differential diagnosis of hemifacial spasm.

Nerve blocks, electrical stimulation and radiofrequency lesions for pain relief
• Describe peripheral nerve blocking procedures including the techniques expected outcomes.
• Discuss the potential complications of a peripheral neural blockade (including anaphylaxis, neural injury,
and intravascular or intrathecal administration).

SET3 & SET4 Learning Outcomes

Pathophysiology of pain
• Explain how central or spinal neurostimulation is thought to modulate pain perception.

General and psychosocial factors in pain management

• Discuss methods of assessing outcomes of pain management.
• Describe commonly used pain and disability assessment scales.

Analgesics and pain relief

• Describe the mode of action of the major classes of medications listed in level one.

Facial pain including trigeminal neuralgia

• Describe the percutaneous techniques of trigeminal rhizotomy including radiofrequency, glycerol and
balloon compression.
• Describe alternative procedures to the peripheral branches of the trigeminal nerve.
• Describe and contrast the approaches to the cerebellopontine angle for microvascular decompression or
rhizotomy of the trigeminal and glossopharyngeal nerves.

Glossopharyngeal neuralgia
• Discuss the medical and surgical management of glossopharyngeal neuralgia.

Hemifacial spasm
• Discuss the medical (including botulinum toxin) and surgical management of hemifacial spasm.

Nerve blocks, electrical stimulation and radiofrequency lesions for pain relief
• Describe indications for ablative peripheral nerve procedures.

Intraspinal narcotic infusions

• Demonstrate the percutaneous insertion of epidural and intrathecal catheters.
• Describe the classes of drugs used for intraspinal administration in the management of pain.
• Discuss their mechanism of action.
• Discuss the risks and potential complications of intrathecal drug administration.

Spinal cord ablative procedures

• Discuss the indications for spinal cord ablative procedures (eg DREZ lesions, cordotomy and myelotomy)
in the management of pain.

Updated 18 January 2007 Page 2 of 4

SET5 Learning Outcomes

Pathophysiology of pain
• Discuss the role of the autonomic nervous system in chronic pain.
• Describe subcortical and brainstem sites that appear to be involved in the modulation of nociception to
targets for deep brain stimulation for pain control.

General and psychosocial factors in pain management

• Discuss specific problems associated with inappropriate post operative pain management.

Analgesics and pain relief

• Describe the indications, contraindications, drug interactions and side effects of the major classes of
medications listed in level one.

Facial pain including trigeminal neuralgia

• Demonstrate percutaneous techniques of trigeminal rhizotomy including radiofrequency, glycerol and
balloon compression.
• Discuss the potential complications of percutaneous procedures for trigeminal neuralgia.
• Hemifacial spasm
• Describe microvascular decompression of the facial nerve and complication avoidance.

Nerve blocks, electrical stimulation and radiofrequency lesions for pain relief
• Discuss the theoretical basis of acupuncture.
• Discuss the methods of permanent neural block including neurolytic blocks (eg phenol, alcohol), ablative
neurosurgical procedures (eg radiofrequency and neurectomy) and augmentative neurosurgical
procedures (eg stimulation).
• Review the indications and pathophysiological basis for radiofrequency facet denervation.
• Describe the techniques of spinal cord stimulation.

Intraspinal narcotic infusions

• Discuss the role of intraspinal drug administration in pain management.
• Compare the different methods of intraspinal drug administration (eg Epidural vs intrathecal, tunnelled
catheter vs implanted infusion system).

Spinal cord ablative procedures

• Describe the techniques of spinal cord ablative procedures (eg DREZ lesions, cordotomy and myelotomy).

SET6 Learning Outcomes

Pathophysiology of pain
• Describe the functional anatomy of the thalamic nuclei.
• Discuss the possible therapeutic interventions for pain management related to thalamic nuclei.

General and psychosocial factors in pain management

• Describe the specific clinical features of various types of non organic pain-type behaviour.
• Describe the clinical features of drug dependence.

Facial pain including trigeminal neuralgia

• Discuss the advantages and disadvantages of microvascular decompression versus percutaneous
procedures in the management of trigeminal neuralgia.
• Discuss the options if no vascular compression is found at MVD surgery.
• Demonstrate microvascular decompression of the trigeminal nerve.

Updated 18 January 2007 Page 3 of 4

• Discuss the role of radiosurgery in the management of trigeminal neuralgia.

• Discuss the role of intra operative monitoring during microvascular decompression.

Glossopharyngeal neuralgia
• Describe the detailed surgical anatomy of the glossopharyngeal and vagus nerves and the appropriate
extent of resection for glossopharyngeal neuralgia.

Hemifacial spasm
• Demonstrate microvascular decompression of the facial nerve.

Nerve blocks, electrical stimulation and radiofrequency lesions for pain relief
• Discuss the role of ablative brain and brainstem procedures (eg cingulotomy, mesencephalic tractotomy,
trigeminal tractotomy) in the management of chronic benign pain and cancer pain.
• Discuss the role of spinal cord stimulation in the management of pain.
• Describe the maintenance and programming of spinal cord stimulation systems.
• Discuss the role of peripheral nerve stimulation in the management of pain.

Intraspinal narcotic infusions

• Demonstrate the insertion of an intraspinal drug infusion pump.
• Describe the maintenance and programming of spinal drug administration systems.
• Recognize and evaluate malfunctions of intraspinal drug administration systems.

Spinal cord ablative procedures

• Describe the role of DREZ lesioning in the overall management of the patient with deafferented pain.
• Demonstrate the procedure of DREZ lesioning including localization and lesion generation in cases of root
avulsion.

Updated 18 January 2007 Page 4 of 4

Paediatric Neurosurgery and Developmental Neurology

Syllabus Module Overview

Module Rationale
The trainee is expected to develop proficiency in the management of the range of paediatric
neurosurgical conditions.
Prior to graduation the trainee is required to be able to:
• take a neurological history, examine, diagnose, perform appropriate therapeutic procedures, and
manage patients (and their families) exhibiting the range of paediatric neurosurgical conditions
• recognise and differentiate between paediatric and adult neurosurgical practice

Recommended Readings
Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or
"Neurological surgery" Youmans.
Desirable • Paediatric Neurosurgery: Surgery of the Developing Nervous System" - 3rd
Edition - American Society of Paediatric Neurosurgeons - Ed William R Cheek
Publishers Saunders 1994
• Principles and Practice of Paediatric Neurosurgery" A Albright, R F Pollack and P
D Adelson, published by Thieme, 1999

Learning Opportunities and Methods

• Trainees are required to spend a prescribed period of time in an accredited paediatric neurosurgical
facility.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Paediatric neurosurgery will be examined during the Fellowship Examination.

SET1 & SET2 Learning Outcomes

Neurological evaluation
• Describe the normal milestones of neurological development in the infant.
• Describe the normal neurological examination of a neonate.
• Describe the Babinski, Morrow, stepping and grasp reflexes at different ages.
• Define the Apgar score.
• Describe modifications of the Glasgow coma score for use in paediatrics.
• Describe normal and abnormal states of the fontanelles.

Neural tube defects including spinal dysraphism

• Describe the risk factors associated with the development of neural tube defects.
• Describe the spectrum of neural tube defects.
• Discuss the significance of sacral skin lesions in infants.
• Define diastematomyelia.

Craniovertebral junction anomalies

• Define the classification of Chiari malformations.

Hydrocephalus
• Describe normal CSF production, circulation and absorption.
• Discuss the classification of hydrocephalus.
• Discuss the causes of neonatal hydrocephalus.

Updated 18 January 2007 Page 1 of 4

• Discuss the different management options for different types of hydrocephalus.

Craniosynostosis
• Describe the normal ages at which the sutures close.

Arachnoid cysts
• Describe the common locations of arachnoid cysts.
• Discuss the theories regarding formation of sylvian arachnoid cysts.
• Describe clinical features that may be associated with arachnoid cysts.

Paediatric trauma
• Discuss aspects of head injuries peculiar to children.
• Discuss aspects of general trauma management peculiar to children.
• Discuss the normal radiological appearance of the cervical spine in infancy and childhood.
• Describe the age at which there would be complete ossification of C2.

Miscellaneous
• Discuss the common spectrum of paediatric CNS tumours.
• Contrast the features of common paediatric gliomas compared to adult gliomas.
• Describe the thickness of the cerebral mantle in childhood.
• Describe in detail the clinical features of paediatric meningitis and its management.
• Discuss the issues regarding consent in minors.

SET3 & SET4 Learning Outcomes

Neurological evaluation
• Describe normal child hood and adolescent neurological development.

Neural tube defects including spinal dysraphism

• Discuss the early management of spina bifida cystica.
• Describe the intracranial anomalies commonly associated with spina bifida.
• Discuss the presentation and management of lumbosacral lipomata.

Craniovertebral junction anomalies

• Describe the clinical features of the various types of Chiari malformations at different ages.

Hydrocephalus
• Compare and contrast different shunt techniques such as VP, VA and LP diversions.
• Discuss the indications and contraindications of third ventriculostomy.
• Define the slit ventricle syndrome.
• Define Dandy-Walker malformation.
• Discuss aqueduct stenosis.
• List the complications of shunt insertion.

Craniosynostosis
• Discuss the theories regarding premature suture closure.
• Discuss the various types of craniosynostosis and their clinical features.
• Discuss the indications for treating craniosynostosis.
• Discuss the relationship of craniosynostosis and intracranial pressure.

Arachnoid cysts
• Discuss the indications for treatment of an arachnoid cyst.
• Discuss the management options for a symptomatic arachnoid cyst.

Updated 18 January 2007 Page 2 of 4

Paediatric trauma
• Describe the clinical and radiological features of shaken baby syndrome.
• Discuss the features suggestive of child abuse.
• Define a growing fracture and discuss its management.

Miscellaneous
• Discuss differences in the management of gliomas between children and adults.
• Discuss the effects of radiation on the developing brain.
• Discuss differential diagnosis of fourth ventricular tumours.
• Define holoprosencephaly.
• Discuss the various neurological manifestations of in-utero infections.

SET5 Learning Outcomes

Neurological evaluation
• Describe normal child hood and adolescent neurological development.

Neural tube defects including spinal dysraphism

• Discuss the clinical features, causes, diagnosis and management of tethered cord syndrome.
• Discuss the specific problems and management associated with spina bifida in late childhood and
adolescence.
• Discuss the features on neurological and radiological diagnosis of major prognostic significance in a
neonate with encephalocele.

Craniovertebral junction anomalies

• Discuss the management options for hydrocephalus associated with Chiari malformations.
• Discuss the management options for syrinx associated with Chiari malformations.
• Discuss platybasia and basilar invagination and their associations.

Hydrocephalus
• Describe the technique of third ventriculostomy.
• Demonstrate the insertion of a VP shunt.
• Discuss the different types of shunting systems available.
• Discuss the options of flow and pressure regulated shunts.
• Discuss in detail the management of an infected shunt.

Craniosynostosis
• Describe the named craniofacial disorders associated with craniosynostosis.
• Describe the spectrum of management techniques for craniosynostosis.

Arachnoid cysts
• Compare and contrast techniques of shunting and fenestration of arachnoid cysts.

Paediatric trauma
• Discuss post traumatic brain swelling in infancy and its management.

Miscellaneous
• Discuss the management of subdural empyema in children.
• Diiscuss the prognostic factors of paediatric fourth ventricular tumours.
• Discuss dysembryoplastic neuroepithelial tumours (DNET) and their management.

Updated 18 January 2007 Page 3 of 4

SET6 Learning Outcomes

Neural tube defects including spinal dysraphism

• Demonstrate the closure of all types of neural tube defects including techniques of skin coverage.

Hydrocephalus
• Discuss treatment options for slit ventricle syndrome.

Craniosynostosis
• Discuss management of complex craniofacial dysmorphic syndromes.
• Demonstrate the surgical management of sagittal craniosynostosis.

Paediatric trauma
• Describe the methods of performing cranioplasty in children of various ages.

Miscellaneous
• Discuss surgical options for the treatment of epilepsy in children.

Updated 18 January 2007 Page 4 of 4

Operative Neurosurgery

Syllabus Module Overview

Module Rationale
Operative skills and judgement are paramount in the practice of neurosurgery. Such judgements and
skills are based on a thorough understanding of the anatomy, physiology, pathophysiology, and
presentation of neurosurgical conditions.
Prior to graduation the trainee is required to be able to:
• demonstrate sound basic surgical skills and safely carry out specific neurosurgical skills
• demonstrate rational and ethical determination of the appropriateness of surgery, timing of
surgery, and appropriate pre- and post-operative management of patients of various ages and
competencies with the spectrum of neurological conditions.
• safely and effectively perform macroscopic, microscopic, and endoscopic procedures in the fields of
cranial, spinal and peripheral nerve surgery
• select and apply appropriate operative techniques within each of these parameters
• communicate with and co-ordinate surgical teams to achieve an optimal surgical environment

Recommended Readings

Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans.
Desirable • Operative Neurosurgery, Kaye and Black
• Operative Neurosurgical Techniques, Schmidek & Sweet
• Brain Surgery; Complication Avoidance and Management, Apuzzo
• Atlas of operative technique volumes 1 -9- AANS
• Greenberg operative neurosurgery

References • Surgery of the third ventricle - apuzzo

• BSS Resource Materials

Learning Opportunities and Methods

• Skills laboratories, CNS and AANS Courses are identified as beneficial learning opportunities for
trainees.
• The Midas Rex Practical Course (or similar) is strongly recommended.
• Online videos available (e.g. [Link] ) are identified as beneficial learning
opportunities.
• Opportunities to operate with allied specialties (such as Plastics, Orthopaedics and ENT) should be
utilised.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Operative neurosurgery will be examined during the Fellowship Examination

SET1 & SET2 Learning Outcomes

Surgical ligatures, knots, stapling devices and tissue glues

• Describe different types of suture materials, their uses, advantages and disadvantages.
• Describe different surgical needle profiles, their uses, advantages and disadvantages.
• Demonstrate different types of suturing techniques, including interrupted and continuous, simple,
mattress and subcuticular.
• Demonstrate dexterity with use of needle holders, forceps and standard surgical instruments, and
detailed understanding of their appropriate applications.
• Demonstrate hand-ties and instrument ties of sutures in dextrous manner and describe the applications
of each.

Updated 18 January 2007 Page 1 of 11

• Demonstrate use of skin staples.

• Demonstrate use of basic micro-dissection instruments, including micro-suction, scissors and bayonette
instruments.
• Demonstrate careful and atraumatic tissue-handling techniques.
• Expertly perform wound debridement, wound closure in layers and routine layered closure of standard
cranial and peripheral surgical exposures.

Haemostasis in neurosurgery
• Describe the physiological processes involved in clotting, including the intrinsic and extrinsic coagulation
cascades, platelet and endothelial factors.
• Describe the composition, mechanism of action, advantages and disadvantages of common neurosurgical
haemostatic agents including oxidised cellulose, fibrillary collagen, gelatin sponge, and topical thrombin.
• Define the haematological parameters of normal coagulation, and the acceptable range of these
parameters for the safe performance of intracranial neurosurgery.
• Describe the factors which may predispose a patient to coagulopathy and the investigation and
management of this.
• Describe the investigation of abnormal haemostasis.
• Describe the effects of common medications (including aspirin, low-dose heparin, low-molecular weight
heparin, and warfarin) on haemostasis, investigation for these effects and management of coagulopathy
due to these medications.

Thrombo-embolic prophylaxis
• Discuss the management of a patient with pulmonary embolism after craniotomy.
• Describe risks and benefits of types of anticoagulation for thrombo-embolic complications following
surgery.
• Discuss in detail the various methods (including drugs and mechanical devices, physiological
manipulations) of thrombo-embolic prophylaxis available and their applicability to neurosurgical practice.
• Identify neurosurgical conditions and individual patient factors which pre-dispose to thrombo-embolism,
and recommend appropriate prophylaxis.
• Identify the clinical features suggestive of thrombo-embolic complications, and perform appropriate
investigation and management.
• Describe in detail reversal of the effects of different types of anticoagulants and anti platelets agents in
both emergency and elective situations.

Tracheostomy
• Discuss the indications for a tracheostomy.
• Describe the routine nursing management of a patient with tracheostomy.
• Describe the common available types of tracheostomy tubes, including cuffed and uncuffed, fenestrated
and removable inner tube. Describe the uses, limitations and risks associated with each type.
• Demonstrate the management of a patient in respiratory distress possibly due to occluded tracheostomy
tube.
• Demonstrate a detailed knowledge of the cervical anatomy as pertaining to tracheostomy.

Infection avoidance in neurosurgery

• Discuss in detail the methods of infection avoidance in neurosurgery.
• Demonstrate uncompromising sterile technique in the operating room and during bedside procedures.
• Discuss the aseptic management of CSF drains in the neurosurgical ward.
• Describe the CSF parameters indicative of meningitis following a neurosurgical procedure.

Approaches to abdominal and thoracic cavities

• Describe the anatomy of the anterior abdominal wall and the chest wall with particular reference to the
layers encountered and relations of vital structures encountered during access to these cavities.
• Describe appropriate methods of layered closure of abdominal and thoracic cavities, including use of
drains and suture types/techniques.

Updated 18 January 2007 Page 2 of 11

History of neurosurgery
• Discuss neurosurgery in antiquity.
• Demonstrate appreciation of contributions of surgeons at the turn of the 20th century to neurosurgery,
such as MacEwan and Horsely.
• Discuss the contributions of Cushing and Dandy to the development of neurosurgery.

Patient positioning in neurosurgery

• Discuss in detail the devices and techniques for stabilising and holding the head during intracranial
neurosurgery and their relevance to different procedures and positions.
• Demonstrate proficient and safe use of the Mayfield 3-point head clamp or similar devices.
• Describe in detail risks associated with skull-fixation devices during surgery, safe and appropriate pin
placement and risks associated with its use.
• Position a patient for burr-hole ventriculostomy.
• Demonstrate safe and appropriate padding of pressure points and peripheral nerves for neurosurgical
cases in the supine, prone and lateral positions.
• Demonstrate rapid and safe positioning of the patient for large trauma craniotomy, including protecting
the cervical spine during intubation and positioning.
• Demonstrate the positioning of a patient for a pterional craniotomy.
• Discuss appropriate care of the eyes and ears during intracranial surgery.

Principles of micro neurosurgery

• Describe the design advantages and use of bayonette instruments.
• Describe the advantages and disadvantages of the various types of magnification and illumination.

