CURRICULUM / STATUTES & REGULATIONS

FOR
5 YEARS DEGREE PROGRAMME
IN
NEUROSURGERY
(MS Neurosurgery)
 UNIVERSITY OF HEALTH SCIENCES,
LAHORE

STATUTES

Nomenclature Of The Proposed Course

The name of degree programme shall be MS Neurosurgery. This name is well
recognized and established for the last many decades worldwide.

Course Title:
MS Neurosurgery

Training Centers
Departments of Neurosurgery (accredited by UHS) in affiliated institutes of University
of Health Sciences Lahore.

Duration of Course
The duration of MS Neurosurgery course shall be five (5) years with structured
training in a recognized department under the guidance of an approved
supervisor.

After admission in MS Neurosurgery Programme the resident will spend first 6

Months in the relevant Department of Neurosurgery as Induction period
during which resident will get orientation about the chosen discipline and will
also participate in the mandatory workshops (Appendix E). The research
project will be designed and the synopsis be prepared during this period.
On completion of Induction period the resident will start formal training in the
Basic Principles of General Surgery for 18 Months. During thi s period the
Research Synopsis shall be got approved by AS&RB of the university. At the end
of 2nd calendar year, the candidate will take up Intermediate Examination.
During the 3rd, 4th & 5th years, of the Program, there shall be two components of
the training.
1) Clinical Training in Neurosurgery
2) Research and Thesis writing

The candidate will undergo clinical training in the discipline to achieve the
educational objectives (knowledge & Skills) alongwith rotation in relevant fields
during 4th & 5th years of the programme. The clinical training shall be
competency based. There shall be generic and specialty specfic competencies
and shall be assessed by Continues Internal Assessment. (Appendix F&G).
The Research Component and thesis writing shall be compl eted over the five
years duration of the Programme. Candidates will spend total time equivalent to
one calendar year for research during the training. Research can be done as one
block or in small periodic rotation as long as total research time is equival ent to
one calendar year.

Admission Criteria

Applications for admission to MS Training Programs of will be invited through

advertisement in print and electronic media mentioning closing date of
applications and date of Entry Examination.

Eligibility: The applicant on the last date of submission of applications for

admission must possess the:

i) Basic Medical Qualification of MBBS or equivalent medical qualification

recognized by Pakistan Medical & Dental Council.

ii) Certificate of one year's House Job experience in institutions recognized by

Pakistan Medical & Dental Council Is essential at the time of interview. The
applicant is required to submit Hope Certificate from the concerned Medical
Superintendent that the House Job shall be completed before the Interview.

iii) Valid certificate of permanent or provisional registration with Pakistan

Medical & Dental Council.
 Registration and Enrollment

 As per policy of Pakistan Medical & Dental Council the number of PG Trainees/
Students per supervisor shall be maximum 05 per annum for all PG
programmes including minor programmes (if any).
 Beds to trainee ratio at the approved teaching site shall be at least 5 beds per
trainee.
 The University will approve supervisors for MS courses.
 Candidates selected for the courses after their enrollment at the relevant
institutions shall be registered with UHS as per prescribed Registration
Regulation.

Accreditation Related Issues Of The Institution

A. Faculty
Properly qualified teaching staff in accordance with the requirements of
Pakistan Medical and Dental Council (PMDC)

B. Adequate Space
Including class-rooms (with audiovisual aids), demonstration rooms, computer lab
and clinical pathology lab etc.

C. Library
Departmental library should have latest editions of recommended books, reference
books and latest journals (National and International).

 Accreditation of Neurosurgery training program can be suspended on temporary

or permanent basis by the University, if the program does not comply with
requirements for residents training as laid out in this curriculum.
 Program should be presented to the University along with a plan for
implementation of curriculum for training of residents.
 Programs should have documentation of residents training activities and
evaluation on monthly basis.

 To ensure a uniform and standardized quality of training and availability of the

training facilities, the University reserves the right to make surprise visits of
the training program for monitoring purposes and may take appropriate action
if deemed necessary.
 AIMS AND OBJECTIVES OF THE COURSE
AIM

The aim of five years MS programme in Neurosurgery is to train residents to

acquire the competency of a specialist in the field so that they can become
good teachers, researchers and clinicians in their specialty after completion of
their training.
GENERAL OBJECTIVES
MS Neurosurgery training should enable a student to:

1. Access and apply relevant knowledge to clinical practice:

 Maintain currency of knowledge
 Apply scientific knowledge in practice
 Appropriate to patient need and context
 Critically evaluate new technology
2. Safely and effectively performs appropriate surgical procedures:
 Consistently demonstrate sound surgical skills
 Demonstrate procedural knowledge and technical skill at a level
appropriate to the level of training
 Demonstrate manual dexterity required to carry out procedures
 Adapt their skills in the context of each patient and procedure
 Maintain and acquire new skills
 Approach and carries out procedures with due attention to safety of
patient, self and others
 Critically analyze their own clinical performance for continuous
improvement
3. Design and implement effective management plans:
 Recognize the clinical features, accurately diagnose and manage
neurological problems
 Formulate a well-reasoned provisional diagnosis and management plan
based on a thorough history and examination
  Formulate a differential diagnosis based on investigative findings

 Manage patients in ways that demonstrate sensitivity to their physical,

social, cultural and psychological needs
 Recognize disorders of the nervous system and differentiate those
amenable to surgical treatment
 Effectively manage the care of patients with neurotrauma including
multiple system trauma
 Effectively recognize and manage complications
 Accurately identify the benefits, risks and mechanisms of action of
current and evolving treatment modalities
 Indicate alternatives in the process of interpreting investigations and
in decision-making
 Manage complexity and uncertainty
 Consider all issues relevant to the patient
 Identify risk
 Assess and implement a risk management plan
 Critically evaluate and integrate new technologies and techniques.
4. Organize diagnostic testing, imaging and consultation as needed:
 Select medically appropriate investigative tools and monitoring
techniques in a cost-effective and useful manner
 Appraise and interpret appropriate diagnostic imaging and
investigations according to patients' needs
 Critically evaluates the advantages and disadvantages of different
investigative modalities
5. Communicate effectively:
 Communicate appropriate information to patients (and their family)
about procedures, potentialities and risks associated with surgery in
ways that encourage their participation in informed decision making
 Communicate with the patient (and their family) the treatment
options including benefits and risks of each
 Communicate with and co-ordinate health management teams to
achieve an optimal surgical environment
 Initiate the resolution of misunderstandings or disputes

 Modify communication to accommodate cultural and linguistic

sensitivities of the patient
6. Recognize the value of knowledge and research and its application to clinical
practice:
 Assume responsibility for self-directed learning
 Critically appraise new trends in neurosurgery
 Facilitate the learning of others.
7. Appreciate ethical issues associated with Neurosurgery:
 Consistently apply ethical principles
 Identify ethical expectations that impact on medico-legal issues
 Recognize the current legal aspects of informed consent and
confidentiality
 Be accountable for the management of their patients.
8. Professionalism by:
 Employing a critically reflective approach to Neurosurgery
  Adhering with current regulations concerning workplace harassment
 Regularly carrying out self and peer reviewed audit
 Acknowledging and have insight into their own limitations
 Acknowledging and learning from mistakes

9. Work in collaboration with members of an interdisciplinary team where

appropriate:
 Collaborate with other professionals in the selection and use of various
types of treatments assessing and weighing the indications and
contraindications associated with each type
 Develop a care plan for a patient in collaboration with members of an
interdisciplinary team
 Employ a consultative approach with colleagues and other professionals
 Recognize the need to refer patients to other professionals.
10. Management and Leadership
 Effective use of resources to balance patient care and system resources
 Identify and differentiate between system resources and patient needs

 Prioritize needs and demands dealing with limited system resources.

 Manage and lead clinical teams
 Recognize the importance of different types of expertise which contribute
to the effective functioning of clinical team.
 Maintain clinically relevant and accurate contemporaneous records
11. Health advocacy:
 Promote health maintenance of patients
 Advocate for appropriate health resource allocation
 Promote health maintenance of colleagues and self scholar and teacher
 SPECIFIC LEARNING OUTCOMES

On completion of the training programme, Neurosurgery trainees including those

pursuing an academic pathway will be expected to have demonstrated competence in
all aspects of the published syllabus. The specific training component would be
targeted for establishing clearly defined standards of knowledge and skills required to
practice Neurosurgery at secondary and tertiary care level with proficiency in the
Basic and applied clinical neurosciences, Basic neurosurgical care, Neurointensive
care, Emergency (A&E) medicine and Complementary surgical disciplines.

1. Neuroanatomy:
 To have a working knowledge of the structure and development of the
central and peripheral nervous system together with the related parts of
the head and spine and associated structures of neurosurgical
importance.
2. Neurophysiology:
 To be familiar with the normal and abnormal physiology and metabolism
of the body and central nervous system.
 To be familiar with the basic principles of neuropharmacology and
 Neurochemistry with special reference to the actions, interactions and
toxic effects of drugs currently used in neurosurgery.
 To be familiar with the basic principles and interpretation of EEG, EMG
and other techniques of applied neurophysiology, particularly those used
intra-operatively and in neurointensive care.
3. Neuropathology:
 To be familiar with the pathological changes and cellular organization of
the central and peripheral nervous system during disease process.
 To have a working knowledge of the gross and microscopic pathology of
diseases affecting the nervous system.
 To recognize gross and microscopic preparations


 To be familiar with the various pathogenic organisms responsible for

infections of the nervous system
4. Neuroradiology:
 To be able to recognize and comment on abnormalities present on plain
X-Rays of the skull, spine and other regions of neurosurgical interest
and to interpret special investigations such as myelograms,
angiograms, CT and MRI scans
 To be familiar with the principles of radiobiology and radiotherapy
 To be familiar with the application of radionuclide studies to the
diagnosis of neurological disorders.

