Pediatric Neurosurgery Curriculum

Pediatric Neurosurgery is an integral part of all clinical rotations at Yale with the senior resident having the most prominent role in this area.  Pediatric cases account for approximately 20% of the operative case volume of the Department and more than 30% of the inpatient service.  While Dr. Duncan is the Chief of Pediatric Neurosurgery, a considerable number of the Epilepsy cases are in children.  When Dr. Duncan is away the General Neursurgery Attending covers Pediatrics according to the Call Schedule.  Katie Hagenow, APRN is the P.A.-C for Pediatrics. 

The three irreverent rules for pediatrics are: the mother is always right, it’s always the shunt (Itzak’s Rule), you’re better off learning how to talk to pediatricians than memorizing Harriet Lane, and if you or I annoy a pediatrician we’ll all pay for it for three months.

Junior Residents

The goals for junior residents are, learn to take appropriate histories with emphasis on development and recognition of the critical role of mechanism of injury whenever non-accidental injury is potential, learn age appropriate interactions with children including establishing rapport, history, expected skills across development, and examinations, learn the necessity for close monitoring and reevaluation in the infant or child with a central nervous system disorder, begin to understand the differences in physiology across age groups in the young and the influence of neurosurgical interventions on them, begin to understand the spectrum of central nervous system diseases and disorders in the young which are extensive and complex begin to master an approach to frequently presenting problems including hydrocephalus, trauma, IVH in the premature infant, raised intracranial problems, congenital spinal anomalies, craniosynostosis, develop and understanding of the laboratory studies required to evaluate infants an children develop an understanding of the diagnostic imaging for them as well. learn to tell and write a clear, succinct summary for consults, inpatients and progress, engage the pediatricians in the care of our pediatric patients – you will both learn a great deal, look at everything yourself, do your own examinations, our system works  lot better if we don’t propagate each other’s errors report anything to the attending without delay – believe it or not – attendings can be helpful and contribute to your education and even occasionally make a difference in care, and, enjoy the kids – they’re nice people.

Finally, you need to have a clear goal to write and publish; not just in pediatrics but pediatrics provides an excellent forum to consider.  Many of the cases you see will be sufficiently unusual to merit reporting and our colleagues in neuroradiology, neuropathology, neuro-oncology, pediatrics, plastics and pediatric surgery are delighted to help.  Additionally, trauma has one of the finest longitudinal databases in the institution.

Senior Residents

The goal for Senior Residents is quite simply to run the pediatric service.  In order to do this along with Chief Resident coverage, other case assignments, teaching, managing NICU patients – all within 88 hours – requires a great deal of knowledge, thoughtful efficiency, and help.

Some of the Senior Resident responsibilities include:

Attending clinic and evaluate children with history/physical exam.  Review imaging and formulate a plan with Dr. Duncan.

Review pediatric neurosurgery consults with Junior residents and assess children where appropriate.

Daily rounds in Newborn Special Care Unit, Pediatric ICU and pediatric wards.  Interact with nurses, pediatricians, pediatric intensivists and surgeons regarding patients.  Each patient discussed with Dr. Duncan at least once daily.

Review patients to be presented at monthly Morbidity and Mortality conference.

Increasing responsibility in surgery for pediatric patients including preoperative assessment, positioning, exposure, operation, closure for following procedures:

  1. CSF diversion – VP, VA, ventriculopleural, shunts etc.
  2. Cranioplasty for craniosynostosis
  3. Craniotomy for trauma including skull fractures, epidural and subdural hematoma, intracerebral hemorrhage
  4. Closure of myelomeningocele
  5. Surgical management of lipomeningocele, tethered cord, Dandy Walker malformation, arachnoid cysts
  6. Suboccipital craniotomy for Chiari Malformations and associated syrinx
  7. Craniotomy for posterior fossa  and supratentorial tumor
  8. Endoscopic surgery including endoscopic third ventriculostomy, fenestration, cyst resection
  9. Closed and open reduction of atlantoaxial rotatory subluxation and cervical subluxation
  10.  Halo application
  11.  Surgical management of cervical, thoracic and lumbar spine fractures