Surface anatomy
• Demonstrate the surface anatomy of the sylvian fissures, central sulcus, and the occipitoparietal sulcus.
• Identify the surface anatomy of the transverse and sigmoid sinuses
• Identify the surface anatomy of the sensorimotor cortex and Wernicke's and Broca's areas.
• Define the pterion and identify its surface anatomy.
• Define the surface anatomy of the lumbar vertebrae and of the conus medullaris.
• Demonstrate a safe diagnostic lumbar puncture.
• Demonstrate the surface anatomy of the carpal tunnel and the neural and vascular structures at the
wrist.
• Describe the surface anatomy of the major peripheral nerves, including median, ulnar, radial, sciatic,
medial and lateral popliteal (common peroneal), femoral, saphenous and sural nerves.
• Demonstrate the cutaneous distribution of the sensory distribution of the major peripheral nerves,
including median, ulnar, radial, sciatic, medial and lateral popliteal (common peroneal), femoral,
saphenous and sural nerves and perform a full clinical examination of these nerves.
• Demonstrate the dermatomes and the cutaneous sensory distribution of the cranial nerves.
• Demonstrate the traditional points for diagnostic burr-holes used in trauma patients prior to scanning
availability. Discuss the reasons for their positions, the order of insertion, and the scalp incisions used for
them and how these incisions could be extended for craniotomy.

Craniotomy Flaps
• Describe in detail the technique of pterional craniotomy and its application to microsurgical exposure of
the basal cisterns.
• Describe the arterial and nervous anatomy as it relates to craniotomy flaps and scalp flaps.
• Discuss the significance of the size and shape of scalp flaps.
• Describe the placement and bony anatomy of a pterional craniotomy.
• Describe the placement of a trauma craniotomy for large acute hemispheric subdural haematoma.
• Demonstrate the safe use of perforators and burrs using a Hudson brace, twist drill craniostomy and
craniotomy using high-speed craniotome.
• Demonstrate the use of the Gigli saw for craniotomy.
• Compare and contrast the technique of free bone flap and pedicled bone flap for use in routine
neurosurgical procedures.
• Describe the anatomical factors relevant to dural opening in craniotomies.

Updated 18 January 2007 Page 3 of 11

Cortical incisions
• Describe the topographical anatomy of the cerebral hemispheres with respect to localisation of eloquent
cortex.
• Describe the anatomy of a typical cerebral gyrus and adjacent sulci with respect to the thickness of the
cortex and the local blood supply, and indicate how this may affect choice of alignment of cortical
incisions.

Lobectomy and Surgery for intra-axial lesions of the cerebral and cerebellar hemispheres
• Describe the anatomical boundaries to the cerebral lobes and their relationship to the skull bones/sutures
and identify the areas of eloquent cortex.
• Define the extent of a traditional frontal lobectomy relative to the cranial vault and identify which parts of
the frontal lobe are removed and which are resected.
• Discuss the deficits which are likely to result from complete anatomical removal of the dominant temporal
lobe.
• Describe the extent of resection of the temporal lobe in a traditional temporal lobectomy, the
measurements used for this, and whether this varies according to side.

Approaches to intraventricular lesions

• Demonstrate the appropriate position to place a burr-hole for ventricular puncture through a frontal
approach and also through a parieto-occipital approach.
• Compare and contrast twist drill craniostomy and burr hole for ventricular access.
• Describe the surface landmarks and orientation of the trajectory for ventricular puncture.
• Define the normal thickness of the cerebral mantle and appropriate lengths of catheters for ottimal
ventricular placement using these approaches.

Approaches to the brainstem

• Describe the gross anatomy of the brain stem, cranial nerves and vascular structures of the posterior
fossa.
• Describe the anatomy of the cisterns adjacent to the brainstem.
• Describe the relationships of the brainstem to the skull base, in particular to the posterior clinoids,
petrous apex, clivus and foramen magnum.

Surgical approaches to the spine

• Discuss the particular anatomical differences in the cervical, thoracic and lumbar spine and their influence
on choice of approach to the disc space at each level.
• Demonstrate exposure of the posterior aspect of the spinal column in preparation for laminectom
• Decompression of spinal cord
• Describe the anatomical extent of the spinal cord, the relationship of neurological level and vertebral
level, and the blood supply to the cord

Decompression of cauda equina and spinal nerves

• Define the anatomical relationship of the spinal nerve roots to the disc spaces in the cervical, thoracic
and lumbar spine.
• Describe in detail the pathological changes in lumbar canal stenosis, and their implications for surgery.
• Describe the typical surgical approach to extradural compressive lesions of the cauda equina.

Spinal stabilisation and fusion techniques

• Define the terms spinal instability, spinal fusion, and spinal internal fixation (stabilisation).
• Define the terms spondylolisthesis and spondylolysis, and any relationship they may have.
• Discuss different types of spinal fusion.
• Define the role of the various structural elements of the spine (joints, ligaments, discs) in maintaining
physiological stability.
• Demonstrate familiarity and understanding of the role of external spinal orthosis (collars and braces), and
their suitability for management of instability at different spinal levels.

Updated 18 January 2007 Page 4 of 11

• Demonstrate the application of cervical traction and describe the management in terms of nursing care
and recommended weights for management of cervical subluxation
• Demonstrate the application of a halo-thoracic brace

Surgical equipment
• Describe the history and development of surgical diathermy.
• Discuss the differences between bipolar and monopolar diathermy and the application of each to safe
neurosurgical practice.
• Describe the difference between cutting and coagulation settings of diathermy.
• Describe the surgical risks of diathermy including micro-shock and burns.
• Describe factors affecting risk of fire hazard in surgery.
• Demonstrate safe and effective use of surgical diathermy, using monopolar and bipolar in appropriate
circumstances.
• Demonstrate the setup and balancing of the neurosurgical operating microscope, and be able to drape it
in a sterile manner.
• Describe the principles of stereotaxy, and how this is practically applied using framed and frameless
stereotaxy.
• Describe the mechanical principles of the high-speed air drill, and of cutting and diamond burrs.
• Demonstrate safe use of Hudson Brace the perforator and burr, Gigli saw and the high-speed air
craniotome.

Skull base surgery

• Define the skull base

SET3 & SET4 Learning Outcomes

Surgical ligatures, knots, stapling devices and tissue glues

• Discuss the origins, applications and limitations of different types of tissue glues.
• Demonstrate cosmetic repair of facial wounds.

Haemostasis in neurosurgery
• Describe haemostatic techniques previously used commonly in neurosurgery, such as muscle stamps and
hydrogen peroxide, and their application to modern neurosurgery.
• Discuss techniques for definitive control of bleeding from a venous sinus.
• Demonstrate effective haemostatic techniques as applicable to surgery for head injuries and intracranial
haematoma.
• Describe the types and applicability of wound drains to neurosurgical practice, their management, risks
and complication avoidance.

Thrombo-embolic prophylaxis
• Describe potential alternatives to anticoagulation for management of major venous thromboembolism.
• Discuss appropriate management of DVT with no embolic complications following neurosurgery.

Tracheostomy
• Compare and contrast techniques of percutaneous and open tracheostomy.
• Describe in detail the technique of open tracheostomy.
• Describe the assessment of a patient for removal of tracheostomy.

Infection avoidance in neurosurgery

• Discuss the role of prophylactic antibiotics in neurosurgery, evidence for their effectiveness, and risks
associated with their use.
• Discuss the role of patient health (including compromised states), drugs, radiotherapy and implants on
the risk of surgical infection, and appropriate prophylactic measures
• Compare and contrast different types of skin antiseptic preparation for neurosurgical procedures.
• Discuss the evidence for the use of occlusive incise drapes.

Updated 18 January 2007 Page 5 of 11

Approaches to abdominal and thoracic cavities

• Demonstrate proficient closure of thoracic/abdominal wall, for example, following VP shunt insertion or
thoracotomy.
• Discuss advantages and disadvantages of different types of approaches to plural and peritoneal cavity.

History of neurosurgery
• Discuss the contributions of Yasargil and Drake to the development of microsurgical technique.

Patient positioning in neurosurgery

• Position a patient in the lateral position for posterior fossa surgery.
• Discuss positioning options for surgery in the posterior fossa, including advantages and disadvantages.
• Compare and contrast lateral and prone positions for posterior spinal surgery and position patients in
these positions.
• Discuss the risks and complication avoidance associated with the sitting position.
• Demonstrate the appropriate selection and use of cushions and frames for positioning in the prone
position for a variety of spinal procedures.

Principles of micro neurosurgery

• Discuss the uses of sharp and blunt dissection techniques in the subarachnoid spaces with particular
reference to the descriptions of Yasargil.
• Demonstrate dexterity with use and selection of basic microsurgical instruments.
• Discuss the principles and techniques of microsurgical anastomotic techniques.
• Describe in detail techniques available to minimise brain retraction during microsurgical dissection.
• Describe in detail exposure and dissection techniques as applied to all anterior circulation aneurysms.

Surface anatomy
• Define the surface anatomy of the vertebral levels according to landmarks on the anterior aspect of the
neck.
• Define the vertebra prominens and describe its accuracy in assessment of vertebral levels.
• Define the surface anatomy of the thoracic vertebra relative to the sternum.
• Describe the surface anatomy of the cervical carotid artery and the level of the bifurcation.
• Describe the surface anatomy of the internal jugular and subclavian veins, their relationships to adjacent
structures, and be able to demonstrate the safe insertion of central venous catheter into both of these
veins.
• Describe the surface anatomy of the thoracic cavity, including the diaphragm and internal mammary
arteries.
• Demonstrate safe insertion of an intercostal catheter and discuss placement options for drainage of
haemothorax and pneumothorax.
• Demonstrate the safe insertion of a lumbar drain using surface landmarks.
• Describe the vascular and neural supply of the scalp, and discuss their importance in relationship to
various scalp incisions used for craniotomy.

Craniotomy Flaps
• Describe the implications of previous surgery in the position of skull flaps and craniotomy.
• Demonstrate standard pterional craniotomy and craniotomies for a variety of supratentorial approaches,
with particular attention to skin incision placement and appropriate placement of the bone flap.
• Demonstrate a midline posterior fossa craniotomy.
• Describe different posterior fossa craniotomies in detail for access to different areas of the posterior
fossa.
• Compare and contrast posterior fossa craniotomy with craniectomy in evidence-based terms.
• Discuss the options for securing craniotomy flaps, and compare the results in terms of stability, cosmesis,
infection, and other complications.

Updated 18 January 2007 Page 6 of 11

Cortical incisions
• Describe the preferred alignment and placement with respect to sulci/gyri of a cortical incision into
eloquent cortex.
• Describe the preferred orientation of a cerebellar incision for access to a deep lesion
• Describe the measurements from known landmarks which may be used to define eloquent cortex

Lobectomy and Surgery for intra-axial lesions of the cerebral and cerebellar hemispheres
• Describe the tests which may be used to identify the location and extent of Wernicke's area with
reference to temporal lobectomy.
• Perform appropriate craniotomy and expose the brain and identify the extent of resection for a frontal
and temporal lobectomy.
• Describe the anatomy of structures on the medial aspect of the temporal lobe, the deficit caused if these
are injured, and techniques to minimise risk of injury during temporal lobectomy.
• Describe the anatomy of structures on the medial aspect of the frontal lobe, the deficit caused if these
are injured, and techniques to minimise risk of injury during frontal lobectomy.
• Describe the extent of the ventricular system in the cerebral hemispheres, and whether this is expected
to be opened in a classical frontal and temporal lobectomy.
• Discuss complications which may arise from opening the ventricular system during a lobectomy and
methods by which these complications may be avoided

Approaches to intraventricular lesions

• Reliably demonstrate insertion of ventricular catheter (via both the frontal and parieto-occipital
approaches), using surface landmarks.
• Discuss in detail the advantages and disadvantages of the transcortical and transcallosal approach to the
foramen of Monro (eg for colloid cyst resection).
• Perform an appropriately placed craniotomy in preparation for colloid cyst resection.
• Discuss the microsurgical access to lesions in the 4th ventricle, including whether incision of the vermis is
required.
• Discuss the site and trajectories which could be chosen for ventriculoscopy for lesions in various parts of
the lateral ventricle.
• Describe the significant features identifiable at surgery in the lateral ventricle and how to use them to
navigate within the ventricle.

Approaches to the brainstem

• Describe the anatomy of the floor of the fourth ventricle.
• Describe the brainstem nuclei and pathways at each level in the brainstem.
• Describe the blood supply to the brainstem.

Surgical approaches to the spine

• Describe the approach to the anterior cervical column, the anatomical relationships to this approach and
specific risks and complications.
• Describe the alternative surgical approaches for thoracic discectomy.
• Describe the relationship of the ribs to the thoracic disc space, and methods of accurately determining
the level during surgical discectomy.

Approaches to the pineal gland

• Describe the anatomical relations of the pineal.
• Describe the anatomy of the infratentorial space, and structures which would be encountered in
approaching the pineal by this route.
• Discuss the advantages and disadvantages of stereotactic biopsy of a pineal tumour.
• Discuss the different approaches available for exposure of the pineal and the advantages and
disadvantages of each (include infratentorial and transtentorial approaches).
• Describe in detail the positioning options for the each of the different approaches to the pineal, and the
advantages and disadvantages of each.

Updated 18 January 2007 Page 7 of 11

Decompression of spinal cord

• Demonstrate a cervical laminectomy.

Decompression of cauda equina and spinal nerves

• Demonstrate the exposure, and accurately identify the nerve root for a lumbar microdiscectomy.
• Perform a decompressive lumbar laminectomy.
• Describe radiological findings of intradural and extradural compression of the cauda equina.

Spinal stabilisation and fusion techniques

• Discuss the surgical options for management of lumbar canal stenosis with associated minor (Grade 1)
degenerative spondylolisthesis, including the advantages and disadvantages of the different management
options.
• Describe anterior cervical discectomy and fusion by Cloward, Smith-Robinson and interbody cage
techniques.
• Compare and contrast the options of anterior cervical discectomy with and without fusion.
• Define factors which affect bone union following spinal fusion.
• Discuss the options for reduction of cervical subluxation with jumped facets.
• Define the named fracture types involving C1 and C2, and the treatment options available for each

Surgical equipment
• Discuss effects of diathermy on bleeding dural sinuses.
• Demonstrate the use and limitations of the neurosurgical operating microscope.
• Describe the mechanism of action of the surgical ultrasonic aspirator, its uses and limitations.
• Demonstrate frameless stereotactic localisation, including data acquisition, data transfer, registration and
localisation.
• Demonstrate framed stereotactic localisation, including frame application, data transfer and coordinate
computation, and localisation.
• Demonstrate the use of a high speed air drill for accurate bone dissection in the laboratory and in cranial
and spinal applications.
• Describe the mechanisms of action and use of the radiofrequency generator.
• Discuss the principles and uses of ultrasound in neurosurgery.

Skull base surgery

• Describe the detailed anatomy of the skull base and upper cervical spine, including neurovascular
relationships, and also relationships to orbital, facial, subtemporal and oro-pharyngeal structures.
• Describe the history and anatomical principles in trans-sphenoidal surgery.
• Describe skull base methods utilised for resection and repair of lesions involving the frontal sinus.
• Describe the approaches and potential complications of different surgical approaches to the pituitary
fossa.

SET5 Learning Outcomes

Surgical ligatures, knots, stapling devices and tissue glues

• Demonstrate rapid, precise and dexterous suture and knot tying techniques by all methods (hand and
instrument ties).

Haemostasis in neurosurgery
• Demonstrate competency in obtaining effective and safe haemostasis in cranial and spinal surgery.
• Describe techniques available for haemostasis following injury to major intracranial arteries.
• Describe considerations relating to sacrifice of intracranial veins and venous sinuses.

Thrombo-embolic prophylaxis
• Discuss appropriate prophylactic and therapeutic measures for arterial thromboembolism during and after
intracranial interventional radiological procedures, such and aneurysm coiling, angioplasty and stenting,
and thrombolysis of intra-arterial thrombo-embolism.

Updated 18 January 2007 Page 8 of 11

Tracheostomy
• Demonstrate an open surgical tracheostomy.
• Demonstrate alternative methods to control bleeding from a large thyroid isthmus during tracheostomy.
• Discuss the alternative methods of opening the trachea for tracheostomy and the advantages and
disadvantages of each method.
• Discuss particular considerations for tracheostomy relating to paediatric patients.

Infection avoidance in neurosurgery

• Discuss evidence for and against shaving the scalp for intracranial surgery.

History of neurosurgery
• Discuss specific published neurosurgical anatomy papers (e.g. the work of Rhoton).
• Discuss the history of peripheral nerve surgery.

Principles of micro neurosurgery

• Demonstrate dexterity of use of microscopic dissection instruments under the operating microscope (eg
splitting Sylvian fissure).
• Discuss the principles of aneurysm clipping, including the use of temporary clipping and the selection and
use of various clips including fenestrated clips.
• Demonstrate competence in microscopic dissection technique in elective spinal procedures such and
lumbar microdiscectomy and anterior cervical discectomy.
• Discuss in detail complex microsurgical approaches including highly selective amygdalohippocampectomy,
exposure and clipping techniques for posterior circulation aneurysms, microvascular anastomotic
procedures.
• Demonstrate microscopic suture techniques of dural closure under operating microscope.

Surface anatomy
• Describe the relations of the foramen magnum, and demonstrate a cisternal puncture.
• Demonstrate surface representation on the scalp of lesions identified on CT and MRI, their relationship to
eloquent brain, and perform appropriately placed craniotomy.
• Perform the appropriately placed craniotomy and dural opening for a transcallosal approach to the third
ventricle, with particular reference to the surface anatomy and venous anatomy.
• Perform the appropriately placed craniotomy and dural opening for microvascular decompression of the
fifth nerve, with particular reference to the surface anatomy and venous anatomy.

Craniotomy Flaps
• Demonstrate a variety of supratentorial and posterior fossa craniotomies in preparation for standard
neurosurgical elective and trauma procedures.
• Cortical incisions
• Describe the anatomy of the major white matter tracts in the cerebral hemisphere, and which parts of
those carry significant motor or special sensory pathways and the deficit likely to be caused if these are
injured.
• Perform appropriate cortical incision for microscopic resection of a lesion (eg metastasis) from eloquent
cortex.
• Discuss the variety of means by which eloquent cortex can be localised, and the accuracy, reliability and
applicability to neurosurgical procedures.

Lobectomy and Surgery for intra-axial lesions of the cerebral and cerebellar hemispheres
• Demonstrate a traditional frontal lobectomy.
• Discuss the differences in aims and extent of resection in a temporal lobectomy for treatment of mesial
sclerosis and low grade glioma.

Approaches to intraventricular lesions

• Demonstrate exposure of the foramen of Monro by both transcerebral and transcallosal techniques.

Updated 18 January 2007 Page 9 of 11

• Discuss in detail the variety of microsurgical approaches to the 3rd ventricle, their particular indications,
risks and specific complications associated with them.
• Describe in detail third ventriculostomy, including indications, ventriculoscopic and open methods, and
specific risks and complications.
• Discuss the surgical approaches to a lesion in the trigone of the left lateral ventricle, including the relative
advantages and disadvantages of each.
• Describe in detail the anatomy of the foramen of Monro, surgical methods of improving access from the
lateral into the third ventricle, and problems associated with injury to structures in the region.
• Demonstrate the exposure and identification of structures in the floor of the fourth ventricle.

Approaches to the brainstem

• Describe the various approaches for open surgical exposure to the brainstem.
• Discuss localisation of pontomedullary lesions according to visible landmarks on the floor of the 4th
ventricle.
• Demonstrate a framed stereotactic biopsy of a pineal lesion.

