Tumul Chowdhury, MD, DM, FRCPC
Eugenia Ayrian, MD, FASA
Marie-Angele Theard, MD
Suneeta Gollapudy, MD
Rashmi Vandse, MD
Alexander Papangelou, MD
Kamilla Esfahani, MD
Lauren K. Dunn, MD, PhD
Arnoley S. Abcejo, MD
L. Jane Easdown, MD, MHPE
Advanced Rotation Schedule
Goals & Objectives and Milestones
In 2005, SNACC leadership created a task force to author rotation goals and objectives for the basic and advanced neuroanesthesia resident rotation. Rotation milestones were also drafted and published in JNA in 2019. Residents in their second month of neuroanesthesiology are expected to achieve a minimum of level 4 proficiency in the various milestones. These documents may be used to guide resident rotation development by program and rotation directors. They are attached here for reference..
Advanced Neuroanesthesiology Rotation Goals and Objectives
Neuroanesthesiology Milestones
How to Use This Document
“Neuroanesthesia Classroom” links key rotation topics to resources on the SNACC website. Resources may be in many forms, including problem-based-learning discussions (PBLDs), neuroanesthesia quizzes, expert podcasts, interactive clinical cases and topic specific peer-reviewed articles. The manuscripts were chosen from a library of the most impactful papers in the subspecialty, which have been archived by members of the society.
These resources are not exhaustive, but serve as a stepping stone for further discussion and knowledge acquisition. These materials can be used to supplement and facilitate learning, but are not intended to replace a formal curriculum. SNACC strives to be a resource for both educators and learners.
Content Outline
Clinical Focus: Open Neuro Vascular procedures
Monitoring Focus: ICP monitoring, EVD, Transcranial Doppler
Critical Events: Aneurysmal Rebleeding, Vasospasm, Neurogenic Stress Cardiomyopathy
1. Intracranial open neurovascular procedures
a. Cerebral Aneurysms: elective and emergent
b. AVM resection
c. Surgical revascularization for Moya Moya Disease (MMD)
i. Direct bypass procedures – STA-MCA
ii. Indirect bypass procedures
1. Encephaloduroarteriosyngiosis (EDAS)
2. Encephalomyosynangiosis (EMS)
3. Encephalomyoarteriosynangiosis (EMAS)
4. Temporoparietal facial flap (TPFF)– in pediatric MMD
- Subarachnoid Hemorrhage
- Carotid endarterectomy
Clinical Focus: Complex spine, Awake Craniotomy
Monitoring Focus: SSEP, MEP, EMG
Critical Events: Massive transfusion, TXA, Visual loss
1. Spine AVF and AVM resection
2. Complex spine surgery
3. Spinal tumor resection
a. Neuromonitoring
b. Anesthetic technique/TIVA
4. Multimodal analgesia for spine surgery
5. Awake craniotomy-
a. Scalp blocks
b. Anesthetic Techniques
c. Airway management
d. Intraoperative seizure prevention and management
Clinical Focus: Remote Interventional Neuroanesthesia
Monitoring Focus: EEG, ECog, Processed EEG, Cerebral Oximetry
Critical Events: Seizure, Cerebral Ischemia, Aneurysmal rupture during coiling
1. Intraoperative EEG/qEEG
2. Cerebral oximetry
3. Interventional Neurosurgery
a. Coiling Cerebral Aneurysms
b. AVM embolization
c. Carotid Stenting
d. Stroke thrombectomy
Clinical Focus: Epilepsy Surgery, Posterior fossa surgery including cranial nerve decompression, Advanced Neurosurgical positioning, Transsphenoidal Surgery.
Monitoring Focus: Precordial Doppler
Critical Events: Air Embolism, Difficult Airway
1. Epilepsy surgery
a. ECOG
b. Rosa/depth electrode placement
c. Vagal Nerve Stimulator (VNS)
2. Posterior fossa surgery including cranial nerve decompression, Arnold Chiari malformation.
3. Complex Neurosurgical Positioning
a. Sitting Craniotomy ( venous air embolism).
b. Parkbench (3/4 prone) Craniotomy
4. Transsphenoidal pituitary resection
a. Acromegaly
b. Cushing’s Disease