Neuropathology Rotation (AP-1 and AP-2)
- Dr. Alexander Vortmeyer
- Dr. Anita Huttner
Training in neuropathology includes both surgical and autopsy neuropathology. During surgical neuropathology training, the neuropathology resident has the opportunity to see many interesting and unusual in-house neurosurgical cases. In addition, the neuropathology faculty receives numerous extramural consultation cases, which are often diagnostically challenging and highly educational. The neuropathology resident receives training in the special handling of certain neurosurgical cases, including the peripheral nerve and skeletal muscle.
Autopsy neuropathology is learned at the weekly "Brain Cutting" gross conference, where the resident describes the gross findings of postmortem brains and takes sections of the brain for histological evaluation. The neuropathology resident learns the normal CNS histology as well as pathological changes in various neurological disorders when he/she signs out postmortem cases.
The neuropathology resident is responsible for cases for conferences, particularly the Neuro-oncology Tumor Board and neurosurgical morbidity and mortality conferences. For the neurosurgical M&M conference, the neuropathology resident prepares a PowerPoint presentation with photomicrographs.
Handling of specimens for neuropathology is not, in general, different from those for other subspecialties. However, there are some specimens (peripheral nerve, skeletal muscle) that need to be treated differently. Details of these specimens are described in the Grossing Manual, and the resident is expected to be familiar with the special handling these specimens require.
When a case is presented at the brain cutting conference, the Neuropathology resident will be responsible for the gross description of the brain, trimming tissue blocks and logging them into the computer, and bringing the tissue blocks to histology. He/she will signout the cases with one of the neuropathology attendings, and shall complete the report on the brain. For brain only cases, the neuropathology resident is also responsible for FAD and CPC.
Additional Resident Duties and Responsibilities
- Prepare PowerPoint presentations for cases at neurosurgery morbidity and mortality conference
- Cut in and evaluate brains from the autopsy service; review these at neuropathology signout and prepare neuropathology addendums for the autopsy reports
- For "Brain Only" autopsies, the neuropathology resident is the primary prosector. This means he/she is responsible for the entire autopsy report, including the FAD and CPC.
Additional Goals and Objectives for the Neuropathology Rotation
- Understand uniqueness of neuropathological evaluation in CNS disorders that are often serious in nature.
- Determine what types of cases need appropriate history or other laboratory data, including imaging, and be able to acquire information from charts, clinicians, or other related personnel before signing out cases with an attending.
- Be able to technically handle different types of tissue (muscle, nerve, CNS and PNS, for example) proficiently so that there may be no delay in rendering appropriate patient care based on the final findings of the specimen.
- Demonstrate appropriate knowledge of normal anatomy, histology and biology of the nervous system, and skeletal muscle.
- Understand the basic principle behind routine and immunohistochemical stains that are commonly used in neuropathology.
- Be able to describe succinctly and accurately the postmortem brain grossly and microscopically.
- Be able to render clinicopathological correlation on postmortem brains.
- Be able to prepare the muscle and peripheral nerve for histochemistry, electron microscopy and routine histology without assistance.
- Understand the reason why various routine histochemical and enzyme histochemical stains are needed for the evaluation of the skeletal muscle.
- Develop knowledge on histological and biological differences among common brain tumors, and on the principle of histological grading, if applicable.
- Be able to describe salient neuropathological features in various neurological disorders including neurodegenerative and metabolic disorders.