Surgical approaches to the spine

• Discuss the options for surgical access to the anterior aspect of the upper thoracic spine.
• Discuss surgical approaches to the anterior aspect of the thoracolumbar junction.
• Describe the surgical options for exposure of the anterior aspect of the upper cervical spine (C1, C2, C3).
• Describe the anterior relationships to the lumbosacral lesion.

Approaches to the pineal gland

• Demonstrate the positing of the patient in each of the possible positions for access to the pineal, and be
able to discuss with the anaesthetist specific problems which may be encountered during the procedure
and how to minimise the risks of these complications.
• Demonstrate the craniotomy in preparation for a pineal tumour by both the infra- and supratentorial
approach.
• Discuss the options for the trajectory for a framed stereotactic biopsy of a pineal lesion, and the relative
risks and merits of each approach.
• Demonstrate a stereotactic biopsy of a pineal lesion.

Decompression of spinal cord

• Demonstrate anterior cervical discectomy, fusion and stabilization.
• Describe in detail the method of thoracic discectomy using both costotransversectomy and transthoracic
approaches.

Decompression of cauda equina and spinal nerves

• Demonstrate a lumbar microdiscectomy and neurolysis .
• Demonstrate intradural exposure of the cauda equina and perform precise anatomical closure.
• Discuss the management options for intra-operative dural tear and CSF leak.
• Spinal stabilisation and fusion techniques
• Demonstrate the exposure of the atlanto-occipital junction for stabilisation procedure.
• Describe the methods of C1/2 stabilisation in detail.
• Describe the procedure of odontoid screw fixation.
• Describe the entry points, trajectories, and complication avoidance techniques for cervical stabilisation
using lateral mass screws and C1/2 transarticular screws.
• Describe surgical options for stabilisation of the thoracic spine.
• Describe the anatomical landmarks, technique and complication avoidance strategies for the insertion of
lumbar pedicle screws.
• Demonstrate anterior cervical discectomy fusion and instrumentation.

Surgical equipment
• Demonstrate stereotactic biopsy of intracranial lesions.
• Demonstrate frameless stereotactic localisation in spinal surgery.
• Demonstrate use of the operating microscope with complete familiarity.

Updated 18 January 2007 Page 10 of 11

• Demonstrate accurate use of high speed air drill in bone dissection for basic skull base exposure and in
spinal applications.
• Describe the procedure of electrophysiological localisation for functional stereotactic surgery.
• Demonstrate a percutaneous rhizotomy of the trigeminal ganglion.
• Discuss the surgical application of lasers, including risks, uses and limitations

Skull base surgery

• Discuss the options for resection of lesions in the cavernous sinus.
• Describe the trans-oral and mid-facial approaches to the skull base.
• Discuss the relative merits and risks of the retrosigmoid, translabarynthine, far-lateral (trans-condylar)
and transpetrosal approaches to parts of the brain stem, with particular reference to which areas are well
exposed and which are not.
• Describe the approaches for skull base craniotomies, including anterior fossa floor, orbitozygomatic,
petrosal and far-lateral (transcondylar) posterior fossa approaches.

SET6 Learning Outcomes

Tracheostomy
• Perform an open surgical tracheostomy.
• Perform alternative methods to control bleeding from a large thyroid isthmus during tracheostomy.

Approaches to intraventricular lesions

• Demonstrate the foramen of Monro and landmarks in the lateral and 3rd ventricles with a
ventriculoscope.

Approaches to the brainstem

• Demonstrate the exposure of the cranial nerve attachments to the pons and medulla.
• Describe the removal of a brain stem cavernoma.

Surgical approaches to the spine

• Demonstrate thoracic discectomy by different approaches.
• Demonstrate the set up and surgical exposure for odontoid screw fixation.
• Demonstrate the exposure and insertion of lumbar pedicle screws.

Approaches to the pineal gland

• Demonstrate the infratentorial exposure of the pineal region.

Spinal stabilisation and fusion techniques

• Demonstrate the anatomical landmarks, technique and complication avoidance strategies for the insertion
of lumbar pedicle screws.
• Discuss the potential advantages and disadvantages of lumbar interbody fusion compared to
posterolateral fusion.
• Discuss the mechanism of stabilisation utilised by inter body devices, and compare their effectiveness
with other techniques in the lumbar and cervical regions.

Skull base surgery

• Demonstrate the trans-oral and mid-facial approaches to the skull base.
• Demonstrate the retrosigmoid and far-lateral (trans-condylar) approaches to parts of the brain stem.
• Demonstrate the approach for skull base craniotomies, including anterior fossa floor, orbitozygomatic,
petrosal and far-lateral (transcondylar) posterior fossa.

Updated 18 January 2007 Page 11 of 11

Nuclear Medicine

Syllabus Module Overview

Module Rationale
The trainee needs to develop proficiency with nuclear medicine techniques in neurosurgical patients.
Trainees are required to understand the principle underlying each type of test, together with the
indications, risks and benefits.
Prior to graduation the trainee is required to be able to:
• utilise knowledge of the uses and limitations of the spectrum of nuclear studies in the selection and
use of the most appropriate investigations (nuclear, radiological or other) of patients with
neurological conditions

Recommended Readings

Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans
Desirable • Brain Tumors by A Kaye and E Laws (Chapters on SPECT and PET)

Learning Opportunities and Methods

• Trainees are encouraged to gain regular exposure to nuclear medicine studies.
• Trainees are encouraged to be involved in consultations with radiologists/ nuclear medicine
physicians.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Nuclear medicine studies will be examined during the Fellowship Examination.

SET1 & SET2 Learning Outcomes

Radionuclide Imaging
• Discuss the various radiopharmaceuticals available and list those most commonly used eg. Technecium-
99m-hexamethylpropyleneamineoxime (Tc-99m-HMPAO), Tc-99m-ECD, Tc-99m-DTPA.
• Describe the function of the gamma camera.

PET scanning; SPECT scan

• Describe the principle of Single Photon Emission Computered Tomography.
• Discuss the radio pharmaceuticals used and understand the clinical indications, uses and limitations of
this technique.

SET3 & SET4 Learning Outcomes

Radionuclide Imaging
• Discuss the use of radionuclide cisternography in the diagnosis of normal pressure hydrocephalus and
identification of cerebrospinal fluid (CSF) leaks. (In-111-DTPA).
• PET scanning; SPECT scan
• Discuss the history and the principles of Positron Emission Tomography. Describe the
radiopharmaceuticals used in this technique, for example FDG (fluorodeoxyglucose)
• Describe the function of a cyclotron and how this contributes to the clinical uses of PET scanning.
• Discuss the clinical application of nuclear bone scans.

Updated 18 January 2007 Page 1 of 2

SET5 & SET6 Learning Outcomes

Radionuclide Imaging
• Discuss this technique in evaluating lung function, particularly as this applies to pulmonary embolus. For
example, use of inhaled Xe-133 and intravenous Tc-99m-MAA.

PET scanning; SPECT scan

• Discuss the clinical applications of PET scanning, together with advantages, limitations and cost.

Updated 18 January 2007 Page 2 of 2

Neuroradiology

Syllabus Module Overview

Module Rationale
Neuroradiology comprises both imaging and interventional procedures related to the central and
peripheral nervous systems, including the vascular, skeletal and anatomically related structures . I n
depth understanding of neuroradiology and its interpretation is essential in the practice of
neurosurgery.
At the completion of the program trainees are expected to be able to:
• demonstrate neuroradiological diagnostic skills equal to or greater than that of a general radiologist
• weigh up the principles, indications, risks and benefits of each type of investigation

Recommended Readings

Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans.
Desirable • Diagnostic Neuroradiology. Osborn

References • American Society of Neuroradiology; [Link]

• Image database [Link]

Learning Opportunities and Methods

• Trainees are encouraged to attend and actively participate in formal neuroradiology meetings (at
least weekly).
• Trainees are expected to personally review all neuroradiological studies and make their own
interpretations prior to consulting with the neuroradiologists and reports. It is expected that trainees
would have daily exposure to neuroradiological investigations and engage in regular discussions with
neuroradiologists.
• The trainee should regularly participate in and observe interventional procedures.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Radiological investigations will be presented during the Fellowship Examination for interpretation.

SET1 & SET2 Learning Outcomes

Plain Xrays of the Skull and Spine

• Discuss the indications and limitations of plain radiography.
• Identify the important bony landmarks in plain Xrays of the skull and spine.
• Discuss the indications for spinal Xrays following trauma.
• Describe the views of plain cervical spine and lumbar spine series and identify the normal anatomy.
• Identify the radiological features of common spinal fractures and common spinal disorders.
• Discuss the radiological determination of spinal stability following trauma.
• Demonstrate a working knowledge of an image intensifier and basic radiation safety involved in its use.

CT Scanning
• Describe in detail the physics and principles of CT scanning.
• Discuss the development and evolution of CT scanning systems.
• Discuss the role of Hounsefield in radiology and define the Hounsefield Unit.
• Describe current CT scanning technology eg helical scanning, multislice scanning.
• Identify the detailed anatomy of a normal cranial CT scan.
• Describe the indications for cranial CT following head injury.

Updated 18 January 2007 Page 1 of 4

• Describe the indications for CT scan of the spine following trauma.

• On abnormal CT scans, identify the following:
• skull fractures
• intracranial haematomas
• subarachnoid haemorrhage
• ischaemic and venous infarction
• tumours and cysts
• hydrocephalus
• Discuss the uses, indications and risks of contrast agents in CT scanning

MRI
• Describe the underlying principles of MRI.
• Demonstrate the ability to identify normal anatomical structures on MRI.
• Discuss the conditions for which MRI is superior to CT imaging.
• Discuss the conditions for which MRI is inferior to CT imaging.
• Discuss the risks and limitations of MRI.
• Discuss the types and use of contrast in MRI.
• Describe commonly used pulse sequences and standard MR protocols.
• Identify the following pathological conditions shown on MRI:
• Infarction
• intracranial haemorrhages
• infections
• tumours
• cysts
• congenital abnormalities
• Identify the signal characteristics of intracranial haemorrhage of different ages on MR scans.
• Discuss the specific contraindications to a patient having MR scan.

Cerebral and Spinal Angiography

• Describe the evolution of angiographic techniques.
• Describe the principles underlying equipment used for angiography e.g. Digital Subtraction Angiography.
• Discuss the use of current angiographic techniques.
• Describe detailed cerebral vascular anatomy on angiography.
• Demonstrate a detailed understanding of the current indications, limitations and risks of angiography. For
example, be able to identify all relevant extra- and intra-cranial arteries (secondary and tertiary branches
of the carotid and basilar arteries) and veins (cortical and deep cerebral veins) on angiography.

Interventional Neuroradiology
• • Discuss the interventional techniques available in neuroradiology.

Radiographic Contrast Agents

• Discuss the basic chemical properties of radiographic contrast agents currently used for angiography,
myelography, CT and MRI.
• List the most commonly used contrast agents and discuss the properties of each. eg. Non ionic iodinated
contrast media. Gadolinium.
• Describe the features and management of contrast reaction.
• List the indications, contra indications and risks of contrast agents.

Ultrasound and Doppler

• Describe the principles of ultrasound, Doppler, how it works, and its limitations.

Subarachnoid Contrast Agents

• Discuss the historical uses and application of ventriculography.
• Discuss the current application indications and risks of myelography and cisternography.

Updated 18 January 2007 Page 2 of 4

SET3 & SET4 Learning Outcomes

Plain Xrays of the Skull and Spine

• Discuss the plain Xray features associated with raised intracranial pressure.
• Discuss the features of the sella turcica on plain skull Xray and its relevance to neurosurgery.

CT Scanning
• Describe the levels and window settings for CT scanning and how they can be manipulated to gain
maximum information.
• Discuss the principles of image manipulation, 3D reconstruction and CT angiography.
• Identify spinal traumatic injuries of the cervical, thoracic and lumbar spines in CT scans, including
vertebral body fractures (and subtypes) facet fractures and dislocations, posterior element fractures,
vertebral subluxation/dislocation.
• Describe radiological findings of traumatic craniovertebral junction, atlantoaxial and subaxial injuries.

MRI
• Discuss the risks and limitations of MR scan in patients with aneurysm clips.
• Discuss spatial inaccuracies in MR scanning and its effect of stereotaxy.
• Discuss the use and limitations of MRI in head and spinal trauma.
• Demonstrate the ability to recognize detailed neuro-anatomy as shown by MRI.
• Describe MRI appearance of spinal ligament injury, traumatic disc herniation, spinal cord contusion and
spinal epidural haematoma.
• Use MRI imaging findings to differentiate different types of focal intracranial lesions (neoplastic,
inflammatory, vascular) based on anatomic location (e.g. intra- vs. extra-axial), contour, intensity and
enhancement pattern.
• Identify and differentiate on MRI diffuse intracranial abnormalities (e.g. hydrocephalus and atrophy).
• Identify treatment-related findings on MRI (e.g. post-surgical and post-radiation).

Cerebral and Spinal Angiography

• Identify uncommon vascular anatomical variations on angiography.
• Identify anterior and posterior circulation aneurysms and other vascular anomalies.

Interventional Neuroradiology
• Discuss the radiological equipment facilitating interventional techniques e.g. 3D versus biplanar versus
uniplanar imaging.
• Describe the indications, risks and benefits for neurointerventional procedures including embolization,
angioplasty and stenting.
• Discuss different types of available endovascular coils and their uses.
• Discuss the uses and limitations of balloon technology in interventional radiology.
• Discuss the uses, risks and limitations of stents in interventional radiology.
• Discuss the uses, risks and limitations of glues, particles and other embolic material in interventional
radiology.

Radiographic Contrast Agents

• Discuss confounding factors influencing the use of contrast agents in radiology (e.g. renal function, age
and iodine allergies).

Ultrasound and Doppler

• Describe the neurological applications of ultrasound (for example its use in neonates and intra-operative
ultrasound).

Subarachnoid Contrast Agents

• Identify normal and pathological findings on myelography.

Updated 18 January 2007 Page 3 of 4

SET5 Learning Outcomes

Plain Xrays of the Skull and Spine

• Identify normal anatomical variations in complex pathological conditions identifiable on plain radiology,
including differential diagnosis.
• Describe the application of intraoperative image intensification eg spinal surgery and needle placement
for trigeminal rhizotomy.

CT Scanning
• Demonstrate the manipulation of CT images to obtain data for frame based and frameless stereotaxy.
• Demonstrate the ability to accurately interpret radiological examinations of neurosurgical patients.

MRI
• Describe how pulse sequences are combined to produce effective and efficient imaging protocols for
common disease processes.
• Discuss the applications of spin echo, gradient echo, inversion recovery, chemical shift imaging,
suppression techniques, high-speed imaging, and evolving sequences.
• Identify degenerative spinal conditions on MRI, including disc degeneration, disc herniation, degenerative
spinal stenosis, facet hypertrophy, osteophyte formation, foraminal stenosis, spondylolisthesis, and
ossification of posterior longitudinal ligament.
• Discuss the uses and limitations of diffusion/perfusion MRI, functional MRI and MR spectroscopy.
• Demonstrate the use of CT and MRI sequences in image guided surgery.

Cerebral and Spinal Angiography

• Identify normal and abnormal spinal vascular anatomy on angiography.

Interventional Neuroradiology
• Critically evaluate the use of interventional neuroradiology as an adjunct to conventional surgery.
• Discuss in detail current indications of this modality for treatment of aneurysms, vasospasm, cranial and
spinal vascular malformations, tumour embolization, carotid and vertebral stenosis, carotid and vertebral
dissection.
• Discuss the endovascular management of dural malformations and caroticocavernous fistulae.

Ultrasound and Doppler

• Describe the technique and the uses and limitations of a transcranial Doppler.

SET6 Learning Outcomes

CT Scanning
• Critically appraise latest developments in the technology of CT scanning.
• Discuss the application of CT angiography and compare it with conventional and magnetic resonance
angiography.

MRI
• Discuss the application of MR angiography and compare it with conventional and CT angiography.

Interventional Neuroradiology
• Compare and contrast surgical and endovascular treatment of intracranial aneurysms.
• Discuss the role of embolization and endovascular techniques in the management of AVMs.
• Discuss the role of embolization and endovascular techniques in the management of intracranial and
spinal tumours.

Updated 18 January 2007 Page 4 of 4

Neurophysiology

Syllabus Module Overview

Module Rationale
Knowledge in depth is required in regard to cerebrovascular physiology, brain energy metabolism and
cerebral oedema. The factors that determine the intracranial pressure and produce cerebral ischaemia
with brain shift need to be studied in detail.
Prior to graduation the trainee is required to be able to:
• carry out relevant procedures to collect, analyse, and interpret data to determine normal and
abnormal physiology of respiration, fluid and electrolyte balance and metabolism
• apply their in-depth knowledge of the function of the central and peripheral nervous system to reach
a diagnosis and perform appropriate therapeutic procedures to help resolve a patient's problem
• select medically appropriate investigative tools to carry out clinical neurophysiological investigation
and monitoring techniques in a cost-effective, and useful manner

Recommended Readings

Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans.
Desirable • The nervous system - Ganong

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Neurophysiology will be examined during the Fellowship Examination.

SET1 & SET2 Learning Outcomes

Fluid and electrolyte balance

• Demonstrate the clinical assessment of hydration status.
• Define the clinical syndrome of shock.
• Discuss the various types of shock and their management.
• Define the normal electrolyte concentrations.
• Describe the major intracellular and extracellular ions.
• Describe the sodium potassium pump and calcium channels.
• Calculate total body water deficit / excess.
• Define and calculate the anion gap and discuss its relevance.
• Define the normal fluid and electrolyte replacement.
• Define the composition of normal saline, Hartman's solution, Ringer's solution and commonly used
dextrose intravenous solutions.

Acid base balance

• Differentiate respiratory and metabolic acidosis and alkalosis on blood gas analysis.
• Discuss the management of metabolic acidosis and alkalosis.

Respiratory function
• Define normal blood gases.
• Discuss the uses and limitations of oxygen saturation monitoring.
• Demonstrate the assessment and management of an adequate airway.
• Define normal respiratory function test parameters.
• Discuss V/Q mismatch.
• Describe in detail the effects of blood gas derangement on cerebral blood flow.
• Define the terms positive pressure ventilation, PEEP, CPAP, BiPAP and assisted/controlled ventilation, and
discuss their clinical uses.

Updated 18 January 2007 Page 1 of 4

Principles of nutrition
• Define the normal caloric requirements.
• Discuss the altered nutritional requirements in neurological disease states eg. Trauma

Energy metabolism in the brain

• Define both aerobic and anaerobic pathways for energy production in the central nervous system.

Cerebral blood flow

• Describe normal cerebral blood flow and oxygen consumption.
• Define cerebral perfusion pressure
• Describe in detail the autoregulation of cerebral blood flow.