5. Neurosurgery Related Clinical Competence:

The ability to construct a differential diagnosis, interpret investigations and
construct a management plan for common conditions in practice of
neurosurgery in the following specialties:

i. Clinical Neurology:
 To be able to take a neurological history and to assess the value of different
symptom patterns in indicating involvement of specific neurological systems
and functions and/or particular disease processes
 To be able to conduct and to demonstrate a reliable clinical examination
relating to the nervous system and to elicit and interpret signs of
dysfunction of different systems and their components
 To be able to arrive at a well reasoned diagnosis and to recognize the
common neurological disorders and differentiate those amenable to surgical
treatment
 To be conversant with all common neurosurgical disorders
 To be able to describe in detail and to discuss the choice of the appropriate
conventional neurosurgical procedures available
 To be conversant with safety in the operating theatre, the use of
instruments and infection control procedures
 To demonstrate competence in all aspects of the care of the patient during
diagnostic tests, at operations, in the postoperative period and

during rehabilitation
 To be familiar with the principles of psychiatry, neuro-psychology, neuro-
opthalmology, neuro-otology and neuro-anaesthesia
 To be able to demonstrate those attitudes that reflect awareness of, and
respect for, individuality and autonomy of patients and careers at all stages
of management, including counseling and providing explanations of the
nature of disease and potential methods of treatment
ii. Paediatric Neurosurgery:
The resident shall be proficient in the management of developmental disorders
of the neuraxis including craniofacial anomalies and spinal dysraphism; all
forms of hydrocephalus; intrinsic tumours of the brain and spine and a wide
range of rarer pathologies.
Paediatric neurosurgeons often contribute to the management of related
disorders such as hydrocephalus, spinal dysraphism and epilepsy presenting in
young adults.
iii. Neuro-oncology:
The training is based on advances in basic oncological science and the
sophisticated delivery of intra-lesional therapies for the management of
malignant intrinsic tumours of the nervous system with refinement of surgical
techniques using radiological and functional guidance; improvements in
adjuvant chemotherapy and radiotherapy; greater understanding of the
molecular biology of CNS tumours and better organization of oncology services.
iv. Functional Neurosurgery:
Functional neurosurgery involves the surgical management of a wide range of
neurological problems including intractable pain, epilepsy, spasticity and
movement disorders. Traditional ablative surgery is being replaced by deep brain
and spinal cord stimulation. Research into neuromodulation using gene
therapy, biological vectors and pharmacological agents offers the prospect of
effective treatment for neurodegenerative and disabling psychiatric diseases
Neurovascular Surgery:
Residents should be proficient in working closely with their interventional
colleagues dealing with complex aneurysms, vascular malformations and
occlusive cerebrovascular diseases.
 v. Skull-base surgery:
Residents are expected to flourish in technical advances in microsurgery, surgical
approaches and reconstructions in the routine practice of dealing with disorders of
the skull-base including common tumours such as meningiomas,
acoustic neuromas and pituitary adenomas. Skull-base surgery is often
undertaken jointly with neuro-otological, plastic and maxillofacial surgeons. The
resident should also be aware of the adjuvant treatments with sophisticated
radiosurgery and fractionated stereotactic radiotherapy for patients with skull-
base tumours
vi. Spinal surgery:
Spinal surgery is now the largest subspecialty in neurosurgery and accounts for
more than 50% of the operative workload of some departments in European
hospitals. The resident should demonstrate a comprehensive service delivery for
primary and secondary spinal malignancy, spinal trauma, spinal pain and
degenerative spinal disorders.
vii. Traumatology:
The resident must be able to provide a prompt neurosurgical intervention and
neurointensive care and management in patients with head injury which remains
a major cause of death and disability in children and young adults.

6. Research Experience:
All residents in the categorical program are required to complete an academic
outcomes-based research project during their training. This project can consist

of original bench top laboratory research, clinical research or a combination of

both. The research work shall be compiled in the form of a thesis which is to be
submitted for evaluation by each resident before end of the training. The
designated Faculty will organize and mentor the residents through the process, as
well as journal clubs to teach critical appraisal of the literature.
 REGULATIONS

Scheme of the Course

A summary of five years course in MS Neurosurgery is presented as under:

Course
Structure
Components Examination

At the
 Principles of General Surgery Intermediate Examination at the
End of
 Relevant Basic Science (Anatomy, end of 2nd Year of M.S. Neurosurgery
2nd
Physiology, Pharmacology & Pathology) Programme
year MS
Neurosu
Written MCQs = 300 Marks
rgery
Clinical, TOACS/OSCE & ORAL= 200 Marks
Program
me Total = 500 Marks

Clinical component Final Examination at the end of 5th

year of M.S. Neurosurgery
Programme.
Training in Neurosurgery and rotations in the
At the relevant fields. Written = 500 Marks
end of Clinical, TOACS/OSCE & ORAL = 500 Marks
5th year Contribution of CIS = 100 Marks
MS Thesis Evaluation = 400 Marks
Neurosu
rgery Research component Total = 1500 Marks
Program
me
Research work / Thesis writing must be Thesis evaluation and defense at the end
completed and thesis be submitted of 5th year of the programme.
atleast 6 months before the end of final
year of the programme..
 Intermediate Examinations M.S. Neurosurgery
All candidates admitted in M.S. Neurosurgery courses shall appear in
Intermediate examination at the end of second calendar year.

Eligibility Criteria:
The candidates appearing in Intermediate Examination of the M.S.
Neurosurgery Programme are required:
a) To have submitted certificate of completion of mandatory workshops.
b) To have submitted certificate of completion of first two years of
training from the supervisor/ supervisors of rotations.
c) To have submitted CIS assessment proforma from his/her own
supervisor on 03 monthly basis and also from his/her supervisors
during rotation, achieving a cumulative score of 75%.
d) To have submitted certificate of approval of synopsis or undertaking /
affidavit that if synopsis not approved with 30 days of submission of
application for the Intermediate Examination, the candidate will not be
 allowed to take the examinations and shall be removed from the
training programme.
e) To have submitted evidence of payment of examination fee.

Intermediate Examination Schedule and Fee

a) Intermediate Examination at completion of two years training, will be
held twice a year.
b) There will be a minimum period of 30 days between submission of
application for the examination and the conduction of examination.
c) Examination fee will be determined periodically by the University.
d) The examination fee once deposited cannot be refunded / carried over
to the next examination under any circumstances.
e) The Controller of Examinations will issue Roll Number Slips on receipt
of prescribed application form, documents satisfying eligibility criteria
and evidence of payment of examination fee.

At the end of 2nd year Calendar of the programme

Written Examination = 300 Marks

Clinical, TOACS/OSCE & ORAL = 200 Marks

Written:
MCQs 100 (2 marks each MCQ)
SEQs 10 (10 Marks each SEQ)
 Total = 300 Marks

Written paper
Principles of General Surgery = 70 MCQs 7 SEQs
Specialty specific = 10 MCQs 1 SEQs
Basic Sciences = 20 MCQs 2 SEQs

 Anatomy = 6 MCQs 1 SEQs

 Pharmacology = 2 MCQs -------
 Pathology = 6 MCQs 1 SEQ
 Physiology = 6 MCQs -------

Clinical, TOACS/OSCE & ORAL

Four Short Cases = 100 Marks
One Long Case = 50 Marks
Clinical, TOACS/OSCE & ORAL= 50 Marks

Total = 200 Marks

Declaration of Results

The Candidate will have to score 50% marks in written and oral, practical/
clinical component and a cumulative score of 60% to be declared successful
in the Intermediate Examination.

A maximum total of four consecutive attempts (availed or unavailed) will be

allowed in the Intermediate Examination during which the candidate will be
allowed to continue his training program. If the candidate fails to pass his
Intermediate Examination within the above mentioned limit of four attempts,
the candidate shall be removed from the training program, and the seat
would fall vacant, stipend/ scholarship if any would be stopped.
 Final Examination
M.S. Neurosurgery
At the end of 5th Calendar year of the Programme
Eligibility Criteria:

To appear in the Final Examination the candidate shall be required:

i) To have submitted the result of passing Intermediate Examination.

ii) To have submitted the certificate of completion of training, issued

by the Supervisor will be mandatory.

iii) To have achieved a cumulative score of 75% in Continuous Internal

assessments of all training years .

iv) To have got the thesis accepted and will then be eligible to appear in Final
Examination.

v) To have submitted no dues certificate from all relevant departments

including library, hostel, cashier etc.

vi) To have submitted evidence of submission of examination fee .

Final Examination Schedule and Fee

a) Final examination will be held twice a year.

b) The candidates have to satisfy eligibility criteria before permission is granted

to take the examination.
 c) Examination fee will be determined and varied at periodic intervals by the
University.

d) The examination fee once deposited cannot be refunded / carried over to the
next examination under any circumstances .

e) The Controller of Examinations will issue an Admittance Card with a

photograph of the candidate on receipt of prescribed application form,
documents satisfying eligibility criteria and evidence of payment of
examination fee. This card will also show the Roll Number, date / time and
venue of examination.

Written Part = 500 Marks

Clinical, TOACS/OSCE & ORAL = 500 Marks
Contribution from Internal Assessment = 100 Marks
Thesis Examination = 400 Marks

Total = 1500 Marks

Written Papers:

Paper 1 = 100 MCQs 5 SEQs

Paper 2 = 100 MCQs 5 SEQs

Clinical, TOACS/OSCE & ORAL

Short Cases = 200 Marks
Long Case = 100 Marks
Toacs/OSCE & Oral = 200 Marks
Total = 500 Marks
Declaration of Result

For the declaration of result

I. The candidate must get his Thesis accepted.

II. The candidate must have passed the final written examination
with 50 % marks and the clinical & oral examination securing
50% marks. The cumulative passing score from the written and
clinical / oral examination shall be 60%.
III. The MS degree shall be awarded after acceptance of thesis and
success in the final examination.
IV. On completion of stipulated training period, irrespective of the
result (pass or fail) the training slot of the candidate shall be
declared vacant.

