Residency Training Program

Neuroscience

Neurology

Neurosurgery residents spend three months on a neurology rotation in the Mount Sinai Hospital Neurology Department, a highly qualified accredited unit, where they have broad exposure to all types of neurologic problems including stroke, trauma, demyelinating and degenerative diseases, peripheral neuropathies and myopathies. EMGs and EEGs are reviewed with the neurology residents and staff.

Neuropathology

Neuropathology is taught in regular review sessions as well as during the one-month rotation in The Mount Sinai Hospital Neuropathology Department. Weekly reviews of the surgical cases are done with the neurosurgery residents, staff, and neuropathology attending of the month. The entire Department of Neurosurgery and Division of Neuropathology attend monthly review conferences. Additionally, some residents go to the Armed Forces Institute of Pathology for their neuropathology review course during the second year of training.

Neuroanatomy

The Neurosurgery Department at The Mount Sinai Medical Center gives regular teaching sessions on anatomy and yearly runs one of the anatomy laboratory sections for the first year medical students. There is a dissection laboratory with three fully equipped stations including mounted microscopes, suction and drills where the residents do standard exposures and specific research studies. In the laboratory, skull base dissections are constantly being performed and videotaped for educational purposes. Residents participate in these dissections during their senior years. The faculty also directs the residents in dissection of various surgical exposures in cadavers obtained solely for this purpose. These sessions have covered the gamut of all intracranial approaches to neurosurgical cases as well as spinal instrumentation and endoscopic techniques. The dissection laboratory is staffed by full time neurosurgeons for residents, visitors and surgical courses. It has been an extremely effective laboratory with major peer reviewed articles and two books. There is also a temporal bone laboratory available with neurootology.

Neurophysiology

Don Weisz, Ph.D., directs our intraoperative neurophysiological monitoring program. All four neurosurgical operating rooms have equipment for the monitoring of sensory and motor evoked potentials. In addition, Dr. Weisz performs microelectrode recordings of single units in patients with movement disorders who are undergoing surgery for the implantation of deep brain stimulating (DBS) electrodes.  He teaches his own staff and the neurosurgical residents daily in clinical neurophysiology. Dr. Weisz also has a laboratory which functions for basic neurophysiological and neurological studies in which the residents may actively participate. 

Neuroadiology

Neuroradiology is directed by Thomas Naidich, M.D., a world-renowned expert in clinical and neuroanatomical radiology. Dr. Naidich is assisted by three other full-time neuroradiologists. Each resident has a one month rotation in neuroradiology as well as daily exposure to review sessions. Three mornings weekly, a conference is held for the entire resident and staff group to review all the films of the service. Residents often lead these sessions for more intensive teaching purposes. Dr. Naidich also has a formal lecture series in neuroradiology for the neurosurgery residents which covers the spectrum of neuroradiology. Neuroradiology fellows, four each year, interact very closely with the neurosurgery residents in clinical cases and conferences.

Endovascular Neurosurgery

The endovascular service at The Mount Sinai Hospital is run by two attendings, neurosurgeon and interventionalist, Aman Patel, M.D., Director of the service, and David Johnson, M.D., an interventional neuroradiologist. More than 45 procedures are performed each month, about half of which are endovascular interventions. The rest are diagnostic cerebral angiograms. Neurosurgical residents at The Mount Sinai Hospital are involved in the pre-operative and post-operative daily care of all patients, including those with aneurysms, vascular malformations, spinal malformations, intracranial tumors, spinal tumors and spinal compression fractures, acute cerebral infarction, extracranial carotid stenosis and intracranial cerebral stenosis.

The residents participate in the decision making process about indications for treatment for all endovascular cases. They gain an understanding for carotid angioplasty, stenting, and vertebroplasty, for embolization of aneurysms, AVMs, spinal tumors and spinal vascular malformations as well as treatment for vasospasm and acute ischemic stroke. The endovascular suite is viewed as another operating room. All residents have free access to participating in the endovascular procedures, acting as first assistant in any endovascular or angiographic procedure. All residents now have a dedicated rotation on the endovascular service for a minimum of three months. During this time the residents learn basic skills of cerebral angiography, sharpen their vascular anatomic knowledge and learn the basics of endovascular decision making. For residents who have further interest in this subspecialty, an opportunity exists to spend a year on the diagnostic neuroradiology service in the capacity as a first year fellow to jump start fellowship training in endovascular neurosurgery.

Functional and Restorative Neurosurgery

The Functional and Restorative Neurosurgery program at Mount Sinai is headed by Ron Alterman, M.D. Presently, the program is focused on the treatment of medically refractory movement disorders with Deep Brain Stimulation (DBS). Sixty to eighty such procedures are performed each year. Vagus Nerve Stimulation (VNS) is also performed for the treatment of generalized epilepsy and chronic depression. Many additional procedures will be added in the next 1-2 years including the use of DBS for Obsessive-Compulsive Disorders, Chronic Depression, and Epilepsy and the use of Motor Cortical Stimulation to enhance motor recovery after stroke and for the treatment of atypical facial pain and secondary dystonia. Programs in neural transplantation and in vivo gene therapy are in their planning stages.

The Neurosurgery residents are involved intimately in the pre- and post-operative daily care of the all inpatients. They participate in the decision making process concerning surgical indications and target selection. They gain an understanding of advanced stereotactic techniques including the use of frame-less DBS lead implants and intra-operative single-cell microelectrode recording. Residents participate in all aspects of the DBS procedures including frame application, surgical planning, patient positioning, and the interpretation of physiological parameters.

Stereotactic Radiosurgery

The Stereotactic Radiosurgery Service of the Department of Neurosurgery at The Mount Sinai Hospital is led by Isabelle M. Germano, M.D. This multidisciplinary program provides state-of-the-art minimally invasive comprehensive treatment to patients with brain and spine tumors, in collaboration with the Departments of Radiation Oncology, Medical Physics and the Cancer Center. The program recently expanded its capability by acquiring the Novalis Shaped Beam Surgery technology allowing delivery of fine-field shaping stereotactic radiation to cranial and extra-cranial nerves.

Neurosurgery residents are involved in the decision making process about indications for potential candidates who can benefit from stereotactic radiosurgery. They are encouraged to participate in the frame placement, treatment planning, treatment administration and clinical and radiographic follow up of these patients as well as in the post treatment care. The patients include those with metastatic brain disease, primary brain tumors, skull base tumors, vascular malformations and trigeminal neuralgia and spine tumors.