Cerebrospinal fluid and intracranial pressure

• Define the normal contents of the cranium.
• Discuss the Monro-Kellie doctrine.
• Define normal intracranial pressure and physiological factors affecting it.
• Define normal ICP wave form and discuss its components.
• Define the normal processes of cerebrospinal fluid production, circulation and absorption.
• Define the normal composition of cerebrospinal fluid.
• Define normal cerebrospinal fluid pressures.

Neural conduction and muscle contraction

• Define the resting potential of normal axonal membrane and the mechanisms of its maintenance.
• Describe a normal action potential.
• Discuss the role of myelin in action potential transmission.
• Classify peripheral nerve fibres based on size and function.
• Define the neurotransmitters at the neuromuscular junction.
• Define the physiology of smooth and striated muscle contraction.
• Define the monosynaptic spinal reflex arc.
• Discuss the physiological factors affecting muscle tone.
• Describe the more complex reflex arc.
• Discuss the physiological effects of parasympathetic nervous system.
• Discuss the physiological effects of sympathetic nervous system.
• Define the neurotransmitters in the autonomic nervous system.

Consciousness
• Discuss the factors affecting consciousness.

Special senses and other

• Describe the physiology of the perception of light and colour.
• Describe the mechanisms of visual accommodation.
• Describe the physiology of taste and smell sensation.
• Describe the physiology of hearing.

Neuroendocrine
• Describe in detail the hypothalamic pituitary axis.
• List the hormones released by the pituitary and the functions on the end organs.
• Discuss the diurnal variation in hormone production.
• Describe the hypothalamic and pituitary regulation of the reproductive cycle.
• Describe the regulation of adrenal function.

Updated 18 January 2007 Page 2 of 4

SET3 & SET4 Learning Outcomes

Fluid and electrolyte balance

• Describe the composition and uses of colloid solutions.
• Discuss the causes, clinical features and management of hyponatraemia.
• Discuss central pontine myelinosis, its causes and avoidance.
• Describe in detail the causes and management of diabetes insipidus.
• Describe the clinical syndromes associated with hypo and hyper calcaemia, including causes and
management.

Respiratory function
• Describe in physiological terms the cardio pulmonary changes associated with pulmonary embolism.
• Describe the diagnostic features of pulmonary embolism.
• Discuss the indications and uses of bicarbonate therapy.

Principles of nutrition
• Discuss neurological disorders associated with vitamin deficiencies.

Energy metabolism in the brain

• Define the term CMRO 2
• Discuss regional variations in cerebral energy metabolism.

Cerebrospinal fluid and intracranial pressure

• Define the mechanisms for transmission of altered intrathoracic and intraabdominal pressure to the CNS.

Neural conduction and muscle contraction

• Discuss the factors affecting normal axonal conduction rate.
• List the normal excitatory and inhibitory neurotransmitters in the CNS.
• Discuss the physiological basis for the different somatic sensory modalities including specific receptors
and conduction pathways.
• Discuss the physiological control of normal bladder and bowel function.

Consciousness
• Describe the function of the reticular activating system.
• Define the normal sleep patterns.

Special senses and other

• Discuss the physiology of posture maintenance and balance.
• Discussion the function of bulbar reflexes.
• Describe the physiology of pain perception and modulation.

SET5 Learning Outcomes

Fluid and electrolyte balance

• Discuss cerebral salt wasting syndrome.
• Discuss the role of the pituitary and hypothalamus in fluid and electrolyte homeostasis.

Respiratory function
• Discuss the effects of mechanical ventilation on intracranial pressure.

Energy metabolism in the brain

• Define the therapeutic strategies for alteration of neuronal CMRO 2.

Updated 18 January 2007 Page 3 of 4

Cerebral blood flow

• Describe the methods for measurement of regional cerebral blood flow and its clinical application.

Cerebrospinal fluid and intracranial pressure

• Discuss the concepts of compartmentalisation with respect to ICP.

SET6 Learning Outcomes

Neural conduction and muscle contraction

• Discuss the physiological control of normal sexual function.

Neuroendocrine
• Discuss the functions of the pineal gland.

Updated 18 January 2007 Page 4 of 4

Neuropharmocology and Neurochemistry

Syllabus Module Overview

Module Rationale
The trainee needs to be familiar with the basic principles of Neuropharmocology and Neurochemistry
with special reference to the actions, interactions and toxic effects of drugs currently used in
neurosurgery.
Prior to graduation the trainee is required to be able to:
• accurately identify the risks, benefits, and mechanisms of action of currently used drugs
• communicate with the patient and/or family the treatment options, potentials, complications, and
risks associated with the use of drugs

Recommended Readings
Essential The relevant chapter of one of the following:
• Robert, H., M.D. Wilkins, S. Settis and M. D. Rengachary (1996) Neurosurgery .
New York : McGraw-Hill, Health Professions Division.
• Julian R. and M.D. Youmans (2004) Neurological Surgery . 5 th Edition. W. B.
Saunders & Co. CD-ROM.

Assessment and Examination

Aspects of neuropharmacology and neurochemistry will be examined in the Fellowship Examination.

SET1 & SET2 Learning Outcomes

Blood brain barrier

• Discuss the relevance of the blood brain barrier to central nervous system drug delivery.

Steroids
• Describe the basic steroid ring and its modifications to produce the various subgroups.
• Discuss the actions of the steroid subgroups.
• Discuss the pharmacodynamics of dexamethasone, prednisone and hydrocortisone.
• Discuss the side-effects of steroids commonly used in neurosurgery practice.
• Discuss iatrogenic suppression of the adrenal cortex and its management.

Anticonvulsants
• Classify the anticonvulsant medications based on their mechanism of action.
• Describe in detail the pharmacology of phenytoin, sodium valproate, carbamazepine and gabapentin.
• Discuss the role of serum level monitoring in long-term anticonvulsant therapy administration.
• Define status epilepticus and discuss in detail its management.
• Discuss the effect of benzodiazepines on seizure activity.

Calcium channel blockers

• Discuss the mode of action and side-effects of the groups of calcium channel blockers.
• Describe the administration of nimodipine.

Mannitol and diuretics

• Discuss in general terms the pharmacology and clinical use of diuretics.
• Describe in detail the pharmacology of mannitol.
• Describe the indications for mannitol use in acute head injury.

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Barbiturates
• Describe the pharmacology of the barbiturates.
• Describe the effect of the barbiturates on neuronal function

Antibiotics
• Describe the classes of antibiotics commonly used in neurosurgery.
• Describe the mode of action of the commonly used antibiotics.
• Discuss the bioavailability of antibiotics in the central nervous system.
• Discuss the use of antibacterial skin preparations in neurosurgery.

Analgesics
• Describe the classes of analgesics commonly used in neurosurgery
• Describe in detail the pharmacology of paracetamol and aspirin
• Describe in detail the pharmacology of the opiates
• Describe the pharmacology of the non-steroidal anti-inflammatory medications

Other
• Describe the management of acute anaphylaxis.
• Discuss the drug interactions of warfarin.
• Describe the options for therapeutic anticoagulation.
• Describe the options for reversal of anticoagulation.
• Discuss the pharmacology of the anti-platelet agents.
• Discuss, in general terms, the pharmacology of the benzodiazepines.
• Discuss, in general terms, the pharmacology of the anti-depressants commonly encountered in
neurosurgery.
• Discuss the pharmacology of the commonly used anti-emetic drugs.
• Discuss, in general terms, the basic pharmacology of the commonly used local anaesthetic drugs.
• Discuss the pharmacology of the medications used for peptic ulcer prophylaxis.
• Discuss the basic pharmacology of the major tranquillisers used in neurosurgery.

SET3 & SET4 Learning Outcomes

Steroids
• Discuss why dexamethasone is most commonly used in neurosurgery.
• Describe the mechanism of action of glucocorticoids on various types of cerebral oedema.

Anticonvulsants
• Compare and contrast the indications and limitations of phenytoin, sodium valproate and carbamazepine.
• Discuss the evidence for the use of prophylactic anticonvulsants in trauma, elective craniotomy and
aneurysmal subarachnoid haemorrhage.

Calcium channel blockers

• Discuss the evidence for the use of calcium channel blockers in the management of cerebral vasospasm.

Mannitol and diuretics

• Discuss the role of mannitol in neurosurgery practice.
• Describe the potential negative effects of recurrent and prolonged mannitol use.
• Compare and contrast the use of the various types of diuretics fro reducing raised intracranial pressure.
• Discuss the effect of mannitol on the microcirculation.

Barbiturates
• Discuss the use of barbiturates in epilepsy management

Updated 18 January 2007 Page 2 of 4

Antibiotics
• Discuss the evidence for prophylactic antibiotic therapy in operative neurosurgery.
• Discuss the role of prophylactic antibiotic therapy in cerebrospinal fluid leak and drains.
• Discuss the use of topical antibiotics in neurosurgery.
• Discuss the serum monitoring of antibiotics.
• Discuss the use of antibiotics in the presence of known allergy.

Analgesics
• Describe the relative efficacy of the analgesics commonly used in neurosurgery
• Discuss the pharmacology of opiate dependence

Other
• Discuss the evidence for pharmacological deep venous thrombosis prophylaxis.
• Discuss the uses of benzodiazepines in neurosurgery.
• Discuss the uses of the anti-depressants in neurosurgery.
• Discuss, in general terms, the pharmacology of the ionotropes.
• Discuss the pharmacological management of acute hypertension in neurosurgery.

SET5 Learning Outcomes

Blood brain barrier

• Discuss the various interventions that have been used to alter the blood-brain barrier for drug delivery.

Steroids
• Discuss the evidence for glucocorticoid use in cerebral protection.
• Discuss the evidence for glucocorticoid use in neurotrauma.

Anticonvulsants
• Discuss the role of anticonvulsants in pain management.
• Discuss the use of anticonvulsants in pregnancy.

Calcium channel blockers

• Discuss the evidence for the use of calcium channel blockers in the management of neurotrauma.

Mannitol and diuretics

• Discuss the role of mannitol in cerebral protection.
• Discuss the role of urea in the management of raised intracranial pressure.

Barbiturates
• Discuss the role of barbiturate therapy in neuroprotection
• Describe the effects of barbiturates on intracranial and cerebral perfusion pressures.

Antibiotics
• Discuss the use of antiviral agents in neurological disorders.

Other
• Discuss the clinical application of ionotropes.

Updated 18 January 2007 Page 3 of 4

SET6 Learning Outcomes

Steroids
• Discuss the role of steroids in the prevention of lipid peroxidation.

Other
• Discuss the use of anti-platelet and anti-coagulant therapies following cerebral ischaemia.

Updated 18 January 2007 Page 4 of 4

Neuropathology

Syllabus Module Overview

Module Rationale
A detailed knowledge of the gross and microscopic pathology of neurological diseases is essential in
diagnosis.
Prior to graduation the trainee is required to be able to:
• recognise and describe both gross and microscopic neuropathology preparations

Recommended Readings

Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans.

Desirable • Tumours of the Nervous System: Pathology & Genetics, Kleihues and Cavenee
(eds)
• Handbook of Neurosurgery, Greenburg
• Brain Tumours, Kaye and Laws (eds)

References • Pathology of tumours of the nervous system. Russell and Rubinstein

• Surgical pathology of the nervous system and its coverings. Burger and Vogel
• Greenfield 's neuropathology"
• Check authors
• Oxford University Press
• Fundamentals of neuropathology - Okazaki
• Atlas of neuropathology - Okazaki

Learning Opportunities and Methods

• Trainees are expected to regularly participate in neuropathology meetings and participate in regular
case review with neuropathologists.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Neuropathology will be examined during the Fellowship Examination.

SET1 & SET2 Learning Outcomes

General Pathology of neurons and glia

• Describe the normal weight of the brain at different ages.
• Describe the appearance of neurons, astrocytes, oligodendrocytes and ependyma.
• Describe the cellular processes of repair, regeneration and recovery of function.
• Describe the methods used for neuropathological examination (tissue preparation, difference between
frozen and paraffin-embedded sections, staining techniques, etc) and the artefacts that these methods
produce.

Congenital malformations
• Discuss environmental influences in the development of congenital neurological disorders.
• Define the terms commonly used in congenital defects such as porencephaly, hydranencephaly,
microcephaly, megalocephaly, encephalocele, meningocoele, holoprosencephaly, lissencephaly and spinal
dysraphism.
• Describe the classification of Chiari malformations.
• Describe the congenital causes of hydrocephalus.

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Cerebral and spinal vascular disorders

• Discuss the common sites of spontaneous intracerebral haemorrhage and their likely causes.
• Describe the pathological changes of the parenchyma and cerebral vasculature associated with chronic
hypertension.
• Describe the pathological differences between the various vascular anomalies eg. AVM, cavernoma,
venous malformations, capillary telangiectasia, dural arteriovenous fistulae
• Describe the pathological classification of cerebral aneurysms
• Describe the pathology of atherosclerotic occlusive disease

Brain and spinal cord trauma

• Discuss the clinicopathological correlates of head injury mechanisms eg. shear, rotation, contre-coup.
• Describe the difference between primary and secondary injury.
• Describe in detail the causes and patterns of secondary brain injury.
• Describe in detail the differences between focal and diffuse axonal and vascular injury.
• Discuss the spectrum of traumatic intracranial haemorrhage.
• Describe the pathology of contusions as it relates to the mechanism of injury and skull anatomy.
• Describe the gross pathology of acute and chronic subdural haematomas.
• Describe the gross pathology of extradural haematoma.
• Describe in detail the different types of brain swelling.
• Discuss the mechanisms of acute and secondary spinal cord injury.

Miscellaneous nervous system disease

• Describe the pathological findings in the brain associated with ageing.

Demyelinating diseases
• Describe demyelination and classification of demyelinating disease.

Skull, spine and musculoskeletal system

• Describe the pathological changes in intervertebral disc degeneration.
• Describe the pathological process of osteophyte formation.
• Describe the pathology of osteoporosis and osteomalacia.
• Describe the pathology of Paget's disease.
• Discuss the process of fracture healing.

Central nervous system infections

• Discuss the possible routes of intracranial infection.
• Discuss the normal CNS mechanisms of defence against infection.
• Describe the pathogenesis of brain abscess, subdural empyema and epidural abscess.
• Discuss the stages of brain abscess formation.
• Describe the microbiology of common cerebral infection.
• Describe abnormalities (cardiac, pulmonary, metabolic, syndromic) that predispose to abscess formation.
• Describe the pathological features differentiating viral, bacterial and fungal CNS infections.
• Discuss the systemic effects associated with meningitis and encephalitis eg. Skin lesions in meningococcal
infection.

Immunopathological disorders
• Describe the pathology of myasthenia gravis.
• Describe the pathological features in rheumatoid arthritis with particular respect to vertebral column.
• Describe in general terms the neuropathology of autoimmune diseases such as systemic lupus
erythematosis.

Toxic and deficiency disorders

• Discuss the neurological and pathological effects of alcohol intoxication and withdrawal and its
implications with management.
• Describe the neuropathology of chronic alcoholism including Wernicke-Korsakoff syndrome.

Updated 18 January 2007 Page 2 of 7

• Discuss the neuropathological effects of vitamin deficiencies e.g. A, B1, B12.

• Describe the effects of protein and caloric deficiency, especially in the setting of trauma.

Brain shifts and herniation

• Describe the stages of compensation for a space-occupying lesion.
• Describe the pathology of trans-tentorial herniation.
• Describe the pathology of tonsillar herniation.
• Describe the pathophysiology of herniation after lumbar puncture.
• Describe the pathology of subfalcine herniation.
• Describe the pathology of brain herniation through a skull defect.
• Describe the secondary effects of brain herniation: vascular compression, false-localising signs.
• Describe Kernohan's notch.
• Discuss the differences between slowly- and rapidly-expanding lesions.

Neuro-oncology
• Discuss the general molecular changes in neoplastic cells.
• Discuss the method of growth and spread of intrinsic tumours.
• Differentiate between intrinsic and extrinsic tumours on gross specimens.
• List the classification of tumours that occur at the skull vault and scalp.
• Describe the nature of cell division and the cell cycle.
• Describe the abnormalities of the cell cycle commonly identified in neoplasia.
• Define terms "benign", "neoplastic" and "malignant" as relevant to neurological tumours.
• Define "tumour suppressor gene", "oncogene", "loss of heterozygosity", "growth factor", "growth factor
receptor", and "cytokine". List examples of each under current investigation and explain their significance
to common CNS neoplasms.
• Define tumour invasion and angiogenesis and describe the underlying mechanisms. Discuss the
significance of each to tumour progression for common CNS neoplasms.
• Define "tumour markers" and their use in clinical practice.
• Describe elements of immune system and immune response to brain tumours.
• Define "cytokine", "autocrine' and "paracrine".
• Describe the history of brain tumour classification systems.
• Describe different systems for classification of astrocytomas.
• Discuss the use of tumour grade within the classification.
• Describe the multistep nature of tumour pathogenesis in general terms.
• Describe the basis of general tumourigenesis by viruses, chemicals and radiation.
• List the conditions known as neurophakomatoses.
• Define the term glioma.
• List the tumours that may appear within the ventricular system by location.
• List the tumours that tend to metastasize to the central nervous system with particular reference to age
and gender.
• Describe current theories of metastatic spread of tumours to the central nervous system.
• Describe current WHO classification of meningiomas.
• Describe the common intracranial locations of meningioma.
• Define the cell of origin and cytogenetics of meningioma and theories of tumourigenesis.
• Define and differentiate epidermoid, dermoid and teratoma.
• Describe common locations of epidermoid and dermoid and the epidemiology of both.
• Describe the classification of pineal region tumours including WHO.
• Describe the classification and pathology of pineal region tumours.
• List the tumours that may arise in the cerebellopontine angle (CPA).
• Discuss the association of vestibular schwannoma with other disorders, including NF-2 and the underlying
genetic abnormalities.
• Describe the classification of pituitary tumours with respect to the cell of origin and size.
• Discuss the embryogenesis of chordoma.
• Discuss the classifications of lymphoma.
• Discuss the relationship between lymphoma and associated conditions e.g. immunosuppression.
• Describe the common locations in which intracerebral and intraspinal lipomas occur, their anatomical
relationships and relative frequency and embryological origin and development
• List the tumours that tend to metastasize to the spine with particular reference to age, gender and
frequency.

Updated 18 January 2007 Page 3 of 7

• Classify the common extradural, intradural (extramedullary) and intramedullary tumours.

SET3&SET4 Learning Outcomes

General Pathology of neurons and glia

• Describe the biochemical events of neuronal hypoxia resulting in cell death.
• Describe Wallerian degeneration.
• Describe the function of the various types of glial cells.
• Describe the anatomical basis, structure and function of the blood brain barrier.
• Discuss the features of necrosis versus apoptosis in cell death.
• Describe the reaction of glial cells to neural injury.