Submission / Evaluation of Synopsis

1. The candidates shall prepare their synopsis as per guidelines provided by

the Advanced Studies & Research Board, available on university website.
2. The research topic in clinical subject should have 30% component related
to basic sciences and 70% component related to applied clinical sciences.
The research topic must consist of a reasonable sample size and sufficient
 numbers of variables to give training to the candidate to conduct
research, to collect & analyze the data.
3. Synopsis of research project shall be submitted by the end of the 2nd year
of MS program. The synopsis after review by an Institutional Review
Committee shall be submitted to the University for consideration by the
Advanced Studies & Research Board, through the Principal / Dean /Head
of the institution.

Submission of Thesis

1. Thesis shall be submitted by the candidate duly recommended by the

Supervisor.
2. The minimum duration between approval of synopsis and submission of
thesis shall be one year.
3. The research thesis must be compiled and bound in accordance with the
Thesis Format Guidelines approved by the University and available on
website.
4. The research thesis will be submitted along with the fee prescribed by the
University.

Thesis Examination

a) The candidate will submit his/her thesis at least 06 months prior to

completion of training.

b) The Thesis along with a certificate of approval from the supervisory

will be submitted to the Registrar’s office, who would record the date /
 time etc. and get received from the Controller of Examinations wi thin
05 working days of receiving.

c) The Controller of Examinations will submit a panel of eight examiners

within 07 days for selection of four examiners by the Vice Chancellor.
The Vice Chancellor shall return the final panel within 05 working days
to the Controller of Examinations for processing and assessment. In
case of any delay the Controller of Examinations would bring the case
personally to the Vice Chancellor.

d) The Supervisor shall not act as an examiner of the candidate and will
not take part in evaluation of thesis.

e) The Controller of Examinations will make sure that the Thesis is

submitted to examiners in appropriate fashion and a reminder is sent
after every ten days.

f) The thesis will be evaluated by the examiners within a period of 06

weeks.

g) In case the examiners fail to complete the task within 06 weeks with
02 fortnightly reminders by the Controller of Examinations, the
Controller of Examinations will bring it to the notice of Vice Chancellor
in person.

h) In case of difficulty in find an internal examiner for thesis evaluation,

the Vice Chancellor would, in consultation with the concerned Deans,
appoint any relevant person as examiner in supersession of the
relevant Clause University Regulations.

i) There will be two internal and two external examiners. In case of

difficulty in finding examiners, the Vice Chancellor would, in
onsultation with the concerned Deans, appoint minimum of three, one
internal and two external examiners.
 j) The total marks of thesis evaluation will be 400 and 60% marks wil l be
required to pass the evaluation.

k) The thesis will be considered accepted, if the cumulative score of all

the examiners is 60%.

l) The clinical training will end at completion of stipulated training period

but the candidate will become eligible to appear in the Final
Examination at completion of clinical training and after acceptance of
thesis. In case clinical training ends earlier, the slot will fall vacant
after stipulated training period.

Award of MS Neurosurgery Degree

After successful completion of the structured courses of MS Neurosurgery and
qualifying Intermediate & Final examinations (Written, Clinical, TOACS/OSCE & ORAL
and Thesis) the degree with title MS Neurosurgery shall be awarded.
 CONTENT OUTLINE

MS Neurosurgery

Basic Sciences:
Student is expected to acquire comprehensive knowledge of Anatomy,
Physiology, Pathology & Pharmacology relevant to surgical practice appropriate
for Neurosurgery

1. Anatomy
 Detailed Anatomy of the organ systems of body, their blood supply, nerve
supply, lymphatic drainage and important gross relations to other organs as
appropriate for neurosurgical operations
 Developmental Anatomy and associated common congenital abnormalities
 Features of Surface, Imaging and Applied Anatomy within skull, brain, spinal cord,
peripheral nervous system and head and neck
 Relate knowledge to assessment of clinical situation or progress of disease
condition

Embryogenesis of the brain and spinal cord

 Embryogenesis of supporting structures - skull and vertebral column
 Common anatomical variations and developmental abnormalities
 Embryogenesis of the skeleton and muscle development

Structure, blood supply, innervation, surface and three-dimensional

relationships of the:
 Scalp
 Skull
 Meninges
 Orbit
 Cranial fossae
 Cranial foraminae
 Cranial nerves

Cortical Topography:
 Projection and association tracts
 Organization of the basal ganglia
 Structure, organization and connections of the cerebellum, pons and
brainstem
 Cranial nerves and their relationships
 Visual and auditory pathways
 Ventricular system and choroid plexus
 Subarachnoid space and cisterns
 Circle of Willis and principle regional and segmental blood supply
 Venous drainage and dural sinuses
Structure, blood supply, innervation, surface and three-dimensional
relationships of the:
 Vertebral column
 Spinal cord: ascending and descending tracts
 Spinal nerve roots
 Cauda equina

Structure, innervation and Distribution of autonomic and peripheral

nervous system:

 Sympathetic and parasympathetic pathways

 Visceral and pelvic innervation: control of sphincter function
 Brachial plexus
 Lumbosacral plexus
 Course, distribution and innervation of the major peripheral nerves

Applied Anatomy
 Stereotaxis
 Embryology and mal-development
 Differences between foetal, infant, child and adult brain
 Development of facial and cranial skeleton
 Branchial arches and the vascular system
 Development of the ventricular system
 Development of the cerebral hemispheres
 Development of brain stem and cranial nerves
 The notochord
 The subependymal plate (subventricular zone)
 Development of the pituitary gland
 The external granular layer of the cerebellum
 Spinal cord development
 Applied embryology of the CNS and its coverings

2. Physiology

 Functional Neurophysiology: Cellular organization, structure function

correlations and physiological alterations in the central and peripheral
nervous systems of body
  Clinical Neurophysiology: Relate knowledge to assessment of clinical
situation or progress of disease condition

Functional Neurophysiology:
 Structure and function of neurons and glial cells
 Synaptic function, action potentials and axonal conduction
 Higher cerebral functions
 Sleep and coma
 Memory and disorders of the limbic system
 Control of motor function: ascending and descending pathways, basal
ganglia and cerebellar function
 The special senses
 Hypothalamic-pituitary function
 Cerebral blood flow and metabolism
 Cerebral auto-regulation and vasospasm
 Blood brain barrier and cerebral edema
 Intracranial pressure dynamics
 Cerebral ischaemia and neuroprotection
 CSF hydrodynamics - production and absorption

Autonomic Nervous System:

 Differing effects of sympathetic and parasympathetic innervation
 Effects on differing physiological processes

Clinical Neurophysiology:
 Principles of electroencephalography

 Principles of somatosensory, motor and brainstem evoked potential

monitoring
 Peripheral neuropathies and entrapment neuropathies including:
o Structure and function of peripheral nerves
o Use of nerve conduction studies

 Disorders of the neuromuscular junction including:

o Structure and function of smooth and striated muscle
o Use of electromyographic studies

Clinical Skills
 Interpretation of the results of EEG, EMG and NC studies
 Membrane biochemistry and signal transduction
 Enzymes and biologic catalysis
 Tissue metabolism
 Carbohydrate metabolism
 Lipid metabolism
 Nitrogen metabolism

Neurochemistry (Including Neuroendocrinology)

 Fundamentals of Chemistry
 Introduction to acid-base chemistry and equilibrium
 Fundamentals of Neurochemistry
 CNS metabolism
 Principle of neuronal communication
 Mechanism controlling transmitter release
 Transduction mechanisms in the post-synaptic cells
 Characteristics of synaptic potential
 Process of synaptic summation (spatial and temporal)
 Neurotransmitters & Synaptic Transmission
 Neurotransmitters and receptors
 Important neurotransmitters and chemical messengers
Chemical Classification
 Nitric Oxide
 Eicosanoids
 Acetylcholine
 Amino acid transmitters
 Serotonin
 Catecholamines
 Peptides
Functional Classification
 Metabolism
 Important second messenger pathways
 Pathophysiologic mechanism of conditions interfering chemical transmission
 Neurochemistry of common neurological diseases (Alzheimer’s disease,
alcoholism, anxiety, sleep disorders etc.)
 Neuroendocrinology and Neurohormones
 Molecular bases of neuroendocrine regulation
 Neuroendocrinology of hypothalamus, pituitary gland, hypothalamic-
pituitary-gonadal axis, sleep and arousal etc.)
 Homeostasis and biological rhythms
 Gene expression and the synthesis of proteins
 Bioenergetics; fuel oxidation and the generation of ATP
 Biotechnology and concepts of molecular biology with special emphasis
on use of recombinant DNA techniques in medicine and the molecular
biology of cancer

3. Pharmacology

 The Evolution of Medical Drugs

 British Pharmacopia
 Introduction to Pharmacology
 Receptors
 Mechanisms of Drug Action
 Pharmacokinetics
 Pharmacokinetic Process
 Absorption
 Distribution
 Metabolism
 Desired Plasma Concentration
 Volume of Distribution
 Elimination
 Elimination rate constant and half life
 Creatinine Clearance
 Drug Effect
 Beneficial Responses
 Harmful Responses
 Allergic Responses
 Drug Dependence, Addiction, Abuse and Tolerance
 Drug Interactions
 Dialysis
 Drug use in pregnancy and in children
 4. Pathology

