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FOR MEDICAL STUDENTS & NEUROSURGERY SERVICE JUNIOR MEDICAL OFFICERS

CONTENTS OF THIS SECTION:*

  • A Medical School Senior Medicine/Surgery Tutorial Outline
    1. Cerebral Tumours - Benign and Malignant
    2. Subarachnoid Haemorrhage (SAH)
    3. Traumatic Brain Injury (TBI; Head Injury)
    4. Hydrocephalus
    5. Headache
  • Additional "Introductory Neurosurgery" Series Outline
    1. Brain and Spinal Anatomy
    2. Neurological History, Physical Examination and Investigation
    3. Neurosurgical Management and Communication
    4. A Series of Case Studies with Intraoperative Photographs and Videos
  • Neurosurgery Service Junior Medical Officer (JMO) Tutorial Topics
  • An Outline of Comprehensive Neurosurgery Curriculum Delivery
  • Recommended Texts and Atlases for Medical Students and Neurosurgery Service Interns/JMOs

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A MEDICAL SCHOOL SENIOR MEDICINE/SURGERY TUTORIAL OUTLINE:

The following three tutorials are entitled:

  1. Cerebral Tumours - Benign and Malignant
  2. Subarachnoid Haemorrhage (SAH)
  3. Traumatic Brain Injury (TBI; Head Injury)
  4. Hydrocephalus
  5. Headache

The tutorials cover the following topics:

  • Cerebral Tumours - Benign and Malignant
    • A 50 year old man presents with change of personality and headaches
    • Learning Objectives - Assumed/Revision:
      • Classification of brain tumours
    • Learning Objectives - New:
      • Pathophysiology, incidence and clinical presentation of brain tumours
      • Investigation and immediate management
      • Treatment - surgical, radiotherapy, chemotherapy and palliation
        • For information pertaining to all of the above brain tumour learning objectives ("assumed" and "new"), click the following links for information on brain tumours in general and for a series of specific brain tumour case histories (including imaging).
        • For a brief article on the topic of headache (one of the key presenting symptoms of brain tumours), click here
  • Subarachnoid Haemorrhage (SAH)
    • A 45 year old female presents with a history of sudden, severe headache and vomiting
    • Learning Objectives - Assumed (Revision):
      • Pathophysiology, incidence and clinical presentation of SAH
    • Learning Objectives - New:
      • Investigation, grading and immediate management
      • Treatment - medical, surgical, endovascular
      • Management of ruptured and unruptured aneurysms
        • For information pertaining to all of the above SAH learning objectives ("assumed" and "new"), click here. Alternatively, click the following links for information on complications arising from brain aneurysm rupture such as rebleeding and cerebral vasospasm. For brain aneurysm imaging, click here. For a brain aneurysm case study, click here.
      • Arteriovenous malformations (AVM), cavernomas and dural arteriovenous fistulae (DAVF)
      • For a brief article on the topic of headache (one of the key presenting symptoms of brain blood vessel disorders), click here
  • Traumatic Brain Injury (TBI; Head Injury)
    • The tutorial covers the pathogenesis, epidemiology, clinical presentation, investigation and principles of management of TBI (including rehabilitation aspects), in addition to the Glasgow Coma Score (GCS) and post-traumatic amnesia (PTA) score. A number of relevant medical images are included.
    • A brief summary of the tutorial, in the form of an essay, can be accessed by clicking here
  • Hydrocephalus
    • The tutorial covers the definition, causes, classification, clinical presentation, investigation and treatment of hydrocephalus. A number of relevant medical images are included.
    • A brief summary of the tutorial, in the form of an essay, can be accessed by clicking here
  • Headache
    • The tutorial covers some causes of headache (pathogenesis), the clinical presentation (including "red flags"), investigation, and basis of neurosurgical referral. A number of relevant medical images are included. A brief summary of the tutorial, in the form of an essay, can be accessed by clicking here


ADDITIONAL "INTRODUCTORY NEUROSURGERY' SERIES OUTLINE:

The following four lectures/tutorials are entitled:

  1. Brain and Spinal Anatomy
  2. Neurological History, Physical Examination and Investigation
  3. Neurosurgical Management and Communication
  4. A Series of Case Studies with Intraoperative Photographs and Videos

This series of didactic lectures/tutorials include a combination of didactic summary slides, a collection of multiplanar cross-sectional neuroanatomy images, diagnostic radiology images, and intraoperative photographs and videos. The lectures cover the following topics:

  • Brain and Spinal Anatomy:
    • Cross-sectional anatomy - Axial, coronal, and sagittal views
      • Key structures and relationships
    • Base of brain - Circle of Willis and cranial nerves
      • Key structures and relationships
    • Cranial venous anatomy - Deep and superficial venous system
      • Schematics
    • Brainstem/cranial nerves - Gross views
      • Key structures and relationships
      • Relationship of key posterior fossa arteries to cranial nerves
    • Spine and spinal cord anatomy - Axial and sagittal views
      • Key structures and relationships
    • Brachial and lumbosacral plexus anatomy - Schematic views
  • Neurological History and Examination - A Neurosurgical Perspective:
    • Gleaning important aspects of the medical history
    • Identifying neurosurgical risk factors
    • Classic symptoms to note
    • Syndromes to watch out for
    • Neurosurgeon's bedside examination - "Quicklook" exam vs. detailed regional approach
    • Examining the comatose patient
    • Glasgow Coma Score (GCS)
    • Brain death examination
    • Brachial and lumbosacral plexus and specific peripheral nerve examination
  • Communication Skills:
    • Bedside manner - how to be a good communicator
    • Communicating a diagnosis and prognosis
    • Principles of Informed consent
  • Investigating Neurosurgical Conditions:
    • Basic laboratory studies
    • Lumbar puncture (LP) - cerebrospinal fluid (CSF) studies; includes contraindications to LP
    • Plain film interpretation
    • Head CT interpretation
    • Head MRI interpretation
    • Spine CT interpretation
    • Spine MRI interpretation
    • Special studies
  • Neurosurgical Management Discussion:
    • Neurosurgical management options
    • Neurosurgical emergencies
    • Spinal cord injury
    • Traumatic brain injury (TBI)
    • The comatose patient
  • Case Study Series with Intraoperative Photographs and Videos:
    • Brain tumors - glioma, metastasis, miscellaneous tumors
    • Lesions that mimic brain tumors - radiation necrosis, epi/dermoid, cysts
    • Intracranial hemorrhage - aneurysm, arteriovenous malformation, amyloid angiopathy, hypertensive hemorrhage
    • Head trauma - cranial and skull base fractures, contusion, traumatic subarachnoid hemorrhage (SAH), epidural hematoma, subdural hematoma, diffuse axonal injury (DAI)
    • Spine trauma
    • Intervertebral disc herniation
    • Disc space infection


NEUROSURGERY SERVICE JUNIOR MEDICAL OFFICER (JMO) TUTORIAL TOPICS:

  • Introduction to the Neurosurgery Service - An overview of neurosurgical history taking, physical examination and investigations, and a summary of common neurosurgical emergencies
  • Imaging review - A collection of common neurosurgical X-ray, CT and MR images
  • Brain and Spinal Anatomy - Cross-sectional and pictorial basic neuroanatomy review


AN OUTLINE OF COMPREHENSIVE NEUROSURGERY CURRICULUM DELIVERY FOR MEDICAL STUDENTS:

  • Problem-based learning (PBL) or case-based learning (CBL) sessions
    • Case studies (see topics above)
    • History, communication skills, physical examination, investigation, differential diagnosis
    • Where relevant: Neuroepidemiology, neuroembyrology/teratology, neurophysiology, neuropharmacology, neuropathology, neuroradiology
    • Treatment options
    • Note: Surgical approaches, surgical pitfalls, advanced neuroimaging, and patient follow-up are topics reserved for neurosurgical trainees.
  • Didactic sessions
    • See Lecture Series topics above
    • Disease-specific lectures
  • Neuroanatomy tutorials
    • Gross anatomy
    • Cross-sectional anatomy
    • Anatomical models - skull, brain, brainstem and spine
  • Clinical tutorials
    • Neurological history & bedside manner
    • Neurological examination
    • Brain tumours
    • Brain Haemorrhage
    • Traumatic Brain Injury
    • Coma, Glasgow Coma Score (GCS) & brain death


ADDITIONAL WEB-BASED RESOURCES:

  • About brain tumours...
  • About cerebrovascular disease...
  • About traumatic brain injury...
  • About headache...
  • About hydrocephalus...
  • About brain surgery...


RECOMMENDED TEXTS AND ATLASES FOR MEDICAL STUDENTS & NEUROSURGERY SERVICE INTERNS/JMOs:

  • For Neurosurgical/Neurological Basic Principles:
    • Neurology and Neurosurgery Illustrated. Kenneth W. Lindsay, Ian Bone. Fourth Edition. 2004. Churchill Livingstone Pub.
  • For Neuroanatomy:
    • Atlas of Sectional Anatomy: Head, Neck and Trunk. Philomena McGrath, Peter Mills. Second Edition. 1985. Karger Pub.
    • Color Atlas of Anatomy. Johannes W. Rohen, Chihiro Yokochi, Elke Lntjen-Drecoll. Sixth Edition. 2006. Lippincott Williams & Wilkins Pub.
    • Basic Clinical Neuroanatomy. Paul A. Young, Paul H. Young. 1996. Lippincott Williams & Wilkins Pub.


Page last updated: 11 July 2010


  
 
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