Surgical Fellowships at Yale
An enfolded fellowship in endovascular neurosurgery is available through the Neurovascular Section. Opportunities for further developing cerebrovascular and skull base microsurgical skills is also available through operative experience, as well as the Cerebrovascular/Skull Base microsurgical dissection laboratory through the Neurovascular Section.
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The epilepsy surgery program offers a flexible experience in the diagnostic and therapeutic approaches to medically intractable seizures. A single position for six months to one year is available either following completion of neurosurgical training or enfolded within the residency. A Yale-New Haven Hospital resident may elect to concentrate within this specialty for six months to one year and, if choosing this path, may combine clinical experience with ongoing research related to epilepsy.
For individuals choosing the one-year course, either during or following neurosurgery training, the year begins in July and the first three months are spent in Neurology. Here the fellow works with the medical epileptologists attending outpatient clinics, evaluating patients for the surgical program, learning about the appropriate selection of anticonvulsants, and studying both scalp and intracranial electroencephalography. The surgical fellow rotates with the neurology fellows supervising the audiovisual monitoring (AVEEG) of Phase-1 patients (24-hour scalp monitoring selection for surgical candidacy) and caring for the patients undergoing chronic intracranial study (Phase 3). The fellow is supervised in the AVEEG monitoring suite by an epileptology faculty and is then responsible for presenting these patients at the weekly Monday epilepsy surgery conference. The next nine months are then spent in the surgical arm of the program where they take part in both diagnostic and therapeutic surgical procedures. There is a close interaction with the other residents who also take part in the surgical procedures assuming the role of assistant or primary surgeon, depending on year of training and ability. The fellow is expected to carry out at least one clinical research project during this year, attend twice weekly clinics, present at monthly Journal Club, and at the end of the year prepare an abstract for the yearly meeting of the American Epilepsy Society.
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The Yale University Spine Instructorship is a structured advanced training for complex spinal surgeries including spinal deformity, tumors, and trauma. Fellows are expected to participate in 350-400 cases per year, with a large portion in an independent manner.
While under the mentorship of the Spine Faculty, the Clinical Instructor follow the same rules related to other faculty appointments with respect to time off and benefits. The fellows are assigned call days for Spine and general Neurosurgery coverage, but will always take call with a Spine faculty in order to facilitate mentorship and education of complex cases which come in on call.
The Instructors function as independent attending surgeons working with, educating, and overseeing the residents on the service. In addition to clinical care and research, we expect the Spine instructors to develop strong teaching and organizational skills necessary to participate in an academic career. The Instructor will work closely with the residents on the Spine service to coordinate patient care along with instructing the residents and nurse practitioners in patient management and operative techniques. They will have an independent outpatient clinic concurrent with one of the spine faculty members, who is always available to help provide advice and guidance as needed.
The Instructors are expected to attend and participate in a weekly Neurosurgery Grand Rounds, weekly journal club if the topic is spine related, and coordinate a monthly combined Spine Conference with Orthopedics and Neurosurgery. The Instructors are required to have at least one research project and present a paper or abstract at a spring Neurosurgery or Spine meeting.
The Spine Instructor is directly mentored by one of the Spine Faculty, including in the OR when one of the Spine Faculty will be their assistant in surgery, along with outpatient clinics where there will be a Spine Faculty holding a concurrent clinic and available to help review and see any patients with complex issues. The Instructor also chooses a research mentor to help guide and foster their academic work. Dr. Luis Kolb, as the Director of the Complex Spine Instructorship will, have an informal monthly breakfast meeting with the Instructors and the Residents on the Spine service to discuss the state of the Service. In addition, the Complex Spine Instructorship Director will have formal quarterly meetings with the Fellows to ensure that they are meeting their goals, reviewing:
- Patient Care/Clinical Activity
- Professional Services/Activities in Field.
As noted on the Supervision area, the Spine Instructor is evaluated directly by the Spine Faculty on a daily basis when they work together, including in the OR and clinic. The Instructor is also evaluated by their research mentor based on their academic goals. There is an informal evaluation at a monthly breakfast meeting with the Fellow and the Residents on the Spine service, along with a formal quarterly meeting with the Instructorship and Spine Directors to review their performance goals in 5 main areas.
Resident education and training is a core component of our Academic mission, and the Spine Instructorship is only being offered as it will not impact resident training and allow educational benefit for the complex spine cases. As the Instructors function as attending surgeons working with, educating, and overseeing the residents on the service, they do not detract from resident training but provide more surgical cases and educational opportunities for them. In addition, primary coordination of the inpatient service and case assignments are under the auspice of the Chief Resident, which also ensures the residents are able to have the experience and oversight of the cases needed for their core training.
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Gamma Knife Stereotactic Radiosurgery
Historically, the field of stereotactic radiosurgery (SRS) was established by neurosurgeon Lars Leksell in the 1950’s as an adjunct to the treatment of deep brain lesions otherwise not accessible to more conventional neurosurgery. Since its inception, its application has evolved from its initial role in functional lesion generation to include the treatment of a variety of benign neoplastic or vascular lesions such as AVMs, meningiomas and vestibular schwannomas. Since the mid 1990s, however, SRS has additionally achieved a prominent role in the management of both brain and spinal malignant tumors.
With the exponential growth of brain and spine metastases as the single most common indication for SRS today, the relative roles of the radiation oncologist, medical physicist, and neurosurgeon have changed considerably. In addition, current spine and body radiosurgery require increasing knowledge of complex linear accelerator (LINAC)-based technologies that are not included in the training of most neurological surgeons. To date, radiosurgical treatment has achieved widespread success based on careful joint patient selection, optimal treatment planning, and accurate dose delivery based on direct participation by a trained and responsible neurosurgeon working closely in conjunction with a radiation oncologist well versed in the single fraction dosing of radiation. Despite the rapid growth in the availability of radiosurgical-capable technology, however, current US neurosurgery and radiation oncology residents participate in the delivery of less than 5% of radiosurgical procedures. It is also recognized that there is significant variability in the availability of SRS training opportunities across residencies.