Pathological alterations at cellular and structural level in infection,

inflammation, ischaemia, neoplasia and trauma affecting the nervous system.
Cell Injury and adaptation
 Reversible and Irreversible Injury
 Fatty change, Pathologic calcification
 Necrosis and Gangrene
 Cellular adaptation
 Atrophy, Hypertrophy,
 Hyperplasia, Metaplasia, Aplasia
Inflammation
 Acute inflammation
 Cellular components and chemical mediators of acute inflammation
 Exudates and transudate
 Sequelae of acute inflammation
 Chronic inflammation
 Etiological factors and pathogenesis
 Distinction between acute and chronic (duration) inflammation
 Histologic hallmarks
 Types and causes of chronic inflammation, non-granulomatous &
granulomatous,
Haemodynamic disorders
 Etiology, pathogenesis, classification and morphological and clinical
manifestations of Edema, Haemorrhage, Thrombosis, Embolism,
Infarction & Hyperaemia
 Shock; classification etiology, and pathogenesis, manifestations.
 Compensatory mechanisms involved in shock
 Pathogenesis and possible consequences of thrombosis
 Difference between arterial and venous emboli
Neoplasia
 Dysplasia and Neoplasia
 Benign and malignant neoplasms
 Etiological factors for neoplasia
 Different modes of metastasis
 Tumor staging system and tumor grade
 Immunity and Hypersensitivity
 Immunity
 Immune response
 Diagnostic procedures in a clinical Immunology laboratory
 Protective immunity to microbial diseases
 Tumour immunology
 Immunological tolerance, autoimmunity and autoimmune diseases.
 Transplantation immunology
 Hypersensitivity
 Immunodeficiency disorders
 Immunoprophylaxis & Immunotherapy

Related Microbiology
 Role of microbes in various central and peripheral nervous system diseases
 Infection source
 Nosocomial infections
 Bacterial growth and death
 Pathogenic bacteria
 Vegetative organisms
 Spores
 Important viruses
 Important parasites
 Surgically important microorganisms
 Sources of infection
 Asepsis and antisepsis
 Sterilization and disinfection
 Infection prevention
 Immunization
 Personnel protection from communicable diseases
 Use of investigation and procedures in laboratory

Special Pathology
 Cerebral hypoxia and ischaemia
 Cytopathology of neurons and glial in response to ischaemia, hypoxia and
trauma
 Diffuse axonal injury
 Congenital malformations of the nervous system
 Cerebral and spinal vascular disorders and lesions of extracranial vessels
 Brain and spinal cord trauma
 Acute and chronic inflammatory processes in the CNS
 Meningitis, encephalitis, brain abscess and other disorders of bacterial,
viral, fungal or parasitic origin
 Principles and practice of antibiotic therapy
 Slow viruses and the brain
 Bacterial, fungal and parasitic meningitis, encephalitis and abscess
formation
 Viral encephalitis
 Slow viruses, CJD and vCJD
 HIV associated infections, tumours and leucoencehalopathies
 The dementias
 Causes of epilepsy
 Demyelinating diseases
 Diseases of the scalp, skull and meninges
 Diseases and degenerative disorders of the spine
 Inborn errors of metabolism
 Diseases of muscle
 Brain shifts, herniation and raised intracranial pressure
 Classification, epidemiology and pathology of CNS tumours
 Techniques of biopsy and tissue preparation, staining and
immunohistochemical

 Orbital tumours
 Tumour biology, cell kinetics, tumour markers, immunocytochemistry
 MS Neurosurgery
Fundamental Principles of Surgery

 History of surgery
 Preparing a patient for surgery
 Principles of operative surgery: asepsis, sterilization and antiseptics
 Surgical infections and antibiotics
 Basic principles of anaesthesia and pain management
 Acute life support and critical care:
 Pathophysiology and management of shock
 Fluids and electrolyte balance/ acid base metabolism
 Haemostasis, blood transfusion
 Trauma: assessment of polytrauma, triage, basic and advanced trauma
 Accident and emergency surgery
 Wound healing and wound management
 Nutrition and metabolism
 Principles of burn management
 Principles of surgical oncology
 Principles of laparoscopy and endoscopy
 Organ transplantation
 Informed consent and medicolegal issues
 Molecular biology and genetics
 Operative procedures for common surgical manifestations e.g cysts, sinuses,
fistula, abscess, nodules, basic plastic and reconstructive surgery
 Principles of basic diagnostic and interventional radiography
 Principles and interpretation of conventional and advanced radiographic
procedures

Common Surgical Skills

Incision of skin and subcutaneous tissue:

o Langer’s lines
o Healing mechanism
o Choice of instrument
o Safe practice
Closure of skin and subcutaneous tissue:
o Options for closure
o Suture and needle choice
o Safe practice
Knot tying:
o Choice of material
o Single handed
o Double handed
o Superficial
o Deep
Tissue retraction:
o Choice of instruments
o Placement of wound retractors
o Tissue forceps

Use of drains:
o Indications
o Types
o Insertion
o Fixation
o Management/removal
Incision of skin and subcutaneous tissue:
o Ability to use scalpel, diathermy and scissors
Closure of skin and subcutaneous tissue:
o Accurate and tension free apposition of wound edges
Haemostasis:
o Control of bleeding vessel (superficial)
o Diathermy
o Suture ligation
o Tie ligation
o Clip application
o Plan investigations
o Clinical decision making
o Case work up and evaluation; risk management
Pre-operative assessment and management:
o Cardiorespiratory physiology
o Diabetes mellitus
o Renal failure
o Pathophysiology of blood loss
o Pathophysiology of sepsis
o Risk factors for surgery
o Principles of day surgery
o Management of comorbidity
Intraoperative care:
o Safety in theatre
o Sharps safety
o Diathermy, laser use
o Infection risks
o Radiation use and risks
o Tourniquets
o Principles of local, regional and general anaesthesia
Post-operative care:
o Monitoring of postoperative patient
o Postoperative analgesia
o Fluid and electrolyte management
o Detection of impending organ failure
o Initial management of organ failure
o Complications specific to particular operation
o Critical care

Blood products:
o Components of blood
o Alternatives to use of blood products
o Management of the complications of blood product transfusion including
children
Antibiotics:
o Common pathogens in surgical patients
o Antibiotic sensitivities
o Antibiotic side-effects
o Principles of prophylaxis and treatment
Safely assess the multiply injured patient:
o History and examination
o Investigation
o Resuscitation and early management
o Referral to appropriate surgical subspecialties

Technical Skills
 o Central venous line insertion
o Chest drain insertion
o Diagnostic peritoneal lavage
o Bleeding diathesis & corrective measures, e.g. warming, packing
o Clotting mechanism; Effect of surgery and trauma on coagulation
o Tests for thrombophilia and other disorders of coagulation
o Methods of investigation for suspected thromboembolic disease
o Anticoagulation, heparin and warfarin
o Role of V/Q scanning, CT angiography and thrombolysis
o Place of pulmonary embolectomy
o Awareness of symptoms and signs associated with pulmonary embolism and
DVT
o Role of duplex scanning, venography and d-dimer measurement
o Initiate and monitor treatment

Diagnosis and Management of Common Paediatric Surgical Conditions:

 Child with abdominal pain
 Vomiting child
 Trauma
 Groin conditions
o Hernia
o Hydrocoele
o Penile inflammatory conditions
o Undescended testis
o Acute scrotum
 Abdominal wall pathologies
 Urological conditions
 Constipation
 Head / neck swellings
 Intussusception
 Abscess
 In growing toenail
In terms of general experience it is expected that trainees would have gained
exposure to the following procedures and to be able to perform those marked (*)
under direct supervision.
 Elective Procedures
 Inguinal hernia
 (not neo-natal)
  Orchidopexy
 Circumcision*
 Lymph node biopsy*
 Abdominal wall herniae
 Insertion of CV lines
 Management of in growing toenails*
 EUA rectum*
 Manual evacuation*
 Open rectal biopsy
 Excision of skin lesions*
 Emergency Procedures
 Appendicectomy
 Incision and drainage of abscess*
 Pyloromyotomy
 Operation for testicular torsion*
 Insertion of pleural drain*
 Insertion of suprapubic catheter*
 Reduction of intussusception
 MS Neurosurgery
Clinical Component

1. Common Neurosurgical Disorders

Congenital and Paediatric Neurosurgery
 Neurological evaluation of the neonate and infant
 Developmental malformations of the CNS and its coverings
 Spina bifida and its variants; aetiology
 Encephalocoele
 Craniosynostosis; principles of craniofacial reconstruction
 Paediatric head injury
 Prevention and treatment of secondary insults relating to transfer and
emergency surgery in head-injured children
 Subdural effusions of infancy
 Intracranial and spinal tumours in children
 Phakomatoses (neurofibromatoses; tuberous sclerosis)
 Craniovertebral anomalies
 Vascular lesions in the paediatric age-group
 Epidemiology, natural history, pathophysiology and clinical features of
subarachnoid haemorrhage, haemorrhagic stroke and ischaemia stroke in
children secondary to intracranial aneurysms, arteriovenous malformations
and fistulae, cavernomas, arterial dissection, moya-moya disease and
venous sinus thrombosis
  Surgical and endovascular strategies for the management of acute
intracranial vascular disorders in children
 Ethical considerations
 Hydrocephalus and CSF disturbances
 CSF physiology
 Pathophysiology, investigation and classification of hydrocephalus and its
complications
 Benign intracranial hypertension
 Medical and surgical methods of treatment of hydrocephalus and long term
complications
Cerebrovascular Neurosurgery
 Pathophysiology and clinical diagnosis of cerebral ischaemia
 Extracranial carotid/vertebral disease; carotid endarterectomy; brain
revascularisation
 Medical prevention of occlusive cerebrovascular disease
 Spontaneous intracranial/spinal haemorrhage especially SAH and
intracerebral haemorrhage
Pathology, classification and natural history of cerebral aneurysms and
AVM’s
 Surgery of and perioperative management of aneurysms, AVM’s,
cavernomas and haematomas
 Miscellaneous cerebrovascular lesions e.g. Caroticocavernous fistulae,
venous thrombosis.
 Role of interventional radiology
Trauma - Head and Spine
(For neurointensive care and rehabilitation - see relevant sections)
 Mechanisms and patterns of traumatic brain and spinal cord damage
 Pathophysiology of CNS trauma
- Cerebral perfusion and oxygenation
- Raised intracranial pressure
- Impaired intracranial compliance
 Intracranial herniation
 Epidemiology and prevention of head and spinal injury
 Pathophysiology of spinal cord injury
 Classification of cervical spinal fracture dislocations
 Biomechanics of spinal instability
 Indications for halo traction and external stabilization
 Indications for and principles of open reduction and stabilization
  Transport, retrieval and pre-hospital care
 Initial resuscitation and triage
 Clinical Assessment
 Natural history of recovery from head injury including neurological,
 cognitive and behavioural disability and post- traumatic epilepsy
 Management including operation for 'surgical' complications (eg. acute and
chronic haematoma, open injury, CSF fistula, traumatic vascular injuries,
spinal instability, late hydrocephalus).
 'Medical' management of persisting unconsciousness
 Assessment of outcome, factors affecting prognosis and late sequelae
 Perioperative and neuro-intensive care
 Respiratory functions and ventilation
 Management of disorders of fluid balance; nutrition and feeding
 Blood coagulation and transfusion
 DVT and pulmonary embolism
 Fever in neurosurgical patients
 Confusion, restlessness and agitation in neurosurgery
 Informed consent and medicolegal aspects
 Postoperative seizures
 Diagnosis of brainstem death
 Monitoring techniques in Neurointensive care and Theatre
 Principles of prophylactic drug treatment
 Other post-operative complications
 The neurogenic bladder
Infections
 The pathophysiology of intracranial and spinal sepsis
 Infective complications of neurosurgical procedures – treatment and
prophylaxis
 Intracranial and spinal abscess/ empyema-clinical features, investigation
and management
 The aetiology and pathophysiology of spinal sepsis
 Indications for drainage of spinal epidural absces s by laminectomy and
multiple laminotomies
 Bacterial, viral, fungal and parasitic infections of the CNS and spine
 Opportunistic infections, HIV and AIDS

