Residency Training in Neurosurgery - Research

Neurosurgery Residents see also http://neurocare.neurosurgery.mgh.harvard.edu
E-Mail: Khalid Abbed, M., M.D. Manish Aghi, M.D. Ramin Amirnovin, M.D. Daniel Cahill Clark Chen William Curry, M.D. Brian Hoh, M.D. Ekkehard Kasper, M.D. Joseph Neimat, M.D. Ziv Williams, M.D.	Web Page:
MGH Neurosurgery Alumni Homepage

GENERAL DESCRIPTION

The length of the Training Program is six or six-and-a-half years. This consists of five years of required residency with an additional 12-18 months of expanded training. There are 36 months of clinical neurological surgery. The five years of Residency Training consist of seven six-month clinical rotations and 18 months of laboratory research. The mandatory research period occurs as a single time block between the Senior clinical rotations. Following the year of Chief Residency, each trainee has an additional six months of the expanded clinical training as Assistant in Neurosurgery at the MGH. In addition there are 6-12 months of expanded training in laboratory research This expanded period of research occurs either just prior to the trainee's first clinical rotation or in conjunction with the required research block. The trainee has no clinical responsibilities during the research period.

Residency applications are processed solely through the Neurological Surgery Matching Program. Applicants must be graduates of a medical school accredited by The American Association of Medical Colleges. Two candidates are typically selected. The Residency in Neurosurgery at MGH follows a uniform pattern of six years of increasing responsibility beginning after a one year surgical internship. Entering residents are strongly encouraged to complete their PGY-1 surgical training at the Massachusetts General Hospital and separate application is required through the Department of Surgery. Both trainees begin their neurosurgical training on July 1. One of the trainees immediately enters the first clinical rotation; the other initially pursues a period of laboratory based research prior to their first clinical work.

The sequence of rotations is designed to provide the trainee with clinical experience of graded and increasing complexity with responsibilities commensurate with their level of training. In addition to their responsibilities for in-patient and Emergency Ward care, all residents on clinical rotations participate in the Neurosurgical Outpatient Clinic one day a week. With the exception of a three-month rotation at Boston Children's Hospital at the Junior Resident level, all clinical assignments are at MGH. The trainees follow the fixed sequence of rotations described below and finish the program at six month intervals in either June or December, following their year of Chief Residency.

For purposes of coordinating Neurosurgical Service activities Visiting Staff members are assigned to a clinical team (East or West). The order of trainee assignments is such that he/she rotates through all Service teams, thus coming under the supervision of all members of the Visiting Staff. In the final six months of the Chief Resident year, the trainee is directly supervised by the Chief of Service, Dr. Martuza. Thereafter, the graduating Resident completes his/her six months or more of extended clinical training with a Staff appointment at the parent institution. During that period, he/she is responsible for the clinical activities of the North neurosurgical team.

The trainee has no clinical responsibilities during the research period. For more information, see: residents.neurosurgery.mgh.harvard.edu

MAJOR RESEARCH PROJECTS

Trainees within the Neurosurgical Service have access to any of the laboratories within the Harvard University System. These include all of the major current areas of research in neurobiology, as well as cell and molecular biology.

Within the Department of Neurosurgery itself, the research activities can be grouped in 5 major areas:

Cerebral Blood Vessels

Blood vessels are being studied from several perspectives. A major research program concerns the biology of cerebral stroke. Research in this area includes studies on imaging of cerebral blood flow with a variety of
modern imaging techniques. A basic laboratory program studies in vitro systems toward the goal of learning what might protect nervous tissue from interruptions of its supply of glucose and oxygen. Neuroprotective agents such as cooling and neurotransmitter antagonists are currently under study. In addition, laboratory studies aimed at extending the in vitro studies to the in vivo situation are carried out. Commonly ischemia is caused in a neural region, and agents that might reduce the severity of the infarct are tested. These studies have led to introduction of certain therapeutic maneuvers in the operating room, notably mild cooling in patients whose cerebral circulation must be interrupted for surgical reasons.

A major research area concerns the biology of headache. In the laboratory, the innervation of the blood vessels has been intensively studied. The sequence of events attending migraine have been delineated
using extravasation of tracers as a marker. A new series of anti-migraine drugs is being developed and tested both in vitro and in vivo.

A major laboratory studies cerebral vasospasm. In the laboratory, isolated dog arteries are perfused in vitro and the factors that constrict and relax them are studied. In vivo, vasospasm may be experimentally induced in dogs by subarachnoid injection of blood. This provides a model in which to test potential maneuvers aimed at reducing the spasm. Recently, a major collaboration with the MGH Laser Laboratories has resulted in a potential new therapeutic invention. High intensity laser pulses are applied at the site of spasm. In dogs, these succeed in relaxing the vessel. Phase 1 trials of this intervention are being planned.

Neural Growth and Regeneration

A major long-term goal for Neurosurgery is the restoration of damage of function that has been lost due to damage to the nervous system. Two research areas aim toward that goal.

Work carried out in collaboration with the Department of Neurology involves the attempt to implant cultured neurons into the brains of animals following experimentally induced brain damage. The basal ganglia are the
focus of this work and dopamine-releasing neurons are being implanted into the brain following experimental lesions of the dopamine-containing brain neurons. Similar strategies can be applied to other brain models.

On the more fundamental level, we are trying to learn the factors that promote the growth of neurons. This is being carried out using cultured cells. A new factor released by immortalized cultured glia has been discovered. It promotes a neurite outgrowth from a variety of projection neurons. Current studies are aimed at identifying and cloning the factor.

Brain Tumors

The natural history of brain tumors is being studied in collaboration with the Department of Pathology. This work focuses on the mutation or series of mutations that occur in glioblastomas. This work concentrates on the
use of PPCR methodologies to amplify the DNA of biopsy specimens and of archival neuropathology slides. The latter are particularly useful since the outcome is known. A series of mutations have been found to occur in
naturally occurring brain tumors. Many tumors have a mutation of the p53 gene. Another common mutation is amplification of the EGFR (epidermal growth factor receptor) gene.

A second area of brain tumor research is the use of retroviral therapy against glioblastomas. The goal is to use retroviruses to introduce into the tumors genes that would either kill the tumor cells, later their pattern of growth, or sensitize them to chemotherapeutic agents. One such trial involves the introduction of a gene for thymidine kinase. A number of analogous manipulations are being tested both vitro and in rats.

Intraoperative Monitoring and Imaging

A major area of clinical research concerns surgery for epilepsy. Candidates for epilepsy surgery are intensively studied by electrophysiological and imaging techniques. Electrophysiologically, implanted electrodes are used to monitor seizure activity in awake patients. PET imaging is used to localize motor and language areas. New technology allows superimposition of the PET images with MRI scans, providing sharply defined landmarks during surgery. A further area of exploration is the use of virtual imaging in the operating room.

Cellular Neurobiology

Within the Department of Neurosurgery there are also laboratories of fundamental neurobiology. These are concerned with various aspects of neuroanatomy and neurophysiology.

One area of focus is the cell biology of the retina. The retina is used as a model system for studies of how small neural networks operate computationally upon their inputs. This laboratory uses anatomical methods and combined anatomy/physiology studies of in vitro retinas.

Another area of research concerns the biology of membrane proteins, particularly the Na,K-ATPase. These studies are aimed at understanding the heterogeneity of the Na,K-ATPases in the brain and their regulation.

Neurosurgery Clinical Units MGH Neurosurgical Service Spine Tumor Center at MGH Brain Tumor Center at MGH Research at MGH Neurosurgery Neuroscience Care Units at MGH Residents at Neurosurgery