This fellowship began in 2011. It is being offered to radiation oncology and neurosurgery residents as comprehensive clinical training specifically in the area of radiosurgery and offers additional clinical research opportunities. For the radiation oncology resident, the fellowship is of 12 months duration and covers radiosurgical management of both body and brain conditions. For the neurosurgery resident, the fellowship can be of 3-6 month duration and would be predominantly based on training in the Gamma Knife treatment of intracranial pathologies.
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Now accepting applications for 2024-2025 and 2025-2026
The Yale Department of Neurosurgery and the Yale Brain Tumor Center at Smilow Cancer Hospital are recognized for the neurosurgical treatment of all types of brain tumors. We are proud to be the highest volume brain tumor surgical program in the state of Connecticut and we treat patients from throughout New England and beyond. As such, the cases we manage are frequently complex, often referred by other neurosurgeons in the region, rendering a breadth of pathology and challenging clinical experience. Coupled with well-established and unparalleled scientific opportunities that only an institution such as Yale can offer, our fellowship provides a unique and invaluable opportunity for any aspiring neurosurgical oncologist.
The fellowship encompasses a one-year commitment, primarily on the clinical service, but also with the option for participation in clinical and translational scientific research endeavors throughout the year.
For more information, or to apply, please email Jennifer Moliterno. In general, we accept applications and interview candidates a minimum of 2 years prior to the start of the fellowship.
One year of clinical neurosurgical oncology, with an emphasis on clinical and translational research to provide a well-rounded, academic experience. The clinical component includes extensive experience in the microsurgical treatment of benign and malignant brain (i.e., gliomas) and skull base (i.e., meningiomas, acoustic neuromas) tumors and spine tumors, while working alongside fellowship-trained, board-certified neurosurgical oncologists. The broad spectrum of oncologic disease, primarily involving the brain (as opposed to the spine) in adult patients, provides for a unique training experience, promoting a thorough understanding of neuro-oncology. Fellows work closely with colleagues in Neuro-Oncology, Radiation Oncology, Neuropathology, Neuroradiology, as well as Plastics and Reconstructive Surgery, Head and Neck Surgery, Neuro-Otology, and Oculoplastics Surgery and Ophthalmology. Technical training in challenging open procedures is routine, including minimally invasive and endoscopic surgery for the management of skull base tumors.
All surgeries are performed in our state-of-the-art operating rooms in the Smilow Cancer Hospital with 3T intraoperative MRI, ultrasound, and hybrid angiography capabilities. Patients are managed post-operatively in Yale New Haven Hospital, with two dedicated Neuroscience Intensive Care Units, 24/7 coverage by intensivists, and advanced practice provider (APP) support. Fellows, in addition to resident staff, are responsible for preoperative and postoperative patient care, and participate in outpatient clinics and performing hospital consultations. Call requirements include two at-home call weekends per month, and sporadic weeknight home call.
When not operating, fellows are expected to attend in-person clinics, and interact with office staff (i.e., nurses, APPs) to facilitate outpatient care for patients and their families. Broad exposure to the clinical evaluation and appropriate patient selection for operative and non-operative management is provided in both the inpatient and outpatient settings. Progressive responsibility in patient management is provided. In addition, fellows are expected to regularly participate in conferences (see below), interact favorably with resident staff, assist in teaching, and conduct scholarly work. At least one productive research project leading to an abstract and publication submission is expected during the fellowship year, with more projects strongly encouraged. Research resources include access to annotated databases, sequencing data, study research assistants, and biostatisticians.
Core Curriculum and Conferences
Designed within our multidisciplinary Chenevert Family Brain Tumor Center to provide education and training necessary for the practice of neurosurgical oncology, it is expected the fellow attend and participate in a variety of conferences including the weekly Brain Tumor Board and Precision Brain Tumor Board, Metastatic Tumor Board, and Skull base/Pituitary meetings. Departmental educational activities such as Neurosurgery Grand rounds and M&M conferences, journal clubs, and didactic presentations should be attended when feasible.
Responsibility and/or independence given in patient care is dependent upon demonstrated knowledge, manual skills, experience in complexity of illnesses, perceived risks of surgical management, and the fellow’s professionalism and ability to work within a team.
Neurosurgical Oncology Core Curriculum:
- Knowledge of the principles of management of benign and malignant CNS tumors
- Treatment expertise in primary CNS tumors including surgery, radiosurgery, radiotherapy, chemotherapy, medical therapy, and neuro-oncologic investigational agents
- Expertise in treating cancer-related neurologic complications including encephalopathy (toxic, nutritional, metabolic), CNS/systemic infections, cerebrovascular disease, seizures, increased intracranial pressure, hydrocephalus, DVTs, etc.
- Evaluation and basic medical care for neuro-oncologic complications of cancer disorders, including toxic effects of surgery, chemotherapy, radiation etc.; use of approved blood products and growth factor support, supportive and end-of-life care, pain management
- Overall management in neuro-oncology patients, including interdisciplinary management of neuro-oncology patients, indication for referrals to medical oncology, neurosurgery, radiation oncology, neuroradiology, neuropathology, pain management, rehabilitation, palliative care
- Possible involvement in clinical trial design or participation in existing clinical trials
- Help write reviews and book chapters on topics in Neuro Oncology