 The aetiology and pathophysiology of vertebral osteomyelitis and discitis,

including pyogenic, tuberculous and atypical infections
  Indications for percutaneous and open biopsy
 Principles of anti-microbial chemotherapy
 Indications for operative intervention
 Principles of peri-operative care
 Surgical complications and their management

Neuro-oncology
 Presenting features and investigations of tumours involving the central
nervous and peripheral nervous system
 Classification, natural history and pathology of benign and malignant
intracranial neoplasia
 Pathophysiology of raised intracranial pressure associated with space
occupying tumours
 Diagnostic imaging of intracranial tumours including the interpretation of
CT and MRI scans and the role of MRS
 Principles and techniques of tumour biopsy
 Stereotaxy, robotics/ endoscopic techniques in CNS tumour management
 Operative management of intracranial and spinal tumours.
 Principles of fractionated radiotherapy, stereotactic radiotherapy and
radiosurgery
 Role of adjuvant chemotherapy
 Principles of clinical trials and their application to neuro-oncology
 Specific management of tumours of the brain, skull base and orbit
including glioma, meningioma, pituitary and parasellar tumours, cerebellar
pontine angle tumours, metastases, tumours of the ventricular system and
pineal region, lymphoma, medulloblastoma, epidermoid, dermoid,
haemangioblastoma and chordoma
 Specific management of primary and secondary tumours involving the
spinal column, intramedullary, intra and extra dural tumours of the spinal
canal and tumours of the nerve roots and peripheral nerves
 Prognosis of CNS and peripheral nerve tumours
 Principles of palliative care

Spinal disorders (for congenital, trauma, tumour and vascular disorders,

see relevant sections)
 Differential diagnosis of spinal cord compression and root dysfunction –
investigation and management
  Biomechanics of the spine and principles of spinal stabilization/fusion;
approaches to the spine
 Conservative management of spinal disorders
 Degenerative and inflammatory spinal disease - e.g. rheumatoid arthritis,
cervical spondylotic myelopathy/radiculopathy, thoracic discs, lumbar disc
disease, spinal stenosis and spondylolisthesis
 Syringomyelia; arachnoiditis
 Management of spasticity

Pain
 Pathophysiology of pain; differential diagnosis
 General and psychological factors in pain management
 Analgesics and pain relief
 Craniofacial pain syndromes
 Trigeminal and glossopharyngeal neuralgia - history, drug treatment,
percutaneous and posterior fossa approaches
 Nerve blocks, electrical stimulation and RF lesions for pain relief; implants;
cordotomy
 DREZ lesions; Dorsal rhizotomy
Peripheral nerves
 The diagnosis and treatment of common peripheral nerve problems
 including entrapment neuropathies, thoracic outlet and brachial plexus,
causalgia and sympathetic dystrophy
 Theory and practice of nerve repair and cranial nerve reconstruction
Functional and Stereotactic Neurosurgery
 Principles and techniques of stereotactic and computer-assisted image-
guided surgery
 Stereotactic radiosurgery
 Movement disorders and their surgical treatment
 Investigation, medical and surgical management of epilepsy and other
functional disorders
 Classification, causes and presentations of dysphasias, speech dyspraxia
and dyslexia
 Classification, causes and presentations of dysarthria
 Role of speech and language therapists in assessment and t reatment
 Neurological causes of dysphagia
  Indications for laryngoscopy, videofluoroscopy, nasogastric and
percutaneous gastric feeding
 Aaetiology, differential diagnosis, investigation and initial management of
patients presenting with sphincteric disorders
 Interpretation of urodynamic studies
 Aetiology, differential diagnosis, investigation and initial management of
patients presenting with movement disorders
 Parkinson's disease
 Iatrogenic movement disorders
 Dystonic syndromes
 Choreiform syndromes
 Disorders of memory and cognition associated with head injury,
subarachnoid haemorrhage, hydrocephalus, structural lesions of the frontal
and temporal lobes and disorders of the limbic system
Neuro-ophthalmology / Neuro-otology
 Visual acuity and visual fields; fundal examination
 Patterns of visual loss in relation to common bulbar, retrobulbar, sellar,
parasellar and optic pathway disorders
 Analysis of diplopia and nystagmus in relation to common cranial nerve and
brainstem disorders
 Significance of abnormalities of the pupils, fundi, external ocular
movements and the visual fields

 Significance of abnormalities of hearing and of the vestibular system

 Common causes of conductive and sensorineural hearing loss
 Principles of audiological assessment
Rehabilitation of the Neurosurgical Patient
 Distinction between, and relevance of, concepts of limitation, disability and
handicap
 Methods of assessment
 Patterns of natural history of recovery after Neurosurgical treatment,
outcome and confounding factors
 Use of components of rehabilitation provided by specific medical and
paramedical disciplines and interdisciplinary approaches, including
community and family reintegration
Evidence based Neurosurgery; Audit and Trial design
 To understand the provisional nature of knowledge
 To be able to acknowledge and identify failure of current treatments
  To cope with uncertainty and biological variability
 To be able to critically assess the neurosurgical literature
 To be aware of the relevant rational and quantitative methods to resolve
uncertainty
Relevant topics
 Principles of audit and randomized controlled trials
 Outcome assessment
 Design and appraisal of clinical studies - evaluation of published reports
 Clinical trials: design, randomization, patient numbers, end points and
power; statistical analysis, confidence intervals and clinical significance.
 Drug studies : phases 1 - 4
 Informed consent
 Issues of organization and delivery of neurosurgical care

1. Common Neurosurgical Presentations

 Impaired consciousness and non-traumatic coma due to:
- Meningitis
- Encephalitis
- Intracranial haemorrhage
- Acutely raised ICP
- Hydrocephalus
- Hypoxaemia and ischaemia
- Cardiogenic shock
- Hypoglycaemia
- Epilepsy
- Metabolic encephalopathies
- Drugs and toxins
 Traumatic coma
 Weakness and paralysis
- Ocular, cranial nerve, limb, trunk and respiratory muscle
weakness

 Headache - acute and chronic- associated with

- Benign headache syndromes
- Migraine, cluster headache and related syndromes
- Space occupying lesions
 - Meningitic disorders
- Intracranial haemorrhage
- Trigeminal neuralgia
- Atypical craniofacial pain syndrome
 Dizziness, unsteadiness and falls
- Cerebellar, vestibular, extrapyramidal and autonomic
dysfunction
 Pain and sensory loss
- Musculoskeletal, neurogenic and neuropathic pain and sensory
loss
 Movement disorder associated with;
- Parkinson's disease
- Iatrogenic movement disorders
- Dystonic syndromes
- Choreiform syndromes
 Hearing disorder
- Conductive and sensorineural hearing loss
 Visual disorder
- Common bulbar, retrobulbar, sellar, parasellar and optic
pathway disorders
- Nystagmus and diplopia
 Language and speech disturbance presentations;
- Dysphasias
- Speech dyspraxia
- Dyslexia
- Dysarthria
 Swallowing disorders with neurological causes of dysphagia
 Disorders of the Sphincteric and sexual function
- Neurological enuresis
- Constipation
- Diarrhea
- Urgency of micturition/dribbling
 Memory and cognitive disorders associated with;
- Head injury
- Subarachnoid haemorrhage
- Hydrocephalus
- Structural lesions of the frontal and temporal lobes
- Disorders of the limbic system
  Acute and chronic presentations of organic and psychiatric behavioural
disorders relating to;
- Alcohol and drug abuse
- Encephalitis
- Organic dementia
- Psychosis
 Ill child with hydrocephalus, impaired consciousness and sepsis

2. Common Neurosurgical Skills and Procedures

 On completion of the initial training in Part I, the trainees will be competent in all
aspects of the basic, operative and non operative care of surgical patients
 During Part II training, they will understand the importance of neurosurgical care
and management with particular reference to common neurosurgical presentations
recognizing and preventing secondary insults to the central nervous system. They
will be capable of resuscitating, assessing and initiating the surgical management
of patients deteriorating as a result of intracranial and systemic complications.
They will demonstrate sound judgment when seeking more senior support,
prioritizing medical interventions and escalating the level of medical care.