Congenital malformations
• Describe the detailed pathology of anencephaly, encephalocele and meningocoele.
• Describe the pathology of arachnoid cysts.
• Describe the detailed pathology of Chiari malformations including associated abnormalities.
• Describe the pathology of cerebellar malformations eg. agenesis, aplasia of the vermis, and Dandy
Walker syndrome.
• Describe the pathology of craniosynostosis.
• Describe the epidemiology, embryology and pathological characteristics of neural tube defects.
• Describe the following malformations of the spinal cord: hydromyelia, diastematomyelia, diplomyelia,
syringomyelia and syringobulbia.
• Cerebral and spinal vascular disorders
• Describe in detail the gross and microscopic pathology of the vascular malformations of the brain.
• Describe the histological appearances of the various types of cerebral aneurysms.
• Describe the pathological effects of subarachnoid and intraparenchymal haemorrhage.
• Describe the gross and microscopic pathology of amyloid angiopathy.
• Describe the secondary pathological changes that occur in ischaemic stroke.
• Describe the microscopic pathology of infectious and immune mediated arteritis.

Brain and spinal cord trauma

• Describe the cellular and molecular processes occurring after neuronal injury.
• Describe the differences between low velocity and high velocity blunt injuries.
• Describe the detailed gross and microscopic pathology of diffuse axonal injury.
• Discuss in detail the gross and microscopic pathology of cerebral injury associated with raised intracranial
pressure.
• Describe the microscopic pathology and mechanisms of formation and enlargement of chronic subdural
haematomas.
• Describe the gross and microscopic pathology of acute spinal cord injury.
• Describe long term pathological changes following spinal cord injury.

Miscellaneous nervous system disease

• Describe the pathological features of Alzheimer's disease.
• Describe in detail the pathological features of Parkinson's disease.
• Describe the pathological features of Huntington's disease.

Demyelinating diseases
• Discuss the gross and microscopic pathological findings in multiple sclerosis.

Skull, spine and musculoskeletal system

• Describe the pathology of spinal canal stenosis.
• Describe the pathology of spondylolysis and spondylolisthesis.
• Discuss metabolic bone diseases (including renal osteodystrophy, primary hyperparathyroidism).
• Describe the classification of myopathies and the basic pathological findings.

Updated 18 January 2007 Page 4 of 7

Central nervous system infections

• Describe the gross and histological features of a brain abscess at various stages.
• Describe the gross and histological features of subdural empyema and epidural abscess.
• Describe the gross and microscopic features of bacterial meningitis.
• Describe the pathology of herpes simplex encephalitis.
• Discuss the pathology of tuberculous infections of the CNS.
• Discuss the pathology of fungal infections of the CNS.
• Describe the pathology of varicella zoster infections.
• Describe the pathology of opportunistic infections in immunocompromised patients.

Immunopathological disorders
• Describe the pathology of Guillain-Barre syndrome.
• Describe the pathology of sarcoidosis and its neurological manifestations.

Toxic and deficiency disorders

• Describe the neurological effects of vitamin A intoxication.
• Discuss the pathological changes associated with chronic phenytoin use.

Brain shifts and herniation

• Discuss the pathophysiology of upward trans-tentorial herniation.

Neuro-oncology
• Describe the histopathological features of scalp and skull tumours.
• Describe factors secreted by tumours which modulate the immune response and cause immunodeficiency
and the mechanisms by which they do this.
• Describe commonly used histopathological markers of cell kinetics and their significance.
• Describe the immune deficiency syndromes in relation to neurological tumours.
• Outline the current WHO system for brain tumour classification.
• Identify on pathological slides the features on which classification of tumour type and tumour grade are
based - particularly for common tumours including gliomas, meningiomas, metastases, pineal region
tumours, acoustic neuroma, pituitary tumours and craniopharyngioma.
• Describe in detail the pathology of the neurophakomatoses.
• Describe the gross and histopathological features of gliomas.
• Describe the gross and histopathological features of intraventricular tumours.
• Describe the distinguishing features of fourth ventricular tumours including medulloblastoma and
ependymoma.
• Describe the distinguishing features of third ventricular tumours including colloid cysts.
• Describe the distinguishing features of lateral ventricular tumours including meningioma and choroid
plexus tumours.
• Describe the gross and histopathological features of cerebral metastases.
• Describe primary brain tumours that metastasise to CSF and extraneural pathways involved.
• Describe macroscopic and histological features of meningiomas.
• Identify the macroscopic and microscopic features of epidermoid, dermoid and teratoma.
• Differentiate mature, immature and malignant teratoma.
• Describe the classification of germ cell tumours and tumour markers associated with these.
• Describe the gross and microscopic features of schwannoma.
• Descriie the gross and microscopic features of haemangioblastoma.
• Describe the gross and microscopic features of pituitary region tumours.
• Describe the gross and microscopic pathological features of chordoma.
• List the tumours that may arise in the orbit.
• Describe the gross and microscopic pathological features of tumours which may appear in the orbit.
• Describe the gross and microscopic pathological features of cerebral lymphoma and the current WHO
classification.
• Discuss the pathology of CNS lipomas.
• Describe the gross and microscopic pathological features of spinal tumours.

Updated 18 January 2007 Page 5 of 7

SET5 Learning Outcomes

General Pathology of neurons and glia

• Describe Rosenthal fibres and their significance.
• Describe mechanisms of cerebral injury associated with carbon monoxide poisoning.
• Describe the changes in the normal central nervous system induced by radiation.

Congenital malformations
• Describe the pathology of intracranial birth injury and haemorrhage, and ischaemic lesions.
• Describe the disorders of forebrain induction eg. holoprosencephaly, agenesis of corpus callosum and
anomalies of septum pellucidum.
• Describe the pathology of cerebral heterotopias.
• Describe in detail the CNS pathology associated with perinatal infections eg. syphilis, toxoplasmosis,
cytomegalovirus, rubella and HIV.

Cerebral and spinal vascular disorders

• Describe the gross and microscopic effects of radiation on normal and abnormal cerebral vasculature.
• Describe the pathology and sequelae of thrombosis of the dural venous sinuses and the deep venous
system.
• Describe the classification and detailed pathology of the vascular malformations of the spine.

Brain and spinal cord trauma

• Describe the pathology and pathophysiology associated with high velocity missile injuries.
• Describe the cellular processes of repair in the nervous system.

Miscellaneous nervous system disease

• Describe the pathological features of Pick's disease.
• Describe the basic gross and microscopic pathological changes associated with peripheral neuropathies.
• Describe the pathological features of motor neurone disease.
• Describe the general pathology of mitochondrial diseases.

Demyelinating diseases
• Discuss the pathology and aetiology of central pontine myelinolysis.

Skull, spine and musculoskeletal system

• Describe the pathology of ossification of the posterior longitudinal ligament and diffuse idiopathic skeletal
hyperostosis.
• Describe the gross and microscopic pathology of fibrous dysplasia.
• Describe the gross and microscopic features of Paget's disease.

Central nervous system infections

• Describe the pathology of prion diseases and the routes of transmission.
• Describe the pathology of HIV infection of the nervous system.
• Describe the pathology of parasitic infections of the CNS.
• Discuss the tests used to diagnose bacterial, viral, fungal, and prion diseases (including culture
techniques, PCR, tests for prion diseases, and EEG findings).

Immunopathological disorders
• Describe the pathology of immune-mediated vasculitis.

Toxic and deficiency disorders

• Discuss the effects of metal toxicities (e.g. lead, aluminium, mercury).

Updated 18 January 2007 Page 6 of 7

Brain shifts and herniation

Discuss the pathological effects of rapid reduction of intracranial pressure with treatment of herniation
syndromes, including brain swelling and reperfusion injury.

Neuro-oncology
• Discuss the theories of oedema pathogenesis within the brain adjacent to extra-axial tumours.
• Describe common immunological deficits in patients treated for neurological tumours.
• Describe current theories concerning apoptosis and necrosis.
• Describe in detail current WHO classification for neurological tumours.
• Describe common XRT-induced brain tumours - epidemiology, pathology and investigation.
• Identify the macroscopic and microscopic differences between neurofibromas and schwannomas.
• Identify the common histological features used to classify gliomas such as "gemistocyte", "necrosis",
"mitosis", "anaplasia", "endothelial hyperplasia", "Rosenthal fibres", "pilocytes", "palisading", "rosettes"
and "pseudorosettes".

SET6 Learning Outcomes

Cerebral and spinal vascular disorders

• Describe the pathology of Moya Moya disease and Takayasu's arteritis.

Miscellaneous nervous system disease

• Describe the pathology of progressive supranuclear palsy.
• Describe the pathology of the inherited spinocerebellar degenerative diseases.
• Describe the pathology of acute haemorrhagic leukoencephalitis.

Demyelinating diseases
• Discuss the aetiological theories of multiple sclerosis.

Skull, spine and musculoskeletal system

• Describe in detail the pathology of vertebral haemangiomas.
• Describe the pathology of Scheuermann's disease and Schmorl's nodes.

Central nervous system infections

• Describe the inclusion bodies found in various types of viral encephalitis.

Neuro-oncology
• Discuss controversies in tumour classification and review the literature of those encountered in clinical
practice.
• Describe the risks of developing a CNS tumour based on environmental or medical exposure to viruses,
chemical or radiation.
• Describe biochemistry and function of neurofibromatosis I protein (neurofibroma) and Neurofibromatosis
I protein (schwannoma/merlin).
• Describe the pathological features of uncommon tumours of the meninges, including lipoma, angiolipoma,
hibernoma, fibrosarcoma, fibromatoses, fibrous histiocytoma, tumours of muscle and cartilaginous origin,
haemangioma, angiosarcoma, epithelioid haemangioendothelioma, Kaposi sarcoma, melanocytoma,
melanocytosis and malignant melanoma.

Updated 18 January 2007 Page 7 of 7

Neuro-otology

Syllabus Module Overview

Module Rationale
Knowledge of the investigations, differential diagnosis and management of hearing and balance
impairment, which are common clinical presentations, is essential in neurosurgery.
Prior to graduation the trainee is required to be able to:
• apply their thorough knowledge of the anatomy, physiology, and pathology of disorders of the ear to
accurately diagnose and manage patients
• select appropriate investigative tools to aid in the diagnosis of hearing and balance impairment

Recommended Readings

Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans.

References • Brain Tumours" Kaye & Laws

• The Human Nervous System - An Anatomical Viewpoint, Barr & Kiernan
• Anatomy - regional and applied, Last

Learning Opportunities and Methods

• Trainees are encouraged to discuss cases with the neuro-otologists
• Involvement in brain stem intra operative monitoring with audiology technicians and observation of
an audiometry being performed is highly recommended.
Trainees are expected to observe and participate in some temporal bone dissection

Assessment and Examination

• Trainees will undergo regular onging assessment throughout the Training Programme including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• The Fellowship Examination will include neuro-otoloy related cases.

SET1 & SET2 Learning Outcomes

Evaluation of Hearing
• Describe in detail the anatomy of the external, middle and inner ear.
• Describe the auditory pathway.
• Demonstrate otoscopic examination of the ear.
• Demonstrate the Rinne and Weber tests.
• Discuss the examination findings and differential diagnosis of conductive and sensorineural hearing loss.

Disorders of Vestibular System

• Describe the anatomy of vestibular system.

Mastoiditis and Sinus Disorders

• Describe the pathophysiology of middle ear and mastoid infections including acute and chronic infections.

SET3 & SET4 Learning Outcomes

Evaluation of Hearing
• Interpret audiometric evaluation - pure-tone audiometry, impedance testing, speech discrimination,
auditory brain stem evoked response (ABSER).

Updated 18 January 2007 Page 1 of 2

Disorders of Vestibular System

• Describe the classification of peripheral and central vestibular disorders.
• Interpret vestibular evaluation - electronystagmography (ENG), caloric tests, rotation chair testing.
• Discuss the differential diagnosis and the management of dizziness.
• Discuss the differential diagnosis and management of tinnitus.

Mastoiditis and Sinus Disorders

• Discuss cholesteatoma.

SET5 & SET6 Learning Outcomes

Disorders of Vestibular System

• Discuss common neuro-otologic disorders eg. viral labyrinthitis, viral mononeuritis, benign paroxysmal
positional vertigo, Meniere's syndrome, vertebrobasilar insufficiency, Wallenberg's syndrome.

Mastoiditis and Sinus Disorders

• Describe the intracranial complications including otogenic sigmoid sinus thrombosis, extradural abscess,
cerebellar and temporal lobe abscess.

Updated 18 January 2007 Page 2 of 2

Neuro-Ophthalmology

Syllabus Module Overview

Module Rationale
Many neurosurgical conditions present with ophthalmological manifestations.
Prior to graduation the trainee is required to be able to implement appropriate examination procedures
and interpret investigative data to accurately classify neuro-phthalmological findings

Recommended Readings
Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or
"Neurological surgery" Youmans.

Desirable • Brain's Neurology. Ed. Bannister.

Learning Opportunities and Methods

• Trainees should have a regular involvement with specialists who have neuro-ophthalmology
expertise.
• Trainees should develop their own expertise and perform formal neuro-ophthalmological
examinations on their patients.

Assessment and Examination

• Aspects of neuro-ophthalmology will be examined in the Fellowship Examination.

SET1 & SET2 Learning Outcomes

• Describe in detail the visual pathways.

• Describe the neurological control of conjugate eye movement.
• Describe the anatomical and physiological mechanisms involved with the pupillary reflexes.
• Demonstrate the assessment of visual acuity and discuss methods of correcting for refraction errors.
• Demonstrate the clinical assessment of extra-ocular eye movements, visual fields and fundoscopic
examination.
• Discuss the mechanism and relevance of papilloedema and differential diagnosis.
• Discuss the relevance and management of a spontaneous third nerve palsy.
• Discuss the clinical features and causes of Horner's Syndrome.
• Discuss the differential diagnosis of ptosis
• Discuss the differential diagnosis of cavernous sinus syndrome.

SET3 & SET4 Learning Outcomes

• Discuss the mechanism and differential diagnosis of nystagmus.

• Describe the diagnostic significance of different types of nystagmus.
• Describe the appearance and relevance of common fundoscopic findings including vascular changes,
exudates and haemorrhages.
• Discuss the relevance of colour vision assessment in neurological examination.
• Demonstrate formal visual perimetry.
• Interpret the results of computerised visual field testing.
• Discuss the specific features of cortical blindness.
• Discuss the causes of proptosis.
• Demonstrate the clinical localisation of lesions causing gaze palsy.

SET5 & SET6 Learning Outcomes

• Discuss neurological causes of alexia.

Updated 18 January 2007 Page 1 of 1

Neuro-Oncology

Syllabus Module Overview

Module Rationale
Tumours affecting the nervous system are common in neurosurgical practice.
Prior to graduation the trainee is required to be able to:
• recognise and identify the epidemiology and clinical presentation of tumours
• implement appropriate procedures to collect, analyse, and interpret data to investigate tumours
affecting the nervous system
• carry out appropriate techniques to medically and/or surgically manage tumour patients
• communicate with the patient and/or family the treatment options, potentials, complications, and
risks and obtain informed consent

Recommended Readings
Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or
"Neurological surgery" Youmans.

Desirable • Brain Tumours, Kaye and Laws (eds)

• Handbook of Neurosurgery, Greenburg
• Tumours of the Nervous System: Pathology & Genetics, Kleihues and Cavenee
(eds)

Learning Opportunities and Methods

• Trainees are encouraged to attend regular neuro-pathology meetings, preferably of an interactive
format, and spend time with the neuropathologist reviewing individual cases.
• Trainees are encouraged to attend pathology museums and autopsies.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Programme including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Neuro-oncology may be examined during the Fellowship Examination. The Examination may include
interpretation of histopathology slides and pathology specimens.

SET1 & SET2 Learning Outcomes

Tumours of the scalp and skull vault

• List the classification of tumours that occur at the skull vault and scalp.
• Describe epidemiology, clinical presentation and natural history of scalp and skull tumours.
• Perform a history, examination and pre-operative workup of patients with tumours of scalp and skull.
• List the appropriate pre-operative investigations.

Cell kinetics, genetics and immunology of neurological tumours

• Describe the nature of cell division and the cell cycle.
• Describe the abnormalities of the cell cycle commonly identified in neoplasia.
• Define terms "benign", "neoplastic" and "malignant" as relevant to neurological tumours.
• Define "tumour suppressor gene", "oncogene", "loss of heterozygosity", "growth factor", "growth factor
receptor", and "cytokine". List examples of each under current investigation and explain their significance
to common CNS neoplasms.
• Define tumour invasion and angiogenesis and describe the underlying mechanisms. Discuss the
significance of each to tumour progression for common CNS neoplasms.
• Describe the impact of tumour invasion and tumour biology on the accuracy of biopsy of CNS tumours
• Define "tumour markers" and their use in clinical practice.
• Describe elements of immune system and immune response to brain tumours.
• Define "cytokine", "autocrine' and "paracrine".

Updated 18 January 2007 Page 1 of 11

• Define the blood brain barrier and discuss the immune privilege and immune quiescence of the brain.
Discuss the consequences of disruption of the blood brain barrier and the mechanisms by which it may
occur.
• Define "tumour markers" and principles of their clinical use.
• Describe elements of immune system and immune response to brain tumours.
• Define tumour marker and discuss those relevant to CNS tumours and the difficulty of defining true
tumour-associated antigens in the CNS.
• Describe the immune deficiency syndrome related to CNS tumours, particularly malignant astrocytoma.
Describe the clinical features and laboratory examinations abnormalities.
• Define "cytokine", "autocrine' and "paracrine". Describe factors secreted by tumours which modulate the
immune response and cause immunodeficiency and the mechanisms by which they do this.
• Describe the mechanisms of action of commonly used medications for patients with CNS tumours and the
effect on the immune system, in particular, glucocorticoids and anticonvulsants.
• Define the blood brain barrier and discuss the immune privilege and immune quiescence of the brain.
Discuss the consequences of disruption of the blood brain barrier and the mechanisms by which it may
occur.

Classification and epidemiology of cerebral tumours

• Describe the history of brain tumour classification systems.
• Describe different systems for classification of astrocytomas.
• Discuss the incidence of brain tumours.
• Summarise the epidemiology, incidence and risk factors for common CNS neoplasms. Discuss the
influence of gender, ethnicity, age, occupation and predisposing conditions (such as the phakomatoses or
other genetic syndromes).
• Discuss the use of tumour grade within the classification
• Discuss the differential diagnosis of brain tumour - list non-neoplastic lesions that may clinically or
radiologically mimic a brain tumour.
• Describe the multistep nature of tumour pathogenesis in general terms.
• Describe the basis of general tumourigenesis by viruses, chemicals and radiation.

Neurophakomatoses
• List the conditions known as neurophakomatoses.
• Outline the classification of Neurofibromatosis I and II, its incidence and genetic characteristics and
diagnostic criteria used to identify subjects.
• Perform a history, examination and pre-operative workup of patients with neurophakomatoses.
• Demonstrate the clinical findings in a patient with a neurophakomatosis.

