Endovascular Fellowship
The fellowship in cerebrovascular intervention and surgery is designed as a 24-month fellowship according to the guidelines for endovascular neurosurgery advanced by the ACGME and for cerebrovascular surgery by the Senior Neurosurgical Society. Twelve months will be dedicated to the fulfillment of prerequisite training that will be customized to the individual fellow’s needs in preparation for the performance of endovascular interventions and cerebrovascular surgery. The requirements include developing competence in the performance of diagnostic cerebral angiography, management of neurosurgical patients in the critical care unit, and high level of understanding of radiation physics and safety as well as cerebrovascular and skull base anatomy as pertains to surgical approaches. The second 12 months are dedicated to the management of all patients with cerebrovascular disease on the cerebrovascular service, their preoperative evaluation, procedure execution, and postoperative management.

Educational Goals

1. Develop expertise in the diagnosis, evaluation, and critical care management of patients with vascular disorders of the brain and spinal cord.
2. Understand the indications and appropriate use of endovascular, surgical, and medical management techniques for patients with vascular disorders of the brain and spinal cord.
   
3. Gain a high level of knowledge in the pathophysiology of cerebrovascular and spinal vascular disorders.
   
4. Develop technical expertise in the performance of endovascular and open surgical neurosurgical procedures.
   
5. Participate in clinical and / or laboratory research projects to investigate the pathophysiology and / or treatment of cerebrovascular disorders.
   
6. The Fellow will gain knowledge and understanding of the collaborative interaction between neuroradiologists, neurologists, and neurosurgeons (this constitutes the Stroke Team established at the University of Cincinnati).

Duties and Responsibilities
Throughout the fellowship, each fellow is expected to participate in all didactic teaching sessions including morbidity & mortality conference, journal club, professors’ hour, grand rounds, and cerebrovascular multidisciplinary conference. Clinical and academic activities will be customized to the needs of the fellow, but will follow the general guidelines listed below. The expected daily responsibilities are outlined in the attached table and are described in detail below.

 

Curriculum

 

Prerequisite Training

1. Catheter Technique: The ESNR fellow will begin training by gaining experience in diagnostic cerebral angiography and basic catheter techniques. This will be available thru the performance of diagnostic procedures in the neuroangiography suite. Primary experience will be based at Good Samaritan Hospital where the fellow will participate in diagnostic cerebral and spinal angiograms and assist in endovascular neurosurgery procedures. Additional technical training will be available thru the use of anatomical flow models where the fellow will sharpen his or her skills in catheter manipulation and hygiene. Additional experience will be available at the University Hospital where the fellow may participate in cases not covered by the diagnostic neuroradiology or senior endovascular neurosurgery fellow. During this time, the fellow is expected to perform at least 100 diagnostic cerebral angiograms.
2. Surgical Technique: On designated days, or on days without adequate endovascular or research opportunities, the fellow will participate as an active member of the surgical team, enabling him/her to gain the essential surgical experience to conduct these procedures efficiently and effectively.
3. Neurocritical Care: The fellow will be expected to make clinical rounds on all patients in the Neurosurgical Intensive Care Unit at Good Samaritan Hospital on a daily basis, participating in their critical care with the neurosurgery residents. When not participating in endovascular procedures, the fellow will participate in the routine daily management of all NSICU patients including medical management with critical care staff and performance of central venous catheter placement, intraventricular catheter placement, and critical care monitoring.
4. Radiation Physics: The fellow will participate in didactic teaching regarding the generation, use, and shielding of x-rays for medical use. This training will continue throughout the fellow’s first 6-9 months of training and will culminate in taking the radiation safety exam for University Hospital (Minimizing Risks from Fluoroscopic X-rays: Bioeffects, Instrumentation, and Examination). The fellow will be expected to pass this test prior to participation in endovascular procedures at the level of a senior fellow.
5. Basic Research: The fellow is encouraged to participate in, or design and execute, a basic research project pertinent to the field of endovascular neurosurgery or cerebrovascular disease. This may take place under the guidance of faculty in the Departments of Neurosurgery, Neuroradiology, Neurology, or Biomedical Engineering.

Senior Fellowship

The senior fellow is expected to manage the cerebrovascular service, based primarily at the University Hospital, and to perform endovascular interventions and surgical procedures under the direct supervision of the attending physician. The fellow will make rounds on all inpatients on the cerebrovascular service, assess patients in consultation prior to management, and to direct their postoperative management. All evaluations, management decisions and treatment plans will be discussed with the attending physician. In addition, the fellow may participate in and perform endovascular interventions and surgery at Good Samaritan Hospital and participate in the instruction of the junior fellow in prerequisite training. While case assignment will remain flexible, the fellow’s primary responsibility will alternate between surgical and endovascular coverage as described in the table below.

 

The senior fellow is an integral part of the neurosurgery service at the University Hospital. As such, the fellow will participate in conjunction with the Chief Resident as one of the two organizers/supervisors of the daily operation of the clinical cerebrovascular service reporting directly to faculty responsible for the service. The fellow will also be placed in charge of the neurosurgical service one weekend a month as coverage for the chief resident.

 

During this year, the fellow is expected to participate in academic endeavors as well. The fellow is expected to design and complete at least two clinical studies during this year and to oversee their completion to the point of submission for publication. In addition, the fellow will participate in teaching activities to include any and all courses delivered by the Department in the field of endovascular and cerebrovascular neurosurgery and to participate in the training of neurosurgery residents and diagnostic neuroradiology fellows.

 

Evaluation Process
The fellow’s performance will be reviewed formally every 6 months by the faculty participating in his or her training. The fellowship directors will review private, written evaluations from each faculty member. The fellowship directors will then provide a verbal report and evaluation to the fellow in a timely fashion.

 

Teaching Staff
Andrew J. Ringer, MD, Director, Endovascular Neurosurgery
Mario Zuccarello, MD, Director, Cerebrovascular Surgery
Todd Abruzzo, MD, Director, Endovascular Research
Tom Tomsick, MD, Director, Neuroradiology
Jeffrey T. Keller, PhD, Director, Division of Education

University of Cincinnati College of Medicine
Department of Neurosurgery
231 Albert Sabin Way
PO Box 670515

phone 513-558-5387
fax 513-558-4878

 

email: pschwab@mayfieldclinic.com

 

Director: Andrew Ringer, MD
Alternate Program Contact: Jeffrey T. Keller, PhD

Endovascular Fellows

2006 Topher Nichols, MD
2007 Shah-Naz Khan, MD

To apply for any of our fellowships, please complete the application and forward it along with a current CV and 3 letters of recommendation to:

Penny Schwab
University of Cincinnati College of Medicine
Department of Neurosurgery
231 Albert Sabin Way
PO Box 670515
Cincinnati, Ohio 45267-0515

Phone: (513)558-3903
FAX: (513)558-4878
E-mail: pschwab@mayfieldclinic.com