Neuro-Traumatology:

General Management of the Head Injured Patient:

 Medical management of acutely raised intracranial pressure
 Indications for operation intervention including the use of pressure
monitoring
 Principles, diagnosis and confirmation of brain death
 Principles of intensive care of head injured patients
 Principles of spinal stabilization and radiological assessment in head
injury patients
 Role of neurological rehabilitation
 Clinical assessment of the multiply-injured patient.
 Neurological assessment of the head-injured patient including:
- Assessment and categorization of impaired consciousness
- Recognition and interpretation of focal neurological deficits
 Prioritization of clinical risk
 Interpretation of CT scans and plain radiology
 Accurate documentation
 Indications for ICP monitoring
 Insertion of ICP monitor
 Insertion of frontal subdural and intraparenchymal ICP monitors
using a standard frontal burr hole and/or twist drill craniostomy
 Calibration, zeroing and interpretation of ICP traces
 Potential complications of the procedure
 Burr hole evacuation of chronic subdural haematoma
 Management of anti-platelet and anti-coagulant medication
 Neurological assessment of patients with a CSDH
 Interpretation of CT scans
 Post-operative assessment and management
 Performance of single and multiple frontal and parietal burr hole
 Craniotomy for supratentorial traumatic haematoma, in particular:
 Planning and siting of craniotomies for evacuation of extradural
and subdural haematomas
 Handling the "tight" brain
 Achieving haemostasis in the coagulopathic patient

 Achieving haemostasis from the skull base and venous sinuses

 Elevation of compound depressed skull fracture with dural repair
 Delayed cranioplasty of skull vault
 Management of soft tissue trauma
 Indications for primary and secondary closure of wounds
 Indications for antibiotic prophylaxis
 Assessment of tissue perfusion and viability
 Wound exploration under local and general anaesthesia
 Wound debridement
 Arrest of scalp haemorrhage
 Layered closure of the scalp without tension
 Suturing technique
 Wound drainage and head bandaging
 Use of external mobilization including cervical collars and spinal boards
 Application of halo traction
 Application of a halo-body jacket
 The role of posttraumatic neurological rehabilitation
General Management of Hydrocephalus:
 The assessment and operative management of adult patients with
communicating and non communicating hydrocephalus
 The assessment of children with hydrocephalus; emergency external
ventricular drainage in children with acute hydrocephalus
 The insertion and revision of ventriculo-peritoneal, ventriculo-atrial and
lumbo-peritoneal shunts; endoscopic third ventriculostomy
 Image-guided placement of ventricular catheters
 Management of neonatal post-haemorrhagic hydrocephalus

General Management of Subarachnoid Haemorrhage:

 Principles of resuscitation and timing of interventions.
 Indications for CT scanning, diagnostic lumbar punctuure, CT
angiography and digital subtraction angiography.
 Principles of management of post-haemorrhagic hydrocephalus
 Indications for endovascular and surgical intervention
 Interpretation of CT scans including assessment of intracranial blood load,
haematomas and hydrocephalus
 Basic interpretation of cerebral angiography
 Diagnostic & therapeutic lumbar puncture
 To undertake an atraumatic lumbar puncture
 Interpretation of basic microscopy and biochemistry
 Principles of spectrophotometry
 Management of delayed secondary ischaemia
 Principles governing the augmentation of cerebral blood flow
 Assessment of a deteriorating patient
 Recognition and management of secondary insults
 Interpretation of CT scans
 Management of hypervolaemic hypertension
 Insertion of central venous catheter
 Insertion of lumbar drain
 Insertion of external ventricular drain
 Management of post-haemorrhagic hydrocephalus
 Indications for external ventricular drainage and lumbar subarachnoid
drainage
 Assessment of the unconscious and deteriorating SAH patient
 Interpretation of CT scans
 The management of hydrocephalus complicating intracranial
haemorrhage, head injury and intracranial space occupying lesions;
 Insertion and taping of CSF reservoirs; insertion and maintenance of
lumbar and ventricular drains
 External ventricular drainage, ventriculoperitoneal shunting, lumbar CSF
drainage and shunting, ventriculo-cisternostomy
 Insertion of ventricular drain/access device

Neuro-Oncology:
All trainees will be competent to manage patients with high grade intrinsic
tumours, metastases and convexity meningiomas. Trainees with a special
interest in neuro-oncology will participate fully in the multidisciplinary
management of neuro-oncology patients and will be familiar with current
developments in molecular neuro-oncology, emerging surgical techniques and
the ethical, regulatory and practical considerations governing clinical trials in
neuro-oncology

Assessment and Peri-Operative Management of Patients with Space-

Occupying Intracranial Lesions:
 Craniotomy for superficial, lobar supratentorial intrinsic tumour. In particular:
- Safe patient positioning
- Planning and siting of craniotomy with and without image-guidance
- Intra-operative management of raised ICP
- Appropriate exposure of the tumour, using operating microscope as
necessary
- Safe use of fixed retractors
- Precise use of suction, electro-coagulation and ultrasonic aspiration
- Intracranial haemostasis
 Advanced surgical techniques including awake craniotomy; stereotactic
craniotomy, intraoperative neurophysiological monitoring
 Advanced image guidance with integration of functional data; Intraoperative
imaging techniques
 Use of intraoperative chemotherapy wafers
 Third ventriculostomy
 The management of low grade intrinsic tumours using advanced techniques
 The surgical approaches to tumours of the ventricular system and pineal
gland including the transfrontal transventricular excision of intraventricular
tumours and cysts
 Transcallosal transventricular excision of lesions of the third ventricle and
foramen of Munro
 Indications for biopsy of intracranial tumours
 Risks of biopsy
 Principles of image-guided surgery
 Principles of radiosurgery and stereotactic radiotherapy and the
indications for their use as adjunctive and/or primary treatment
modalities.
 Indications for neuroimaging
 Image-guided frameless and/or frame-based stereotactic biopsy
including Setting up a computer workstation and importing and
interrogating image data
- Positioning the patient and applying a cranial fixator
- Obtaining and confirming accurate patient registration
- Positioning and performing a suitable burr hole
- Passage of biopsy probe and biopsy
- Preparation of smear histology (when available)
 Management of raised intracranial pressure
 Principles of operative management
 Detection and management of post-operative complications e.g. cerebral
swelling, intracranial haematomas and intracranial sepsis; the
management of post-operative seizures
 Basic interpretation of CT and MRI scans
 Interpretation of CT and MRI scans and selection of biopsy targets

Assessment and Peri-Operative Management of Patients with Space-

Occupying Intraspinal Lesions:

 Assessment and perioperative management of patients presenting with acute

spinal disorders e.g. cauda equina and spinal root compression
 General and basic surgical management of patients with malignant spinal cord
compression
 The surgical management of degenerative spinal disorders e.g. lumbar
compressive radiculopathies by lumbar microdiscectomy and associated
microsurgical decompressions
 The surgical management of compressive cervical myeloradiculopathies
 Including the multi-disciplinary management of patients with intracranial
neoplasia
  Extradural spinal biopsy and decompression by laminectomy in selected
patients without segmental instability
 Instrumented posterior spinal stabilization
 The management of spinal shock
 The ward management of patients with spinal instability
 The detection and initial management of postoperative complications including
compressing haematomas, CSF fistula and spinal sepsis
 The operative management of supra-tentorial intrinsic tumours
 The operative management of convexity meningiomas e.g. use of
duraplasty and cranioplasty

CNS Sepsis:
 General management of CNS infections e.g. ventriculitis, cerebral abscess,
subdural empyema and spinal epidural abscess
 The operative management of cerebral abscess by burr hole aspiration

Paediatric Neurosurgery:

All trainees will undertake at least a six month placement in a paediatric

neurosurgery service under the direct supervision of paediatric
neurosurgeons with a full-time or major commitment to paediatric
surgery. The service must provide a comprehensive range of paediatric
neurosurgical care. On completion of general paediatric training trainees will
be competent to assess and undertake the emergency neurosurgical
management of the critically-ill child with raised intracranial pressure. On
completion of a special interest fellowship in paediatric neurosurgery
trainees will be competent in all aspects of the non-operative neurosurgical
management of children presenting with disorders of the nervous system.
They will have detailed knowledge of the statutory framework governing
the care of children, paediatric neurointensive care, the principles of
paediatric neuro-rehabilitation and of the management of non-accidental
injury. They will be competent to undertake all aspects of the emergency
neurosurgical operative care of children and to undertake a range of
elective procedures in the following fields with appropriate supervision:
 Paediatric Neuro-oncology:
 Stereotactic and image guided biopsy of paediatric tumours
 Endoscopic biopsy of third ventricular tumours
 Resection of supratentorial and infratentorial intrinsic tumours
 Approaches to suprasellar, third ventricular and pineal tumours
 Management of spinal cord tumours
Paediatric Head Injury:
 Decompressive craniectomy
 Cranioplasty
 Management of growing fractures
 Craniofacial reconstruction including the management of simple
craniosynostosis, syndromic craniosynostosis, post -traumatic deformity
 Management of CSF fistulae
Paediatric Hydrocephalus:
 Assessment of the ill child with hydrocephalus, impaired consciousness
and sepsis
 Differential diagnosis of shunt malfunction
 Interpretation of CT scans in shunted children
 Taping and draining from an Ommaya reservoir
 Taping a shunt
 External ventricular drainage
Spinal Dysraphism:
 Management of neonatal spina bifida, meningoceles and encephal oceles
 Spinal cord tethering syndromes
 Management of congenital and acquired spinal deformity e.g. syndromic
spinal deformity and post-operative spinal deformity

Functional Neurosurgery:
Trainees with a special interest in functional neurosurgery will develop
additional expertise as follows:

Surgical Management of Pain:

 Implantation of spinal cord stimulators
 Insertion of intrathecal drug delivery systems
 Ablative surgical treatment for pain including DREZ lesioning, cordotomy
and myelotomy
  Neuromodulatory techniques including peripheral nerve, motor cortex and
deep brain stimulation.
 Neurovascular compression syndromes: including microvascular
decompression of the trigeminal nerve; microvascular decompression of the
facial nerve; percutaneous trigeminal rhizotomy
Surgical Management of Spasticity:
 Medical and surgical treatments for spasticity
 Implantation of intrathecal drug delivery systems
 Other surgical treatments for spasticity including phenol blocks,
neurectomies and rhizotomy.
Surgical Management of Epilepsy:
 Multidisciplinary assessment and preparation of patients for epilepsy
surgery
 Stereotactic placement of depth electrodes and placement of subdural
 Electrode grids
 Temporal lobectomy
 Selective amygdalohippocampectomy
 Callosotomy
 Insertion of vagal nerve stimulators
 Hemispherectomy
 Multiple subpial transections
Surgical Management of Movement Disorders:
 Multidisciplinary assessment and management of patients with movement
disorders e.g. Parkinson’s disease and dystonia
 Selection, targeting and placement of deep brain stimulation electrodes
 Management of neuro-stimulators; radiofrequency lesioning

Neurovascular Surgery:
Special interest training will take place in units with extensive experience in
the multi-disciplinary management of all common intracranial vascular
disorders. Trainees with a special interest in neurovascular surgery will
develop additional expertise in:

Intracranial Aneurysms:
 Surgical and endovascular strategies for the management of ruptured and
un-ruptured intracranial aneurysms
 Surgical treatment of ruptured aneurysms of the anterior circulation
  Principles of microvascular reconstruction and bypass for complex
aneurysms
Intracranial Vascular Malformations:
 Surgical, endovascular and radiosurgical strategies for the management of
arteriovenous malformations
 Surgical treatment of superficial cortical arteriovenous malformations
Other Vascular Disorders:
 Surgical and endovascular treatment of dural arteriovenous fistulae
 Image-guided resection of cavernomas
 Management of primary intracerebral haematomas
 The management of venous occlusive disorders
 Medical, surgical and endovascular management of extracranial arterial
occlusive disease

Skull-Base Surgery
Special interest training in skull base surgery will take place in units with
extensive multi-disciplinary experience in the management of all common
skull-base disorders. Trainees with a special interest in skull base surgery
will develop additional expertise as follows:

Skull-Base and Craniofacial Surgical Access:

 Standard variations of fronto-basal, fronto-orbital, transzygomatic
infratemporal, transtemporal, far-lateral, transphenoidal and transmaxillary
approaches
Cranial Base Meningiomas:
 Resection of anterior fossa (olfactory groove and suprasellar)
meningiomas; tentorial and petrous temporal meningiomas; petroclival
meningiomas
Pituitary and Sellar Tumours:
 Microsurgical and endoscopic transphenoidal resection of pituitary tumours
 Pterional, subfrontal, interhemispheric and transventricular approaches to
suprasellar tumours
Acoustic Neuromas:
 Retrosigmoid, translabyrinthine and middle fossa resection of acoustic
neuromas
Other skull-base tumours:
  Management of other cranial nerve schwannomas, glomus tumours and
malignant primary and secondary tumours of the skull-base
Management of cranio-facial trauma:
 Management of fronto-orbital disruption
Repair of CSF Fistulae:
 Management of postoperative CSF fistulae
 Indications for endoscopic repair of basal CSF fistula
 Techniques for open repair and skull-base reconstruction

Spinal Surgery:
On completion of a special interest fellowship in spinal surgery trainees will
be competent in all aspects of the emergency and urgent operative

care of patients with spinal disorders. They will develop additional expertise
as follows:
Spinal trauma:
 Reduction and internal stabilization of atlanto-axial, sub-axial and thoraco-
lumbar fractures and dislocations
Metastatic Disease of the Spine:
 Posterior decompression and stabilization using pedicle screw, hook and
sub-laminar wire constructs
 Corporectomy and instrumented reconstruction of the anterior column
 Primary tumours of the spine
 Techniques for local ablation of benign lesions and en bloc resections of
malignant tumours
 Transpedicular and open vertebral and disc biopsy in vertebral osteomyelitis
and discitis
Intradural Tumours:
 The radical resection of intradural, extra-medullary tumours; biopsy and
optimal resection of intramedullary tumours
Syringomyelia and Hind Brain Anomalies:
 Foramen magnum decompression, syringostomy, syringopleural shunting,
detethering and duroplasty
Advanced Surgery of the Ageing and Degenerative Spine:
 Management of osteoporotic collapse, vertebroplasty, kyphoplasty
 Stabilization of the osteoporotic spine
 Operative management degenerative spondylolisthesis and scoliosis
 The assessment, counseling and pre-operative preparation of patients with
lumbar radiculopathies
 Interpretation of plain radiographs, CT scan, MRI scans and CT myelograms
 Primary lumbar microdiscectomy
 Primary posterior decompression (laminotomy, hemilaminectomy etc):
including
- Identification of spinal level by pre and intra-operative fluoroscopy
- Achieving safe access to the spinal canal by micro-surgical fenestration
- Achieving full decompression of the spinal canal, lateral recess and
foramen by appropriate bone and soft tissue resection
- Protection and safe retraction of neural tissues
 The assessment, counseling and pre-operative preparation of patients with
cervical myeloradiculopathies
 Interpretation of plain radiographs, CT scan, MRI scans and CT myelograms
 Single level anterior cervical discectomy with and without fusion
 Standard anterolateral approach to the cervical spine
 Use of fluoroscopy or plain radiographs to confirm spinal level
 Radical and subtotal excision of the cervical disc, PLL, central and unco-
vertebral osteophytes
 Protection and full decompression of the spinal cord and spinal nerve roots
 Interbody fusion using autologous bone with or without interbody cages

The Rheumatoid and Ankylosed Spine:

 Management of atlanto-axial subluxation
 Cranial settling and odontoid migration
 Sub-axial degeneration; cervico-dorsal kyphosis
Spinal Deformity:
 Multidisciplinary management of patients with spinal dysraphism,
diastematomyelia etc
 Thesis Component
(Fifth year of MS Neurosurgery Programme)
RESEARCH/ THESIS WRITING
Total of one year will be allocated for work on a research project with thesis writing.
Project must be completed and thesis be submitted before the end of training.
Research can be done as one block in 5 th year of training or it can be stretched over
five years of training in the form of regular periodic rotations during the course as long
as total research time is equivalent to one calendar year.

Research Experience
The active research component program must ensure meaningful, supervised
research experience with appropriate protected time for each resident while
maintaining the essential clinical experience. Recent productivity by the program
faculty and by the residents will be required, including publications in peer-
reviewed journals. Residents must learn the design and interpretation of research
studies, responsible use of informed consent, and research methodology and
interpretation of data. The program must provide instruction in the critical
assessment of new therapies and of the surgical literature. Residents should be
advised and supervised by qualified staff members in the conduct of research.

Clinical Research
Each resident will participate in at least one clinical research study to
become familiar with:
1. Research design
2. Research involving human subjects including informed consent and
operations of the Institutional Review Board and ethics of human
experimentation
3. Data collection and data analysis
4. Research ethics and honesty
5. Peer review process

This usually is done during the consultation and outpatient clinic rotations.

Case Studies or Literature Reviews

Each resident will write, and submit for publication in a peer-reviewed
journal, a case study or literature review on a topic of his/her choice.

Laboratory Research
Bench Research
Participation in laboratory research is at the option of the resident and may
be arranged through any faculty member of the Division. When appropriate,
the research may be done at other institutions.

Research involving animals

Each resident participating in research involving animals is required to:
1. Become familiar with the pertinent Rules and Regulations of the
University of Health Sciences Lahore i.e. those relating to "Health and
Medical Surveillance Program for Laboratory Animal Care Personnel" and
"Care and Use of Vertebrate Animals as Subjects in Research and
Teaching"
2. Read the "Guide for the Care and Use of Laboratory Animals"
3. View the videotape of the symposium on Humane Animal Care

Research involving Radioactivity

Each resident participating in research involving radioactive materials is
required to
1. Attend a Radiation Review session
2. Work with an Authorized User and receive appropriate instruction from
him/her.
 METHODS OF INSTRUCTION/COURSE CONDUCTION
As a policy, active participation of students at all levels will be encouraged.
Following teaching modalities will be employed:

1. Lectures
2. Seminar Presentation and Journal Club Presentations
3. Group Discussions
4. Grand Rounds
5. Clinico-pathological Conferences
6. SEQ as assignments on the content areas
7. Skill teaching in ICU, Operation theatres, emergency and ward
settings
8. Attend genetic clinics and rounds for at least one month.
9. Self study, assignments and use of internet
10. Bedside teaching rounds in ward
11. OPD & Follow up clinics
12. Long and short case presentations
In addition to the conventional teaching methodologies interactive strategies
like conferences will also be introduced to improve both communication and
clinical skills in the upcoming consultants. Conferences must be conducted
regularly as scheduled and attended by all available faculty and res idents.
Residents must actively request autopsies and participate in formal review of
gross and microscopic pathological material from patients who have been
under their care. It is essential that residents participate in planning and in
conducting conferences.

1. Clinical Case Conference

Each resident will be responsible for at least one clinical case conference
each month. The cases discussed may be those seen on either the
consultation or clinic service or during rotations in specialty areas. The
resident, with the advice of the Attending Surgeon on the Consultation
Service, will prepare and present the case(s) and review the relevant
literature.