Gliomas
• Define the term glioma.
• Describe the clinical presentation of a patient with glioma with consideration of grade and location.
• Perform a history, examination and pre-operative workup of patients with supratentorial gliomas.
• List the appropriate investigations of a patient with glioma.
• List the clinical features, natural history and prognosis of optic nerve glioma and the conditions with
which it is associated.
• List the clinical features, natural history and prognosis of hypothalamic glioma and the conditions with
which it is associated.

Intraventricular tumours
• List the tumours that may appear within the ventricular system by location.
• Describe the clinical presentation of masses within the ventricular system.
• Perform a history, examination and pre-operative workup of patients with an intraventricular tumour.
• List the appropriate investigations of a patient with an intraventricular tumour.
• Discuss the mechanisms of development of hydrocephalus in intraventricular tumours.
• Describe the principles of management of acute ventricular obstruction.

Updated 18 January 2007 Page 2 of 11

Metastatic brain tumours

• List the tumours that tend to metastasize to the central nervous system with particular reference to age
and gender.
• Describe the clinical presentation of patients with metastatic disease to the central nervous system.
• Perform a history, examination and pre-operative workup of a patient with metastatic disease of the
central nervous system.
• List the appropriate investigations of a patient with metastatic disease of the central nervous system.
• Describe current theories of metastatic spread of tumours to the central nervous system.

Meningioma
• Describe current WHO classification of meningiomas.
• Describe the common intracranial locations of meningioma and the expected presentation at each
location.
• Discuss epidemiology of meningioma.
• Define the cell of origin and cytogenetics of meningioma and theories of tumourigenesis.
• List the appropriate investigations of a patient with meningioma.

Epidermoids, dermoids and teratoma

• Define and differentiate epidermoid, dermoid and teratoma.
• Describe common locations of epidermoid and dermoid and the epidemiology of both.
• List the clinical features, natural history and prognosis of epidermoids, dermoids and teratomas.

Pineal region tumours

• Describe the classification of pineal region tumours including WHO.
• Describe the clinical presentation of a pineal region tumour.
• Discuss the appropriate investigations including haematological, CSF and radiological.
• Describe the incidence, classification and pathology of pineal region tumours.
• Describe the anatomy and physiology of the normal pineal gland and the embryology and anatomy of
pineal region tumours, particularly the vascular supply and adjacent important structures.
• Describe Parinaud's Syndrome and its clinicopathological significance.

Cerebellopontine angle tumours, especially vestibular schwannoma (acoustic neuroma)

• List the tumours that may arise in the cerebellopontine angle (CPA).
• Describe the epidemiology and clinical presentation and natural history of vestibular schwannoma.
• Discuss the association of vestibular schwannoma with other disorders, including NF-2 and the underlying
genetic abnormalities.
• List other sites at which cranial schwannomas can occur and compare and contrast with CPA
schwannomas.
• Perform a history, examination and pre-operative workup of patients with CPA tumours.
• List the appropriate investigations of a patient with a CPA tumour.
• Describe the House-Brackmann grading scale of facial nerve weakness.

Haemangioblastoma
• Describe the epidemiology, clinical presentation and natural history of haemangioblastoma.
• Describe the epidemiology, clinical features and natural history of von Hippel Lindau syndrome.
• Perform a history, examination and pre-operative workup of patients with haemangioblastoma.
• List the appropriate preoperative investigations of a patient with suspected haemangioblastoma.

Pituitary and parasellar tumours

• Describe the classification of pituitary tumours with respect to the cell of origin and size.
• Describe the clinical presentation and the epidemiology of pituitary tumours.
• List investigations of a patient presenting with a pituitary region mass.
• Describe pituitary/hypothalamic emergencies including apoplexy, diabetes insipidus and Addisonian crisis.
List their causes and emergency management.
• Perform a full endocrinological assessment and demonstrate the medical management of common
endocrinopathies.

Updated 18 January 2007 Page 3 of 11

• Describe the postoperative care of patients who have had pituitary region surgery including fluid and
electrolyte management, hormone replacement and assessment and treatment of acute visual loss.
• Describe primary and secondary empty sellar syndrome.
• Discuss the embryology of craniopharyngioma and Rathke's cleft cyst.
• Discuss the epidemiology, clinical presentation and natural history of craniopharyngioma and Rathke's
cleft cyst.

Chordoma
• Discuss the embryogenesis of chordoma.
• Discuss location, epidemiology, clinical features and natural history of chordoma.
• Perform a history, examination and pre-operative workup of patients with chordoma.

Tumours of the orbit

• Perform a history, examination and pre-operative workup of patients with orbital tumours.
• List the appropriate pre-operative investigations for a patient with orbital tumour.
• Demonstrate the assessment of and discuss potential causes of proptosis.

Lymphoma
• Discuss the classifications of lymphoma.
• Discuss the relationship between lymphoma and associated conditions e.g. immunosuppression.
• Describe the clinical features, natural history and prognosis of cerebral lymphoma.

Cranial and spinal lipoma

• Describe the common locations in which intracerebral and intraspinal lipomas occur, their anatomical
relationships and relative frequency and embryological origin and development.
• List the clinical features, natural history and prognosis of intracerebral and intramedullary lipomas.

Spinal tumours
• List the tumours that tend to metastasize to the spine with particular reference to age, gender and
frequency.
• Classify the common extradural, intradural (extramedullary) and intramedullary tumours.
• Describe the clinical features of spinal tumours with specific reference to site and location.
• Discuss the natural history and prognosis of tumours within the spine, particularly as related to age at
presentation and position in the spine.
• Perform a history, examination and pre-operative workup of patients with spine tumours. List the
appropriate pre-operative investigations.
• Discuss the management of a patient with acute spinal cord compression.

Radiotherapy and CNS tumours

• Describe the nature of ionizing radiation.
• Describe the different types of ionizing radiation and their short and long term effects on normal and
neoplastic tissue.
• Describe the mechanisms by which radiotherapy induces cell death.
• Describe and compare the sources of radiation commonly used in medical applications.
• Describe and differentiate whole brain radiotherapy, stereotactic radiosurgery, stereotactic radiotherapy,
3-D conformal radiotherapy, intensity modulated radiation therapy and interstitial brachytherapy.

Chemotherapy
• Discuss the basic principles of cancer chemotherapy.
• Describe the side effects of chemotherapy and the management of these.

Updated 18 January 2007 Page 4 of 11

SET3 & SET 4 Learning Outcomes

Tumours of the scalp and skull vault

• Describe the histopathological features of scalp and skull tumours.
• Describe findings of appropriate preoperative investigation (including neuroradiological findings) of
benign and malignant scalp and skull tumours.
• Describe the differential diagnosis of lytic and sclerotic skull lesions.

Cell kinetics, genetics and immunology of neurological tumours

• Describe factors secreted by tumours which modulate the immune response and cause immunodeficiency
and the mechanisms by which they do this.
• Describe commonly used histopathological markers of cell kinetics and their significance.
• Describe the immune deficiency syndromes in relation to neurological tumours.

Classification and epidemiology of cerebral tumours

• Outline the current WHO system for brain tumour classification.
• Identify on pathological slides the features on which classification of tumour type and tumour grade are
based - particularly for common tumours including gliomas, meningiomas, metastases, pineal region
tumours, acoustic neuroma, pituitary tumours and craniopharyngioma.
• Describe the general relationships of tumour classification with management and prognosis. Discuss the
influence of tumour type, tumour grade, tumours site, age at presentation and neurological function at
time of presentation.

Neurophakomatoses
• Describe in detail the definition, genetic basis, pathology, clinical features and natural history of the
neurophakomatoses
• Describe the long-term risks and complications of the neurophakomatoses and the neoplasms associated
with them.
• Discuss the genetic testing and prenatal diagnosis available for neurophakomatoses.

Gliomas
• Describe the gross and histopathological features of gliomas.
• Interpret investigations in patients presenting with suspected glioma.
• Describe the common types of adjuvant therapy for gliomas and the indications for them.

Intraventricular tumours
• Describe the gross and histopathological features of intraventricular tumours.
• Interpret investigations in patients presenting with intraventricular tumours.
• Describe the distinguishing features of fourth ventricular tumours including medulloblastoma and
ependymoma.
• Describe the distinguishing features of third ventricular tumours including colloid cysts.
• Describe the distinguishing features of lateral ventricular tumours including meningioma and choroid
plexus tumours.
• Describe the types of adjuvant therapy and their role in the treatment of childhood ventricular tumours.

Metastatic brain tumours

• Describe the gross and histopathological features of cerebral metastases.
• Interpret investigations in patients presenting with metastatic disease of the central nervous system.
• Describe the common types of adjuvant therapy for with metastatic disease of the central nervous
system.
• Describe primary brain tumours that metastasise to CSF and extraneural pathways involved.

Meningioma
• Describe macroscopic and histological features of meningiomas.
• Discuss the clinical significance of pathological sub types of meningiomas.

Updated 18 January 2007 Page 5 of 11

• Discuss the features of meningioma related to prognosis such as extent of surgical resection, markers of
proliferation, receptor status and histological grade.
• Discuss surgical goals in treatment of meningiomas and general principles of operation.
• Describe the Simpson classification of surgical resection of meningiomas.
• Interpret investigations in a patient presenting with meningioma.

Epidermoids, dermoids and teratoma

• Identify the macroscopic and microscopic features of epidermoid, dermoid and teratoma.
• Identify the radiological features of epidermoid, dermoid and teratoma.
• Differentiate mature, immature and malignant teratoma.

Pineal region tumours

• Discuss the significance of pineal region tumour markers, age, gender and ethnic origin on classification
diagnosis and prognosis.
• Describe the classification of germ cell tumours and tumour markers associated with these.

Cerebellopontine angle tumours, especially vestibular schwannoma (acoustic neuroma)

• Identify the diagnostic radiological features of CPA tumours.
• Describe otological investigations required for CPA tumours.
• Describe the gross and microscopic features of vestibular schwannoma.

Haemangioblastoma
• Describe the gross and microscopic features of haemangioblastoma.
• Identify diagnostic radiological features of haemangioblastoma.

Pituitary and parasellar tumours

• Describe the gross and microscopic features of pituitary region tumours.
• Demonstrate the diagnostic radiological features of pituitary region masses.
• Perform and discuss the results of visual testing in patients with pituitary lesions.
• Discuss the significance of serum prolactin levels.
• Describe the complications and long term risks of endocrinopathies associated with pituitary tumours,
both with and without treatment.

Chordoma
• Describe the gross and microscopic pathological features of chordoma.
• Describe the radiological features and differential diagnosis of chordoma.

Tumours of the orbit

• List the tumours that may arise in the orbit.
• Describe the gross and microscopic pathological features of tumours which may appear in the orbit.
• List the clinical features, natural history and prognosis of tumours and pseudotumours which occur in the
orbit.

Lymphoma
• Describe the gross and microscopic pathological features of cerebral lymphoma and the current WHO
classification.
• Interpret the radiological features of cerebral lymphoma.

Cranial and spinal lipoma

• Discuss the pathology of CNS lipomas.

Spinal tumours
• Demonstrate the radiological diagnostic features of spinal tumours.
• Describe the gross and microscopic pathological features of spinal tumours.

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• Discuss level localization in spinal tumour surgery.

• Discuss the indications for surgery, radiotherapy or conservative approach in spinal tumours.

Radiotherapy and CNS tumours

• Describe indications for radiotherapy and treatment of brain tumours.
• Describe the indication for each type of radiotherapy as related to tumour type, position and patient age.

Chemotherapy
• List the commonly used drugs in central nervous system tumour chemotherapy.
• Explain the rationale for multidrug therapy.
• Discuss the influence of the blood brain barrier on chemotherapy delivery.

SET5 Learning Outcomes

Tumours of the scalp and skull vault

• Describe in detail the management options (surgical and non-surgical) for skull vault and scalp tumours.

Cell kinetics, genetics and immunology of neurological tumours

• Describe imaging techniques that examine cell kinetics of brain tumours.
• Describe common immunological deficits in patients treated for neurological tumours.
• Discuss immune based adjuvant therapies with patients and refer them appropriately.
• Describe the possible indications for immune system based therapy.
• Describe current theories concerning apoptosis and necrosis.

Classification and epidemiology of cerebral tumours

• Describe in detail current WHO classification for neurological tumours.
• Describe common XRT-induced brain tumours - epidemiology, pathology and investigation.

Neurophakomatoses
• Identify the macroscopic and microscopic differences between neurofibromas and schwannomas.
• Discuss the indications for intervention in the treatment of neurofibroma in patients with
neurofibromatosis.

Gliomas
• Identify the common histological features used to classify gliomas such as "gemistocyte", "necrosis",
"mitosis", "anaplasia", "endothelial hyperplasia", "Rosenthal fibres", "pilocytes", "palisading", "rosettes"
and "pseudorosettes".
• Describe the role of surgery and adjuvant therapy for gliomas and the effect on natural history/efficacy.
• Discuss in detail the commonly available adjuvant therapies for glioma.
• Discuss the indications for re-operation in recurrent glioma.
• Describe, differentiate and compare the different techniques for excision, including ultrasonic aspiration,
laser and suction.
• Describe the clinical management of uncommon glial and mixed glial/neuronal tumours for example:
gliomatosis cerebri, giant cell glioblastoma, gliosarcoma, pleiomorphic xanthoastrocytoma, subependymal
giant cell astrocytoma, subependymoma, desmoplastic infantile ganglioglioma, DNET, ganglioglioma,
gangliocytoma, hypothalamic hamartoma, protoplasmic astrocytoma, paraganglioma, and
glioneurocytoma.

Intraventricular tumours
• Describe role of surgery for treatment of medulloblastoma and ependymoma of posterior fossa.
• Discuss the management of an incidental lesion in the third ventricle, with particular reference to colloid
cyst.
• Discuss the management of an incidental lesion in the lateral ventricle.

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Metastatic brain tumours

• Independently determine a differential diagnosis and comprehensive treatment plan for patients with
metastases based on history, examination, laboratory examinations and radiology.
• Discuss the role of surgery for solitary and multiple intracerebral metastases.

Meningioma
• Discuss the role of radiation treatment in the management of meningiomas.
• Discuss non-radiation based adjuvant therapies in the management of meningiomas.
• Discuss the presentation, epidemiology, pathology and management of haemangiopericytoma.

Epidermoids, dermoids and teratoma

• Discuss the options for surgical and non-surgical management of dermoid and epidermoid.
• Describe the indications for and types of adjuvant therapy for teratomas.

Pineal region tumours

• Discuss the indications for and surgical options for pineal region tumours.
• Describe the indications for and types of adjuvant therapy for pineal regions tumours as related to
pathological type, age at presentation and ethnic origin

Cerebellopontine angle tumours, especially vestibular schwannoma (acoustic neuroma)

• Discuss the role of stereotactic radiosurgery for management of CPA tumours.
• Discuss indications for and types of adjuvant therapy for CPA tumours as related to pathological type.
• Describe in detail surgical anatomy, risks and indications of different approaches for CPA tumours e.g.
middle fossa, suboccipital and translabyrinthine.
• Discuss the management of a patient with facial paresis.
• Discuss the uses and indications for intraoperative monitoring during CPA surgery.

Haemangioblastoma
• Describe the indications for and types of adjuvant therapy for haemangioblastoma.
• Describe the on-going investigations, monitoring and genetic counselling of von Hippel Lindau disease.

Pituitary and parasellar tumours

• Discuss in detail the indications for surgery and the application of various surgical approaches in
management of pituitary region tumours.
• Discuss adjuvant treatment for pituitary tumours.
• Discuss the adjuvant treatment for craniopharyngioma.
• Discuss the differential diagnosis of patients with empty sella syndrome based on history, examination,
laboratory tests and radiology. Demonstrate the radiological abnormalities.
• Discuss the management of CSF leak following pituitary region surgery.

Chordoma
• Discuss the therapeutic options in the management of chordoma.
• Discuss the potential difficulties associated with preoperative biopsy of chordoma.
• Describe the indications for and types of adjuvant therapy for chordoma.
• Discuss the implications of incomplete resection for prognosis and adjuvant therapy.

Tumours of the orbit

• Independently determine a differential diagnosis and comprehensive treatment plan for patients with
orbital tumours based on history, examination, laboratory tests and radiology.

Lymphoma
• Discuss the role of surgery in cerebral lymphoma.
• Discuss the effect of steroids in cerebral lymphoma.
• Discuss non-surgical treatments for the management of cerebral lymphoma.

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Cranial and spinal lipoma

• Discuss the options for the management of CNS lipoma.

Spinal tumours
• Discuss the indications for and types of adjuvant therapy for spinal tumours particularly related to
pathology, site and age at presentation.
• Discuss the controversies surrounding intramedullary resective surgery.
• Discuss the role of neurophysiological monitoring and spinal tumour surgery.
• Discuss the role of pre-operative embolisation in the management spinal tumours.
• Discuss the appropriate investigation and differential diagnosis of a sacral mass.

Radiotherapy and CNS tumours

• Explain the rationale for fractionation in radiotherapy and describe radiosensitisers.
• Discuss the clinical presentation, investigation, differential diagnosis and management of radionecrosis.
• Describe common doses and dose regimens for treatment of gliomas.

Chemotherapy
• Describe the role of chemotherapy in paediatric brain tumour patients.
• Explain the indications for and risks and benefits of chemotherapy to individual patients with CNS
tumours.
• Describe the mechanism of action of commonly used drugs in central nervous system tumour
chemotherapy, with particular reference to alkylating agents (particularly the nitrosureas and
temozolamide), antimetabolites, vinca alkaloids, podophyllotoxins, antibiotics, platinum compounds,
tamoxifen and hydroxyurea.
• Describe the role of intracavitary chemotherapy for the treatment of brain tumours.

SET6 Learning Outcomes

Tumours of the scalp and skull vault

• Demonstrate the surgical management of skull vault and scalp tumours.

Cell kinetics, genetics and immunology of neurological tumours

• Discuss the biological basis for anti-tumour vaccines in treatment of neurological tumours (primary and
secondary).
• Evaluate the literature on immune based system therapy and gene therapy as relates to neuro-oncology.

Classification and epidemiology of cerebral tumours

• Discuss controversies in tumour classification and review the literature of those encountered in clinical
practice.
• Describe the risks of developing a CNS tumour based on environmental or medical exposure to viruses,
chemical or radiation.

Neurophakomatoses
• Describe biochemistry and function of neurofibromatosis I protein (neurofibroma) and Neurofibromatosis
I protein (schwannoma/merlin).
• Provide genetic counselling for a patient with neurofibromatosis.
• Discuss the indications for intervention in the treatment of conditions in patients with
neurophakomatoses other than neurofibromatosis.

Gliomas
• Critically evaluate the emerging and controversial adjuvant therapies for glioma.
• Discuss controversies in the management of glioma including surgical management and adjuvant therapy
of low grade gliomas, extent of surgical resection and biopsy vs. excision and timing of adjuvant therapy.
Evaluate the literature on these issues and state a summary and conclusion.

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• Discuss the role of surgery in the management of tumours of the brain stem.
• Critically evaluate the controversial issues in the management of brainstem glioma.

