Program Topics: From the Residency Program Director Program Objectives About Brown University & Medical School Neurosurgery The Hospitals Hospital Facilities Program Overview Educational Program Research Opportunities Libraries Supervision Evaluating Residents Workload and Call Schedule Compensation Support Services and Personnel Applications For More Information

Program Overview

Our neurosurgery residency program, started in 1985 through the efforts of Mel Epstein, M.D., exposes residents to the full spectrum of neurologic conditions and neurosurgical techniques. It provides a complete educational experience in:

• pediatric neurosurgery,


• cerebrovascular surgery,


• spine surgery,


• tumor surgery,


• trauma surgery,


• stereotactic and functional surgery


• epilepsy surgery.

Residents gain critical-care experience in the Intensive Neurosurgical Care Unit, the Trauma Intensive Care Unit, the Pediatric Intensive Care Unit, and the Surgical Intensive Care Unit. They may conduct research at any of the seven Brown-affiliated hospitals or at Brown University and Medical School (see the Research Opportunities section for more information).

Year 1: Introduction to Clinical Neurosurgery

In their first neurosurgical (NS-1) year, residents learn the principles of neurosurgical and neuro-intensive patient care. They become well versed in the bedside care of neurosurgical patients and acquire basic neurosurgical skills. For instance, they gain experience with:

• lumbar punctures,


• lumbar laminectomies,


• cervical and thoracic spine exposures,


• burr holes,


• stereotactic biopsies,


• ventriculoperitoneal shunts,


• simple craniotomies,


• tracheostomies,


• muscle and nerve biopsies,


• deep brain stimulators, and


• intrathecal pump implantation.

Residents also learn to insert:

• intracranial pressure transducers,


• traction/halo vests,


• ventricular catheters,


• arterial and central lines, and


• Swan-Ganz catheters.

Year 2: Concentrated Learning Experience

NS-2 residents spend the first month of the second year mentoring NS-1 residents to ease their transition to clinical neurosurgery. The rest of the year gives NS-2 residents a concentrated learning experience that includes:

• three months of neuropathology,


• three months of neuroradiology,


• a two-month Gamma Knife rotation, and


• at least three months of clinical neurology.

The Neuropathology Rotation

Doctors in Rhode Island Hospital’s Neuropathology Division give consultations on specimens for all Brown-affiliated hospitals. They consult for many other hospitals in Rhode Island and southeastern Massachusetts as well.

During the neuropathology rotation, residents work with neuropathologists Edward Stopa, Suzanne de la Monte, and John Donahue. They learn to use state-of-the-art techniques to perform diagnostic evaluations of neuropathologic material obtained during surgery or autopsy. They participate in conferences with others in the Department of Clinical Neurosciences, in forensic neuropathology conferences at the Rhode Island Medical Examiner’s office, and in perinatal neuropathology conferences at Women and Infants Hospital.

The Neuroradiology Rotation

Faculty members in Brown’s Department of Diagnostic Imaging provide training in diagnostic and interventional neuroradiology. They include attending neuroradiologists Jeffrey Rogg, Glenn Tung, Lawrence Davis, and Jerrold Boxerman, as well as interventional neuroradiologist Richard Haas. All are board-certified.

The neuroradiologists conduct about 12,000 exams annually. They use diffusion, perfusion, and spectroscopy techniques. Each year, interventional radiology performs an estimated 250 procedures such as aneurysm coiling, vertebroplasty, and embolization of arteriovenous malformations.

The neuroradiology rotation enables residents to participate in the interpretation of MRI and CT scans of the brain and spine. They are invited to observe the full range of neurointerventional procedures.

Gamma Knife Rotation

The gamma knife rotation teaches the principles behind, and practical performance of, stereotactic radiosurgery. Under Dr. Norén’s guidance, residents learn to evaluate candidates for gamma knife surgery, interpret imaging studies, and, using a special computer program, devise a treatment plan that specifies the radiation’s target, amount, and duration.

Clinical Neurology Rotation

The large Department of Neurology, chaired by Dr. Easton, manages many patients jointly with the Department of Neurosurgery. Throughout the rotation in clinical neurology, residents work with full-time neurology faculty members who specialize in neuromuscular disorders, cerebrovascular diseases, degenerative diseases, epilepsy, multiple sclerosis, neurooncology, and pediatric neurology.

Neurosurgery residents admit elective and emergency neurology patients. They learn to interpret electroencephalograms and evaluate patients with seizures for possible epilepsy surgery. They participate in the neurology consultation service and attend Neurology Grand Rounds.

Years 3 and 4: Tailored to Each Resident’s Interests

The NS-3 and NS-4 years reflect individual residents’ goals and interests. Third-year residents take clinical neurosurgery electives in two six-month rotations, choosing from offerings in pediatric, spine, trauma, functional, cerebrovascular, and tumor neurosurgery.

Residents may spend the NS-4 year pursuing additional clinical electives. Others interested in academic practice may spend this time developing research by engaging in either basic or clinical research (Please see the Research Opportunities section for more information).

In the third or fourth year of residency, we encourage residents to attend the Chicago Review Course in Neurological Surgery. We also recommend the annual Review and Update in Neuroscience for Neurosurgeons at Woods Hole, Massachusetts.

Year 5: Senior Resident Year

The NS-5 year, devoted to clinical neurosurgery, brings added surgical opportunities and clinical responsibilities. Senior residents run the outpatient neurosurgery resident clinic. They perform:

• lumbar and thoracic laminectomies,


• anterior and posterior cervical operations,


• complex spinal fusions,


• routine supratentorial and infratentorial craniotomies,


• assorted cerebrospinal fluid shunts,


• minimally invasive spine procedures, and


• stereotactic procedures.

Year 6: Chief Resident Year

The final year of residency marks the transition from mentored resident to independent neurosurgeon. At this time, residents assume independent operative responsibility, under faculty supervision, along with administrative responsibility. The chief residents supervise the entire inpatient neurosurgical care program at Rhode Island Hospital. They organize Morbidity and Mortality Conferences, case presentations at Grand Rounds, and many of the teaching courses.

By the end of the year, residents will have provided all types of neurosurgical care. They should be able to treat virtually all of the most specialized neurosurgical conditions in adults and children.