Neuro-Oncology Curriculum

The neuro-oncology curriculum is based on knowledge and performance objectives divided into junior, senior and chief resident sections. Learning is intended to be cumulative with increasing responsibility over the period of training.

Junior Resident (PGY 2, 3)

Knowledge Objectives

  1. Understand the epidemiology, natural history, common locations and incidence of primary brain tumors including hereditary syndromes.
  2. Understand the basics of tumor biology including proliferation, invasiveness and vascularization.
  3. Describe the important MRI and CT findings for the differential diagnosis of primary brain tumors.
  4. Understand the principle histological findings that characterize different gliomas and the criteria for astrocytoma grading.
  5. List the common metastatic tumors that are found in the CNS according to their frequency.
  6. Describe the more common locations and characteristics of meningiomas.
  7. Understand the orientation of cranial nerves entering the cavernous sinus, internal auditory canal and jugular fossa.
  8. Describe the origin of craniopharyngiomas and Rathke’s cleft cyst.
  9. Understand the clinical presentations for pituitary tumors including hormonally active and inactive lesions.
  10. Describe the appropriate use of medications for brain tumor surgery including steroids, mannitol, antibiotics and hormone replacement.
  11. Become familiar with hospital-based information systems utilized for patient care.

Performance Objectives

  1. Demonstrate competency in performing a history and physical examination on a patient with a brain tumor.
  2. Prioritize the findings on the history and physical exam and communicate these with senior residents and faculty.
  3. Maintain professional conduct with staff, families and other residents.
  4. Understand the salient features on MRI and CT that differentiate between primary and metastatic brain tumors as well as intra-axial and extra-axial lesions.
  5. Understand the variations in patient positioning for brain tumor surgery.
  6. Demonstrate competency in opening and closing craniotomies as well as placing lumbar drains and intracranial pressure monitors including ventriculostomy.
  7. Assist in performing stereotactic brain biopsies.
  8. Write clear informative notes in the patient’s chart that reflect important clinical priorities.

Senior Resident (PGY 6)

Knowledge Objectives

  1. Describe the appropriate preoperative workup for a patient with a primary brain tumor or a metastatic brain tumor.
  2. Understand the common clinical signs and symptoms of a patient with a brain tumor and how they influence the differential diagnosis.
  3. Describe the important clinical signs and symptoms for patients that require emergency intervention for a brain tumor.
  4. Explain the rationale for selection of an operative approach for supratentorial and posterior fossa tumors.
  5. Demonstrate the external landmarks used for intracranial surgery including the pterion, asterion, and inion and how to localize the superior sagittal sinus, transverse sinus and sigmoid sinus.
  6. Describe the operative approaches for tumors of the lateral and third ventricles.
  7. Understand the appropriate preoperative imaging studies for tumor surgery and demonstrate understanding of interpretation of these studies
  8. Understand the techniques utilized for intraoperative brain relaxation.
  9. Describe the appropriate postoperative management of a patient after supratentorial and posterior fossa tumor surgery including the relative risk factors and how to minimize complications and the appropriate use of adjuvant therapy.
  10. Understand the signs and symptoms of meningeal carcinomatosis.
  11. Understand the indications for stereotactic brain biopsy vs. resection for a brain tumor and how to select an optimal target for biopsy.

Performance Objectives

  1. Assist in the operative resection of intra-axial and extra-axial brain tumors.
  2. Perform stereotactic brain biopsies.
  3. Demonstrate facility with the use of surgical instruments including the operating microscope.
  4. Demonstrate the ability to identify the interface between the tumor and the brain and how to use this for tumor resection.
  5. Demonstrate the ability to properly identify anatomic landmarks, primary motor, sensory and language regions of the brain, cranial nerves and major arterial and venous structures.
  6. Show how to minimize and control intraoperative bleeding from the tumor and how to achieve brain relaxation.
  7. Maintain a record of surgical experience with brain tumors and utilize this experience to improve patient outcome.

Chief Resident

Knowledge Objectives

  1. Discuss the appropriate use of intraoperative techniques for SSEP and motor and speech mapping.
  2. Describe the techniques for establishing surgical goals for patients with brain tumors.
  3. Establish treatment plans for patients with brain tumors including the criteria for selecting patients for surgery vs. radiosurgery.
  4. Understand the surgical options for accessing tumors in the CPA and suprasellar region.
  5. Illustrate the various options for skull base surgery including tumors of the anterior fossa, middle fossa and posterior fossa.’
  6. Describe the risk factors for and techniques used to treat CSF leaks.
  7. Describe the common genetic mutations associated with gliomas and how they relate to treatment and prognosis.
  8. Describe the relative risk of morbidity and mortality for low-grade and anaplastic gliomas.
  9. Describe the significant factors that influence the risk of transformation from a low-grade to a high-grade glioma.
  10. Understand the appropriate role of arteriography, endovascular embolization and carotid occlusion in the management of brain tumors.
  11. Demonstrate competency in educating junior and senior residents about surgical treatment of brain tumors.
  12. Demonstrate competency in communicating with brain tumor patients and their families.

Performance Objectives

  1. Demonstrate the capability to function independently in all aspects of brain tumor surgery, including supratentorial and infratentorial, intra-axial and extra-axial tumors.
  2. Demonstrate knowledge of how normal anatomical structures are displaced by tumors and how this impacts on surgical treatment.
  3. Carry out complex treatment plans for complicated brain tumor patients, including an understanding of contingency options when surgical problems arise.
  4. Demonstrate competency as first assistant in resection of skull base tumors.
  5. Establish management strategies that provide compassionate but efficient care for brain tumor patients.
  6. Show the ability to teach junior residents appropriate surgical techniques.
  7. Demonstrate appropriate postoperative care of brain tumor patients including the appropriate use of consultation from Radiation Oncology and Medical Oncology.
  8. Communicate effectively regarding treatment and anticipated outcome with patients and their families including end of life care.
  9. Interact with other physicians and residents in a professional manner.