Intraventricular tumours
• Critically evaluate the literature regarding developing and experimental adjuvant therapy for
medulloblastoma and ependymoma.
• Describe high and low risk medulloblastoma patients and the appropriate adjuvant therapy for these
groups.
• Describe appropriate adjuvant therapy for ependymoma.
• Discuss grading of ependymomas and its significance.

Metastatic brain tumours

• Describe role and types of radiation treatment in the management of intracerebral metastases, including
stereotactic radiotherapy.

Meningioma
• Discuss the management of meningiomas related to the dural venous sinuses.
• Describe the pathological and clinical features of uncommon tumours of the meninges, including lipoma,
angiolipoma, hibernoma, fibrosarcoma, fibromatoses, fibrous histiocytoma, tumours of muscle and
cartilaginous origin, haemangioma, angiosarcoma, epithelioid haemangioendothelioma, Kaposi sarcoma,
melanocytoma, melanocytosis and malignant melanoma.
• Discuss the difficulties associated with managing a recurrent meningioma.
• Discuss role of pre-operative embolisation in the surgical management of meningiomas.

Epidermoids, dermoids and teratoma

• Describe the indications for complex resections of epidermoids, dermoids or teratomas, particularly those
involving eloquent structures.

Pineal region tumours

• Contrast appropriate management of parenchymal and germ cell pineal tumours (germ/non-germ), (XRT,
chemotherapy).

Cerebellopontine angle tumours, especially vestibular schwannoma (acoustic neuroma)

• Discuss strategies of hearing preservation in CPA tumours.
• Discuss surgical management of different types of hearing loss.
• Discuss the issues relating to the management of patients with bilateral vestibular schwannomas.

Haemangioblastoma
• Discuss strategies for managing vascularity in recurrent haemangioblastomas.
• Discuss the role of angiography and embolization in the management of haemangioblastoma.
• Describe the function of the protein product and the involved genetic defect in von Hippel Lindau disease.

Pituitary and parasellar tumours

• Discuss in detail the relationship of pituitary region lesions and their management in relation to the
treatment of fertility and pregnancy.

Chordoma
• Critically evaluate the literature on evolving adjuvant therapies for the management of chordoma such as
boron neutron capture therapy.

Tumours of the orbit

• Discuss the role for adjuvant therapy for orbital tumours.
• Discuss in detail surgical approaches to orbital lesions and their complications.

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Spinal tumours
• Discuss en-bloc resection of spinal tumours with respect to appropriate indications, risks and
complications.
• Radiotherapy and CNS tumours
• Discuss the controversies concerning radiotherapy and neoplasia with particular reference to metastases,
low grade and benign tumours, paediatric patients and the elderly.
• Discuss the indications, efficacy and side-effects of stereotactic radiosurgery and stereotactic
radiotherapy.
• Discuss the different delivery systems for stereotactic radiosurgery.

Chemotherapy
• Discuss the evidence for the efficacy of chemotherapy for brain tumours.
• Discuss drug delivery to the central nervous system and recent development of new methods - including
intra-arterial delivery, blood brain barrier modification and intracranial/local delivery.

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Neuroanatomy

Syllabus Module Overview

Module Rationale
A thorough understanding of anatomy forms the basis for the understanding of disease and its surgical
management.
Prior to graduation the trainee is required to be able to:
• access, retrieve, and apply relevant anatomical knowledge in effectively diagnosing, treating, and
managing a spectrum of patient care problems related to neurosurgery
• apply detailed anatomical knowledge to the safe and efficient performance of the spectrum of
cranial, spinal and peripheral neurosurgical surgical procedures
• utilise an in-depth knowledge of detailed neuroanatomical pathways to facilitate the effective
anatomical localisation of neurological symptoms and signs and to apply this in the selection of safe
surgical approaches for neurosurgical procedures

Recommended Readings
Essential • Last's Anatomy. Regional and applied. McMinn
• The human nervous system. An anatomical viewpoint. Barr and Kiernan

Desirable • Publications by Al Rhoton in Neurosurgery

References • Gray's anatomy

• Yasargil papers re basal arachnoid cisterns and perforator vessels

Learning Opportunities and Methods

• The trainee is encouraged to visit and study specimens in anatomy museums.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Neuroanatomy will be formally examined during the Fellowship Examination.

SET1 & SET2 Learning Outcomes

Development of the nervous system - neuroembryology

• Describe the development of an embryo to week three.
• Describe in detail the embryological development of the notochord, neural tube and neural crest into the
mature nervous system.
• Describe the recognisable divisions and subdivisions of the developing brain.
• Describe the folding of the forebrain into the mature cerebral hemispheres.
• Describe the embryological development of the skull and face.
• Describe the embryological development of the vertebral column.
• Describe the spinal cord levels relative to the vertebral column during development to adulthood

Cellular components of the nervous system - histology

• Describe the ultrastructure of a neurone.
• Describe the different types of neurones.
• Describe the layers of the cerebral and cerebellar cortices.
• Describe the ultrastructure of the blood-brain barrier.

Gross anatomy of the cranium and brain

• Describe the gross anatomy of the frontal lobe with particular reference to boundaries, surfaces, anatomy
relative to the skull and named surface structures.

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• Describe the functions of the frontal lobe and their topographical representation.
• Describe the arterial supply and venous drainage of the frontal lobe.
• Describe the gross anatomy of the parietal lobe with particular reference to boundaries, surfaces,
anatomy relative to the skull and named surface structures.
• Describe the functions of the parietal lobe and their topographical representation.
• Describe the arterial supply and venous drainage of the parietal lobe.
• Describe the gross anatomy of the occipital lobe with particular reference to boundaries, surfaces,
anatomy relative to the skull and named surface structures.
• Describe the functions of the occipital lobe and their topographical representation.
• Describe the arterial supply and venous drainage of the occipital lobe.
• Describe the gross anatomy of the temporal lobe with particular reference to boundaries, surfaces,
anatomy relative to the skull and named surface structures.
• Describe the gross anatomy of the cerebellum with particular respect to named surface structures,
connections, arterial supply and venous drainage.
• Describe in detail the anatomy of the pituitary gland including the stalk.
• Describe the external relationships of the cerebral peduncles.
• Describe the external relationships of the midbrain.
• Describe the external relationships of the pons.
• Describe the external relationships of the medulla.

Gross anatomy of the scalp, the skull and associated muscles

• Describe the anatomy of the scalp including blood supply, innervation and muscles.
• Describe the gross anatomy of the individual bones of the skull.
• Describe the contents of the foraminae of the skull.

Gross anatomy of the dura, its reflections and venous spaces

• Describe the coverings of the brain and spinal cord.
• Describe the layers of the dura and how they separate to form the superficial dural venous sinuses.
• Describe the reflection of the dura to form the falx cerebri and the tentorium cerebelli.
• Discuss the attachments and relationships of the free edge of the tentorium cerebelli.
• Describe the anatomy of the arachnoid villi.

The cranial nerve and their nuclei

• Tabulate the functions of each of the cranial nerves under the headings somatic motor, somatic sensory,
autonomic motor, autonomic sensory and special sensory.
• Identify the attachment of the cranial nerves to the brain.
• Describe the anatomy of the cranial nerves external to the brain (intracranial and extracranial course).

The CSF filled spaces

• Describe, in general terms, the anatomy of the arachnoid cisterns.
• Describe, in general terms, the anatomy of the ventricular system including the choroid plexus.
• Describe the relevant anatomy associated with ventricular puncture.

The arterial supply and venous drainage of the cranium and brain
• Describe the anatomy of the aortic arch and list its branches.
• Describe the anatomy of the external carotid artery, its branches and describe the anatomy of the major
branches.
• Describe the anatomy of the extracranial internal carotid artery.
• Describe the anatomy of the internal carotid artery in the skull base and the cavernous sinus.
• List the branches of the supracavernous internal carotid artery.
• Describe the anatomy of the ophthalmic artery.
• Describe the anatomy of the posterior communicating artery.
• Describe the surgical anatomy of the anterior cerebral artery and its branches.
• Describe the surgical anatomy of the middle cerebral artery and its branches.
• Describe the anatomy and significance of the Circle of Willis including its common variants.
• Discuss in general terms the cerebral venous outflow including the concepts of superficial and deep
drainage systems.

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• Describe the anatomy of the superficial venous system.

• Discuss the surgical significance of the vein of Labbé, vein of Trolard and Rolandic vein.
• Describe the surface anatomy of the superior sagittal sinus, torcula, transverse sinus and sigmoid sinus.

Gross anatomy of the vertebral column, the spinal cord and associated structures
• Describe the bony anatomy of the vertebral column.
• Describe the anatomy of the ligaments of the vertebral column including the joint capsules.
• Describe the anatomy of the intervertebral discs including the biochemical and histological changes with
age.
• Discuss the arterial supply and venous drainage of the vertebral bodies.
• Discuss the anatomy of the vertebral end-plate.
• Describe the anatomy of the muscles attaching to the vertebral column, posterior to and including the
posterior portion of the transverse processes.
• Describe the anatomy of the muscles attaching to the vertebral column anterior to the posterior portions
of the transverse processes.
• Describe the general anatomy of the spinal cord with respect to the zones of grey and white matter,
relationship of spinal nerves to the vertebral column levels, ligament attachments, dorsal root entry zone,
the conus medullaris and filum terminale.
• Describe the detailed anatomy of the spinal nerve including its dorsal root ganglion in the region of the
intervertebral foramen.
• Discuss the rib articulations with the vertebral column.

Gross anatomy of the peripheral somatic nervous system

• Describe the anatomy of the brachial plexus.
• Describe in detail the anatomy of the nerves of the upper limb including their relationships.
• Describe the surgical anatomy of the ante-cubital fossa.
• Describe the surgical anatomy of the cubital tunnel and Guyon's canal.
• Describe in detail the anatomy of the volar aspect of the wrist and the carpal tunnel.
• Demonstrate the dermatomes and myotomes of the upper limb, trunk and lower limb.
• Describe the anatomy of the lumbosacral plexus and its branches within and exiting the pelvis.
• Describe in detail the anatomy of the nerves of the lower limb including their relationships.
• Describe the anatomy of the femoral triangle, popliteal fossa and tarsal tunnel.

Gross anatomy of the autonomic nervous system

• Discuss the anatomy and function of the sympathetic nervous system.
• Discuss the anatomy and function of the parasympathetic nervous system.

Radiological anatomy of the cranium, vertebral column and the central nervous system
• Describe the normal radiological appearance of the prevertebral soft tissue of the cervical spine.
• Describe the normal radiological distances in the occipito-cervical (C0 - C2) junction in all ranges of
normal motion.
• Identify the normal anatomical structures visible on plain radiology of the cervical, thoracic and
lumbosacral spine.

Pathways
• Describe the motor pathways within the central nervous system.
• Describe the somatic sensory pathways within the central nervous system.
• Describe the visual pathways.

SET3 & 4 Learning Outcomes

Development of the nervous system - neuroembryology

• Discuss the differences between the foetal and adult cerebral circulations.
• Discuss the embryological basis for spinal dysraphism.
• Discuss the development of the cerebral microcirculation.

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• Describe the embryological development of the pituitary gland.

Cellular components of the nervous system - histology

• Describe the anatomy of the different types of ganglia.
• Describe the ultrastructural anatomy of the interneuronal junctions and the neuromuscular junctions.
• Describe the anatomy of the alpha motor neurone in the spinal cord.
• Describe the classification, histological features and function of the neuroglia.

Gross anatomy of the cranium and brain

• Describe the gross and functional anatomy of the corpus callosum and commissures.
• Describe the anatomy of the insular lobe.
• Describe the anatomy of the external capsule and claustrum.
• Describe the anatomy of the corona radiata and the internal capsule with particular respect to the arterial
supply of the latter.
• Discuss the concepts of dominance and non-dominance.
• Describe the anatomy of the hippocampus in terms of its position, and layers.
• Describe the components of the basal ganglia and their relationships.
• Describe the components of the limbic system.
• Diagramatically illustrate the internal structure of the midbrain at the levels of the superior colliculus and
the inferior colliculus.
• Describe the arterial supply of the midbrain.
• Diagramatically illustrate the internal structure of the pons at the levels of the upper pons and the lower
pons.
• Describe the arterial supply of the pons.
• Diagramatically illustrate the internal structure of the medulla at the levels of the closed medulla, upper
part of the open medulla and the lower part of the open medulla.
• Describe the arterial supply of the medulla.
• Diagramatically illustrate and describe the anatomy of the floor of the fourth ventricle.
• Describe the deep nuclei of the cerebellum.
• Describe the anatomy of the floor of the third ventricle.
• Describe the anatomy of the hypothalamus including its connections and named nuclei.

Gross anatomy of the scalp, the skull and associated muscles

• Describe the course and position of the temporal branch of the facial nerve.
• Describe the surgical anatomy of the temporalis muscle and its fascia.
• Discuss the surgical anatomy of the pterion and the lateral portion of the lesser wing of the sphenoid
bone.
• Describe the anatomy, relationships and approaches to the anterior clinoid process.
• Describe the anatomy of the structures of the internal acoustic meatus.
• Describe the anatomy of the structures of the craniocervical junction (C0 - C2) including the foramen
magnum.
• Describe the regional anatomy of the nose, sphenoid sinus and pituitary fossa.

Gross anatomy of the dura, its reflections and venous spaces

• Describe the location, tributaries and outflow of the dural venous sinuses.
• Describe the dural reflections of the middle cranial fossa.
• Describe the dural reflections as they form the cavernous sinus.
• Discuss the regional anatomy of the tentorial hiatus.
• Describe the dural anatomy of the superior petrosal sinus and Meckel's cave.
• Describe the vascular and nervous supply of the dura.
• Describe the anatomy of the dural rings around the internal carotid artery.
• Describe the anatomy of the dura related to the pituitary fossa.
• Discuss the dominant flow from the superior sagittal sinus to the transverse sinuses.

The cranial nerve and their nuclei

• Assign the nucleus responsible for each of the functions of the cranial nerves.
• Outline the anatomy and functions of each of the nuclei related to cranial nerves.

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• Describe in detail the anatomy of the cranial nerves as they connect the nuclei.
• Tabulate the cranial nerves which attach to the midbrain, pons, pontomedullary junction and the medulla.
• Describe the meningeal relationships to the optic nerve as it pertains to the development of
papilloedema.
• Describe the blood supply of the optic nerve.
• Describe the relationships of the subarachnoid oculomotor nerve.
• Describe the blood supply of the facial and vestibulocochlear nerves.

The CSF filled spaces

• Name and describe in detail the anatomy of each of the arachnoid cisterns.
• Describe the detailed anatomy of the Sylvian Fissure.
• Describe the histological anatomy of the choroid plexus.

The arterial supply and venous drainage of the cranium and brain
• Discuss the relationship of the internal carotid artery to the middle ear.
• Describe in detail the intradural microsurgical anatomy as exposed in a pterional craniotomy.
• Describe in detail the anatomy of the perforating vessels arising from the anterior cerebral circulation.
• Describe the anatomy of the anatomy of the anterior choroidal artery.
• Discuss the normal variations of the anterior communicating artery complex.
• Describe the anatomy of the vertebral artery in the neck.
• Describe the detailed anatomy of the vertebral artery at the craniocervical junction.
• Describe the course, branches and relationships of the intradural vertebral artery.
• Describe the anatomy of the posterior inferior cerebellar artery including normal variants of origin.
• Describe the anatomy of the basilar artery and its branches.
• Describe the anatomy of the anterior inferior cerebellar artery.
• Describe the anatomy of the superior cerebellar artery.
• Describe the surgical anatomy of the posterior cerebral artery.
• Describe in detail the anatomy of the perforating vessels which arise from the posterior circulation.
• Describe the anatomy of the anterior and posterior perforated substance.
• Describe the anatomy of the veins confluent on the Foramen of Monro.
• Describe the anatomy and relationships of the internal cerebral vein.
• Describe the anatomy and relationships of the basal vein of Rosenthal.
• Describe the anatomy and relationships of the vein of Galen.

Gross anatomy of the vertebral column, the spinal cord and associated structures
• Describe the bony anatomy peculiar to each of the cervical, thoracic, lumbar, sacral and coccygeal
portions of the vertebral column.
• Discuss the surface anatomy of the levels of the vertebral column.
• Discuss the blood supply of the intervertebral discs and its relationship to sepsis.
• Discuss Batson's plexus and its role in the dissemination of malignancy.
• Discuss the anatomy of the occipito-cervical junction (C0 - C2).
• Discuss the biomechanics of the vertebral column with particular reference to the internal axis of rotation,
sagittal alignment and the moment arms of the spinal musculature.
• Describe in detail the white matter tracts, and their connections, of the spinal cord.
• Describe in detail the functional sections of the grey matter.
• Diagrammatically illustrate the cross-sectional anatomy of the spinal cord at the mid-cervical, mid-
thoracic and low-thoracic vertebral levels.
• Describe the arterial supply of the spinal cord and its relationship to known arterial supply deficiency
syndromes.
• Describe the surgical anatomy of the Artery of Adamkiewicz.
• Describe the position on the trunk and limbs of the key sensory levels of the spinal cord.

Gross anatomy of the peripheral somatic nervous system

• Discuss in detail the surgical anatomy of the common exposures of the peripheral nerves.
• Describe the anatomy of the thoracic outlet with particular reference to vascular and neurological
compression syndromes.

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Gross anatomy of the autonomic nervous system

• Describe the origins and pathways of sympathetic supply in the central nervous system.
• Describe the anatomy of the sympathetic chain including its connections to the spinal cord and regions of
supply.
• Describe the origins and pathways of the parasympathetic nervous system in the central nervous system.
• Describe the parasympathetic ganglia of the head and neck.
• Describe the parasympathetic supply of the thorax.
• Describe the parasympathetic supply from the lumbosacral region.
• Discuss the innervation of the urinary bladder.

Radiological anatomy of the cranium, vertebral column and the central nervous system
• Identify anatomical structures on axial, coronal and sagittal sections of the brain.
• Identify the anatomical structures visualised with 2-dimensional angiography.
• Identify anatomical structures as represented in 3-dimensional imaging.
• Identify anatomical structures on axial, coronal and sagittal sections of the spine.

Pathways
• Describe the auditory pathways.
• Describe the pathway subserving pupillary responses.

SET5 Learning Outcomes

Development of the nervous system - neuroembryology

• Discuss the embryological basis for cerebral arteriovenous malformations.
• Discuss the embryological basis for craniopharyngioma and Rathke's cleft cyst.
• Discuss theories of the embryological basis for colloid cysts.
• Discuss the embryological basis for neuroectodermal cysts.

Gross anatomy of the cranium and brain

• Discuss, in general terms, the degree of eloquence of the named portions of the frontal lobe.
• Describe the relationship of the gyrus rectus to the anterior communicating artery.
• Describe the connections of the hippocampus.
• Discuss the anatomical connections between the basal ganglia.
• Describe the anatomy, connections and function of the reticular formation.
• Describe the anatomy of the thalamus including its important nuclei.
• Describe the surgical anatomy of the pineal region.

Gross anatomy of the scalp, the skull and associated muscles

• Describe the surgical anatomy of the temporal bone.
• Describe the anatomy of the structures encountered during the far lateral transcondylar approach to the
posterior fossa.
• Describe in detail the anatomy of the superior orbital fissure.
• Describe in detail the anatomy of the jugular foramen.

Gross anatomy of the dura, its reflections and venous spaces

• Discuss the relative surgical importance of the dural venous sinuses in terms of the options for sacrifice.
• Discuss the anatomical basis for acute venous congestion syndromes associated with occlusion of
different venous sinuses.

The cranial nerve and their nuclei

• Describe the anatomical basis for the clinical features of injury to various parts of the facial nerve.
• Describe the anatomy of the cranial nerves of the cerebellopontine angle as visualised in an approach to
the trigeminal nerve above the cerebellum.

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• Describe the anatomy of the cranial nerves as visualised in a retrosigmoid suboccipital approach to the
cerebellopontine angle.
• Describe the anatomy of the cranial nerves of the cerebellopontine angle as visualised in a
translabyrinthine approach.
• Describe the anatomy of the lower cranial nerves as visualised in a far lateral transcondylar approach.

The CSF filled spaces

• Describe the anatomy of the choroidal fissure.
• Describe in detail the anatomy of each of the ventricles and the Aqueduct of Sylvius.
• Discuss the landmarks for navigation within the lateral ventricle.
• Describe the anatomy of the approaches to the third ventricle.

The arterial supply and venous drainage of the cranium and brain
• Describe the anatomical variants of the cerebral arteries such as persistent trigeminal artery.
• Discuss the anatomical variations of the posterior communicating artery and its relationship to the
oculomotor nerve.
• Describe the anatomy exposed in the approaches to the basilar artery.
• Describe the vascular relationships to the trigeminal, facial and glossopharyngeal nerves as they pertain
to microvascular compression syndromes.
• Describe the venous anatomy as encountered in a supracerebellar infratentorial approach to the pineal
gland.

Gross anatomy of the vertebral column, the spinal cord and associated structures
• Describe the anatomy of the cervical lateral masses and facet joints.
• Describe the anatomy and orientation of the thoracic pedicles relative to the costotransverse structures
and the vertebral body.
• Describe the anatomy and orientation of the lumbar pedicles relative to the transverse processes and the
vertebral body.
• Describe the anatomy and orientation of the sacral pedicles relative to the ala of the sacrum (S1) and the
sacral foraminae.
• Describe the innervation of the intervertebral discs.
• Describe the innervation of the facet joints.
• Discuss the function of the facet joint as its varies between the cervical, thoracic and lumbar regions.
• Describe the anatomical basis for correct level localisation in the thoracic spine during thoracotomy
procedures.

Gross anatomy of the autonomic nervous system

• Discuss the anatomy exposed in a transthoracic endoscopic cervical sympathectomy.

Radiological anatomy of the cranium, vertebral column and the central nervous system
• Demonstrate the vessels visible on spinal angiography.

Pathways
• Describe the anatomical basis for extra-pyramidal motor control
• Describe the neurological pathways for speech.

SET 6 Learning Outcomes

Development of the nervous system - neuroembryology

• Discuss the embryological basis for cerebral heterotopias.

Gross anatomy of the cranium and brain

• Discuss the anatomical basis for personality.
• Discuss the anatomical and physiological basis for memory, both short and long term.

Updated 18 January 2007 Page 7 of 8

Gross anatomy of the scalp, the skull and associated muscles

• Describe the anatomy of the structures encountered in the translabyrinthine approach for lesions of the
cerebellopontine angle.

Gross anatomy of the dura, its reflections and venous spaces

• Describe the anatomy of the Dolenc approach to the cavernous sinus.
• Describe in general terms the triangles of possible lateral entrance to the cavernous sinus.

The CSF filled spaces

• Describe in detail the anatomy of the Foramen of Monro as it pertains to surgical access to the third
ventricle.

Radiological anatomy of the cranium, vertebral column and the central nervous system
• Demonstrate the anatomy visible with ventricular and cisternal contrast injection.

Pathways
• Describe the pathways for conjugate eye movement .

Updated 18 January 2007 Page 8 of 8

Neuroanaesthesia

Syllabus Module Overview

Module Rationale
The trainee is required to be familiar with the various types of anaesthesia used in neurosurgery.
Prior to graduation the trainee is required to be able to:
• collaborate with other professionals in the selection and use of various types of anaesthesia used in
neurosurgery, assessing and weighing the indications and contraindications associated with each
type
• communicate information about procedures and risks associated with general anaesthesia in relation
to disorders of the nervous system to patients (and/or their family) in ways that encourage their
participation in informed decision making

Recommended Readings
Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or
"Neurological surgery" Youmans.

References

Learning Opportunities and Methods

• Regular observation and active involvement with the neuroanaesthetists, including specific
instruction for emergency airway management are required.

Assessment and Examination

SET1 & SET2 Learning Outcomes

General anaesthesia: effect on I.C.P. and cerebral blood flow

• Demonstrate emergency airway management including intubation, medications, tube sizes etc.
• Discuss the uses of premedication in neurosurgical patients.
• Describe the agents used in induction of general anaesthesia.
• Describe drugs used for the maintenance of general anaesthesia including inhalational and intravenous
agents.
• Discuss drugs used for neuro muscular blockade including monitoring and reversal.
• Discuss the role of hypnotics, analgesics, anaesthetic agents and muscle relaxants.

Regional anaesthesia
• Discuss the indications for the use of regional anaesthesia in neurosurgical patients.
• Discuss the role of neuroleptic agents in addition to regional anaesthesia.
• Discuss the use of adrenaline with local anaesthetics.

SET3 & SET4 Learning Outcomes

General anaesthesia: effect on I.C.P. and cerebral blood flow

• Discuss awareness under anaesthesia.
• Discuss the variations on anaesthetic induction appropriate for patients with raised intracranial pressure.
• Discuss the variations on anaesthetic induction appropriate for patients with potentially unstable cervical
spine.
• Describe specific anaesthetic manoeuvres which may be used to reduce intracranial pressure.
• Describe in basic terms the ASA classification.

Updated 18 January 2007 Page 1 of 2

• Discuss the anaesthetic precautions and risks in the lateral and prone positions

Regional anaesthesia
• Discuss the uses and risks associated with epidural anaesthetic and epidural analgesia.

SET5 & SET6 Learning Outcomes

General anaesthesia: effect on I.C.P. and cerebral blood flow

• Discuss the anaesthetic precautions and risks in the sitting position.
• Describe the anaesthetic detection and treatment of air embolism.

Regional anaesthesia
• Discuss the use of regional anaesthesia in awake craniotomy.

Updated 18 January 2007 Page 2 of 2

Infection

Syllabus Module Overview

Module Rationale
Neurosurgical infection occurs as a primary disorder or as a complication of neurosurgical procedures.
Prior to graduation the trainee is required to be able to:

• review the incidence of, and recommend appropriate prophylaxis for the prevention of neurosurgical
infection
• recognise the symptoms of, accurately diagnose, prescribe for, and manage all CNS and surgical
infections

Recommended Readings

Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans

References • Haines paper in "Neurosurgery" around 1995.

Learning Opportunities and Methods

• Trainees must consult with hospital microbiology and infectious diseases departments to determine
the most up to date management of infections.

Assessment and Examination

• Aspects of infection will be examined in the Fellowship Examination.

SET1 & SET2 Learning Outcomes

Primary bacterial infections

• Describe the clinical and diagnostic features of bacterial meningitis.
• List the common responsible pathogens for bacterial meningitis, pathogenesis and appropriate antibiotic
management.
• Describe the clinical and diagnostic features of cerebral abscess.
• List the common responsible pathogens for cerebral abscess, pathogenesis and appropriate antibiotic
management.
• Discuss clinical conditions predisposing to the development of bacterial meningitis.
• Discuss clinical conditions predisposing to the development of cerebral abscess.
• Describe in detail the clinical management of acute bacterial meningitis.
• Describe the management options for intracerebral abscess.
• Discuss the indications and contraindications of lumbar puncture in patients with CNS infections.

Primary viral infections

• Discuss the various viruses responsible for viral encephalitis.
• Describe the clinical presentation, diagnostic features, pathogenesis and management of viral meningitis.
• Describe neurological complications of HIV infection.
• Discuss the various causes of immune compromise.

Primary fungal/parasitic infections

• Discuss the various fungal and parasitic infections that can affect the central nervous system.
• Describe predisposing factors to fungal/parasitic infections of the CNS.

Updated 18 January 2007 Page 1 of 3

Postoperative and post traumatic infections

• Discuss the common causes, diagnosis, predisposing factors and management of postoperative and post
traumatic wound infections.
• Discuss the common organisms responsible for post operative and post traumatic infections.

SET3 & SET4 Learning Outcomes

Primary bacterial infections

• Describe the clinical and diagnostic features of spinal epidural abscess.
• Discuss the mechanisms by which spinal epidural abscess can cause neurological deficit.
• Discuss in detail the management options for spinal epidural abscess.
• Discuss the prognosis for spinal epidural abscess.
• Describe the clinical and diagnostic features of spinal osteomyelitis.
• Discuss in detail the management options for spinal osteomyelitis.
• Discuss in detail mycobacterial infection of the spine and CNS.
• Discuss the pathogenesis, clinical and diagnostic features of primary discitis.
• Discuss the management options and long term outcome for primary discitis.
• Discuss paranasal sinus infections and its relevance to CNS and skull infection.
• Discuss the features of subdural abscess particularly in paediatric population and its management.

Primary viral infections

• Discuss prion diseases affecting the human CNS, including clinical features, diagnostic features,
management and infection control.
• Discuss the role of biopsy in prion disease.

Primary fungal/parasitic infections

• Discuss the pathogenesis and management of hydatid disease of the brain.

Postoperative and post traumatic infections

• Discuss the common causes, diagnosis, predisposing factors and management of shunt infections.
• Discuss the evidence regarding the use of prophylactic antibiotics following trauma and neurosurgical
procedures (contaminated and clean).

SET 5 Learning Outcomes

Primary bacterial infections

• Describe the common long term neurological sequelae following bacterial meningitis and intracerebral
abscess.
• Compare and contrast aspiration and surgical excision of intracerebral abscess.
• Describe the neurological manifestations of syphilis.

Primary viral infections

• Discuss the CNS sequelae of in-utero viral infection.
• Discuss the current NH&MRC Guidelines regarding prevention and management of CJD.

Primary fungal/parasitic infections

• Describe the pathogenesis, diagnostic features, clinical features and management for cryptococcal CNS
infection .

Postoperative and post traumatic infections

• Discuss in detail the evidence for various measures to decrease operative infections.

Updated 18 January 2007 Page 2 of 3

SET 6 Learning Outcomes

Primary bacterial infections

• Discuss the role of immunisation and prophylactic antibiotics in the prevention of bacterial meningitis in
the community.

Primary viral infections

• Discuss the spectrum of neurological conditions associated with herpes viral infections.

Postoperative and post traumatic infections

• Discuss the management options, and evidence for their effectiveness, for an infected shunt.

Updated 18 January 2007 Page 3 of 3

Vascular Disease

Syllabus Module Overview

Module Rationale
The trainee is expected to have an expert knowledge of the medical and surgical management of
cerebrovascular disease
Prior to graduation the trainee is required to be able to:
• utilise evidence based medicine to make rational and ethical management decisions regarding use of
medical and surgical techniques for patients with cerebrovascular disorders
• medically and surgically manage cerebrovascular disease

Recommended Readings

Essential • The relevant chapter(s) in either "Neurosurgery": Wilkins and Rengachary or

"Neurological surgery" Youmans.

Desirable • Diagnostic Neuroradiology. Osborne

• Spetzler
• Batjer

References • Vascular studies by Al Rhoton

Learning Opportunities and Methods

• Trainees are advised to work closely with stroke physicians in the management of ischaemic and
haemorrhagic conditions.
• Trainees are expected to participate in the full variety of cerebrovascular surgical procedures and in
extracranial cerebrovascular procedures (with vascular or neurosurgeons).
• Trainees are expected to spend time with a neuroradiologist and participate in diagnostic and
endovascular interventions.

Assessment and Examination

• Trainees will undergo regular ongoing assessment throughout the Training Program including
minimum six monthly completion of assessment reports by the Supervisor of Surgical Training.
• Vascular disease will be examined during the Fellowship Examination.

SET1 & SET2 Learning Outcomes

Stroke (excluding subarachnoid haemorrhage)

• Describe in detail the anatomy of intracranial arteries and extracranial cervical arteries.
• Describe in detail the anatomy intracranial veins and extracranial cervical veins.
• List the causes of cerebral ischaemia.
• Discuss the risk factors for occlusive cerebrovascular disease.
• Describe the risk factors for thromboembolic cerebrovascular disease.
• Discuss the clinicopathological effects of progressive cerebral ischaemia.
• Describe the clinical presentation of ischaemia to each of the major intracerebral vascular territories.
• Describe the clinical syndrome of vertebral steal.
• Describe the vascular supply of the spinal cord.
• Describe the clinical presentation of anterior and posterior spinal territory ischaemia.
• Discuss the use and limitations of CT scan and MRI in cerebral ischaemia.
• Discuss the use and risks of angiography in cerebral ischaemia.
• Describe the mechanisms of thrombus formation and dissolution.
• Describe the techniques, uses and limitations of doppler sonation in cerebral vascular disease.
• Discuss the prothrombotic disorders.
• Discuss the aetiology, clinical presentation and natural history of arterial dissection.

Updated 18 January 2007 Page 1 of 3

• List the investigations of suspected arterial dissection.

• Discuss risk factors, medical management and prognosis of brain haemorrhage.
• Discuss the common sites of spontaneous intracerebral haemorrhage and their likely causes.

Extracranial vascular disease

• Describe the risk factors for atheromatous carotid disease.
• Discuss the clinical diagnosis, differential diagnosis and significance of transient ischaemic attack (TIA).
• List the treatment options for carotid stenosis.
• Describe the perioperative management of carotid endarterectomy.
• Describe the perioperative management of stent deployment.

Aneurysms and non-traumatic subarachnoid haemorrhage

• Describe in detail the clinical and radiological grading systems of subarachnoid haemorrhage.
• Discuss the aetiology, clinical presentation and natural history of non-traumatic subarachnoid
haemorrhage.
• List the investigations of a patient with presumed non-traumatic subarachnoid haemorrhage.
• Define the features on CT of subarachnoid haemorrhage.
• Describe the early management of non-traumatic subarachnoid haemorrhage.
• Describe the outcome of intracranial aneurysm rupture.
• Discuss the risks associated with surgical and endovascular treatment of aneurysm treatment (for
obtaining informed consent).
• Discuss the aetiology, common sites, clinical presentation and natural history of traumatic aneurysms.
• Discuss the aetiology, microbiology, common sites, clinical presentation and natural history of mycotic
aneurysms.

Cerebral AVMs
• Discuss the epidemiology, aetiology and gross pathology of brain AVMs.
• Discuss the spectrum of presentation of cerebral AVMs.

Cavernous angioma
• List the angiographically occult vascular malformations.
• Discuss the clinical presentation of angiographically occult vascular malformations.

SET3 & SET4 Learning Outcomes

Stroke (excluding subarachnoid haemorrhage)

• Discuss the use and limitations of nuclear medicine investigations in cerebral ischaemia.
• Describe the aetiology, clinical presentations, natural history, histopathology and investigation of moya-
moya syndromes.
• Describe the gross and microscopic pathology in arterial dissection.
• Describe in detail the diagnostic studies to confirm arterial dissection.
• Discuss the management options of arterial dissection.
• Describe the clinical syndromes associated with intracranial venous occlusion.
• Discuss in detail the investigations of intracranial venous occlusive disease.
• Discuss the long-term complications of intracranial venous occlusion.
• Discuss in detail the approaches to and techniques of evacuation of spontaneous intracerebral
haemorrhage.
• Discuss gross and microscopic pathology of intracerebral haemorrhage eg Amyloid.

Extracranial vascular disease

• Discuss the investigation and management options for TIA..
• Discuss the natural history of asymptomatic and symptomatic carotid stenosis.
• Discuss the indications, risks and benefits of carotid endarterectomy.
• Discuss the management of complications of carotid endarterectomy.
• Discuss the indications, risks and benefits of carotid stenting.

Updated 18 January 2007 Page 2 of 3

• Discuss the management of complications of carotid stenting.

• Demonstrate the surgical exposure of carotid bifurcation, protecting the cranial nerves.
• Discuss the natural history of acute arterial sacrifice.
• Discuss methods of assessing risk of acute arterial sacrifice.
• Demonstrate microsurgical anastomotic suturing techniques in laboratory.
• Demonstrate harvesting vein or artery for use in bypass.

Aneurysms and non-traumatic subarachnoid haemorrhage

• Discuss the systemic effects of non-traumatic subarachnoid haemorrhage.
• Describe in detail the management of the complications of subarachnoid haemorrhage including
vasospasm and hydrocephalus.
• Describe the histopathology of intracranial aneurysms.
• Discuss the influence of site, size, shape, age, environment and hereditary factors in natural history of
intracranial aneurysms.
• Discuss the outcome and natural history of symptomatic unruptured intracranial aneurysms.
• Discuss the endovascular and surgical role for aneurysm treatment.
• Discuss the role of non-interventional management of intracranial aneurysms.
• Discuss the investigation of a patient with mycotic aneurysms.

Cerebral AVMs
• Discuss haemodynamics of brain AVMs.
• Describe the microscopic pathology of cerebral AVMs.
• Discuss the natural history of AVMs.
• Discuss the risk of haemorrhage from an AVM including the impact of angiographic factors, demographic
and clinical factors.
• Describe the grading scales for cerebral AVMs and the risks of surgical treatment.
• Describe the non-interventional management of AVMs.
• Discuss perioperative management of cerebral AVMs.

Spinal AVMs
• Discuss the aetiology, presentation, classification and natural history of spinal AVMs.

Cavernous angioma
• Discuss the gross and microscopic pathology of angiographically occult vascular malformations.
• Discuss the radiological findings in angiographically occult vascular malformations

SET5 & SET6 Learning Outcomes

Stroke (excluding subarachnoid haemorrhage)

• Discuss the uses and risks of anticoagulation in the prevention and treatment of cerebral ischaemia.
• Discuss the uses and risks of antiplatelet therapy in the prevention and treatment of cerebral ischaemia.
• Discuss the uses and risks of thrombolysis in cerebral ischaemia.
• Discuss in detail the role of angioplasty in cerebral ischaemia.
• Discuss the management options, complications and follow up of moya-moya syndromes.
• Describe the complications of management of arterial dissection and explain the reasons for long-term
follow-up.
• Discuss the method and indications for endovascular management of venous occlusive disease.
• Discuss in detail controversies surrounding surgery for spontaneous intracerebral haemorrhage.
• Discuss the evidence for the role of specialist stroke units and rehabilitation units.

Updated 18 January 2007 Page 3 of 3

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