2. Monthly Student Meetings

Each affiliated medical college approved to conduct training for MS

Neurosurgery will provide a room for student meetings/discussions such as:

a. Journal Club Meeting

b. Core Curriculum Meetings
c. Skill Development

a. Journal Club Meeting

A resident will be assigned to present, in depth, a research article or topic of

his/her choice of actual or potential broad interest and/or application. Two
hours per month should be allocated to discussion of any current articles or
topics introduced by any participant. Faculty or outside researchers will be
invited to present outlines or results of current research activities. The
article should be critically evaluated and its applicable results should be
highlighted, which can be incorporated in clinical practice. Record of all such
articles should be maintained in the relevant department.
 b. Core Curriculum Meetings

All the core topics of Neurosurgery should be thoroughly discussed during

these sessions. The duration of each session should be at least two hours
once a month. It should be chaired by the chief resident (elected by the
residents of the relevant discipline). Each resident should be given an
opportunity to brainstorm all topics included in the course and to generate
new ideas regarding the improvement of the course structure

c. Skill Development

Two hours twice a month should be assigned for learning and practicing
clinical skills.

List of skills to be learnt during these sessions is as follows:

1. Residents must develop a comprehensive understanding of the

indications, contraindications, limitations, complications, techniques, and
interpretation of results of those technical procedures integral to the
discipline
2. Residents must acquire knowledge of and skill in educating patients
about the technique, rationale and ramifications of procedures and in
obtaining procedure-specific informed consent. Faculty supervision of
residents in their performance is required, and each resident's
experience in such procedures must be documented by the program
director.
3. Residents must have instruction in the evaluation of medical literature,
clinical epidemiology, clinical study design, relative and absolute risks
of disease, medical statistics and medical decision-making.
4. Training must include cultural, social, family, behavioral and economic
issues, such as confidentiality of information, indications for life
support systems, and allocation of limited resources.
5. Residents must be taught the social and economic impact of their
decisions on patients, the primary care physician and society. This can
be achieved by attending the bioethics lectures
6. Residents should have instruction and experience with patient
counseling skills and community education.
 7. This training should emphasize effective communication techniques for
diverse populations, as well as organizational resources useful for
patient and community education.
8. Residents should have experience in the performance of neurosurgery
related clinical laboratory and radionuclide studies and basic laboratory
techniques, including quality control, quality assurance and proficiency
standards
9. Each resident will manage at least the following essential neurosurgical
cases and observe and participate in each of the following procedures,
preferably done on patients under supervision initially and then
independently;

Essential Neurosurgical Conditions:

 Cranial trauma
 Spontaneous intracranial haemorrhage
 Hydrocephalus
 Intracranial tumours
 CNS infections
 Spinal trauma
 Benign intradural tumours
 Malignant spinal cord compression
 Degenerative spinal disorders
 Emergency paediatric care
Essential Operative Competencies:
Initial Surgical Approaches
 Burr hole
 Craniotomy - convexity
 Craniotomy - pterional
 Craniotomy - midline supratentorial
 Craniotomy - midline posterior fossa
 Lateral posterior fossa
 Lumbar fenestration
 Laminectomy
General Procedures
 Insertion of lumbar drain
 Tapping/draining of CSF reservoir
  Application of skull traction
 Image Guidance/Stereotaxy set up
Management of Cranial Trauma
 Insertion of Intracranial (ICP) monitor
 Burr hole evacuation of CSDH
 Elevation of depressed skull fracture
 Craniotomy for traumatic haematoma (ICH)
Management of Spontaneous Intracranial Haemorrhage
 Craniotomy for spontaneous intracerebral
 Haematoma (ICH supratentorial)
 Craniotomy for spontaneous intracerebellar
 Haematoma (ICH infratentorial)

Management of Hydrocephalus
 Insertion of ventricular drain/access device
 Insertion of VP shunt
 Revision of VP shunt
Management of Intracranial Tumours
 Supratentorial tumour biopsy
 Craniotomy for supratentorial intrinsic tumour & metastasis
 Craniotomy for posterior fossa intrinsic tumour & metastasis
 Craniotomy for convexity meningioma
Management of Intradural Spinal Tumours
 Excision of intradural extramedullary tumour
 Management of degenerative spinal disorders
 Lumbar microdiscectomy
 Anterior cervical discectomy
Emergency Paediatric Care
 Insertion of EVD
 Evacuation of intracranial haematoma (ICH)

3. Annual Grand Meeting

Once a year all residents enrolled for MS Neurosurgery should be invited to

the annual meeting at UHS Lahore.
One full day will be allocated to this event. All the chief residents from
affiliated institutes will present their annual reports. Issues and concerns
related to their relevant courses will be discussed. Feedback should be
collected and suggestions should be sought in order to involve residents in
decision making.
The research work done by residents and their literary work may be
displayed.
In the evening an informal gathering and dinner can be arranged. This will
help in creating a sense of belonging and ownership among students and the
faculty.

LOG BOOK
The residents must maintain a log book and get it signed regularly by the
supervisor. A complete and duly certified log book should be part of the
requirement to sit for MS examination. Log book should include adequate
number of diagnostic and therapeutic procedures observed and performed,
the indications for the procedure, any complications and the interpretation of
the results, routine and emergency management of patients, case
presentations in CPCs, journal club meetings and literature review.

Proposed Format of Log Book is as follows:

Candidate’s Name: _________________________________
Roll No. _____________

The above mentioned procedures shall be entered in the log book as per
format:

Procedures Performed

Sr.# Date Name of Patient, Age, Diagnosis Procedure Supervisor’s

Sex & Admission No. Performed Signature
1
2
3
4

Emergencies Handled

Sr. Date Name of Patient, Age, Diagnosis Procedure/ Superviso

# Sex & Admission No. Manageme r’s
nt Signature
1
2
3
4
Case Presented

Sr.# Date Name of Patient, Age, Case Presented Supervisor’s

Sex & Admission No. Signature
1
2
3
4

Seminar/Journal Club Presentation

Sr.# Date Topic Supervisor’s

signature
1
2
3
4

Evaluation Record
(Excellent, Good, Adequate, Inadequate, Poor)

At the end of the rotation, each faculty member will provide an evaluation
of the clinical performance of the fellow.

Method of Evaluation
Sr.# Date (Oral, Practical, Theory) Rating Supervisor’s
Signature
1
2
3
4
 EVALUATION & ASSESSMENT STRATEGIES

Assessment

It will consist of action and professional growth oriented student-centered

integrated assessment with an additional component of informal
internal assessment, formative assessment and measurement-based
summative assessment.

Student-Centered Integrated Assessment

It views students as decision-makers in need of information about their own

performance. Integrated Assessment is meant to give students responsibility
for deciding what to evaluate, as well as how to evaluate it, encourages
students to ‘own’ the evaluation and to use it as a basis for self-
improvement. Therefore, it tends to be growth-oriented, student-controlled,
collaborative, dynamic, contextualized, informal, flexible and action-
oriented.

In the proposed curriculum, it will be based on:

 Self Assessment by the student

 Peer Assessment
 Informal Internal Assessment by the Faculty
Self Assessment by the Student

Each student will be provided with a pre-designed self-assessment form to

evaluate his/her level of comfort and competency in dealing with different
relevant clinical situations. It will be the responsibility of the student to
correctly identify his/her areas of weakness and to take appropriate
measures to address those weaknesses.

Peer Assessment

The students will also be expected to evaluate their peers after the monthly
small group meeting. These should be followed by a constructive feedback
according to the prescribed guidelines and should be non-judgmental in
nature. This will enable students to become good mentors in future.

Informal Internal Assessment by the Faculty

There will be no formal allocation of marks for the component of Internal

Assessment so that students are willing to confront their weaknesses rather
than hiding them from their instructors.

It will include:

a. Punctuality
b. Ward work
c. Monthly assessment (written tests to indicate particular areas of
weaknesses)
d. Participation in interactive sessions

Formative Assessment

Will help to improve the existing instructional methods and the curriculum in
use

Feedback to the faculty by the students:

After every three months students will be providing a written feedback
regarding their course components and teaching methods. This will help to
identify strengths and weaknesses of the relevant course, faculty members
and to ascertain areas for further improvement.

Summative Assessment

It will be carried out at the end of the programme to empirically evaluate

cognitive, psychomotor and affective domains in order to award diplomas for
successful completion of courses.

MS Neurosurgery Intermediate Examinations

 Total Marks: 500

All candidates admitted in MS Neurosurgery course shall appear in

intermediate examination at the end of second calendar year.

At the end of 2nd year Calendar of the programme

Written Examination = 300 Marks

Clinical, TOACS/OSCE & ORAL = 200 Marks
Total = 500 Marks
Written:
MCQs 100 (2 marks each MCQ)
SEQs 10 (10 Marks each SEQ)

Total = 300 Marks

Principles of General Surgery = 70 MCQs 7 SEQs

Specialty specific = 10 MCQs 1 SEQs
Basic Sciences = 20 MCQs 2 SEQs

 Anatomy = 6 MCQs 1 SEQs

 Pharmacology = 2 MCQs -------
 Pathology = 6 MCQs 1 SEQ
 Physioogy = 6 MCQs -------

Clinical, TOACS/OSCE & ORAL

Four Short Cases = 100 Marks
One Long Case = 50 Marks
TOACS/OSCE & ORAL = 50 Marks

Total = 200 Marks

 Final Examination MS Neurosurgery
Total Marks: 1500

All candidates admitted in MS Neurosurgery course shall appear in Final

examination at the end of structured training programme (end of 5th
calendar year) and after clearing Intermediate examinations.

There shall be two written papers of 250 marks each, Clinical, TOACS/OSCE
& ORAL of 500 marks, Internal assessment of 100 marks and thesis
examination of 400 marks.

Topics included in paper 1

1. Neurotraumatology (25 MCQs)

2. Cerebrovascular Neurosurgery (25 MCQs)
3. Paediatric Neurosurgery (30 MCQs)
4. Infections of Nervous System (20MCQs)

Topics included in paper 2

1. Neuro-oncology (20 MCQs)

2. Functional and Stereotactic Neurosurgery (20 MCQs)
3. Neuro-ophthalmology / Neuro-otology (20 MCQs)
4. Skull-Base Surgery (20 MCQs)
5. Spinal Surgery (20 MCQs)

Components of Clinical Examination

Theory

Paper I 250 Marks 3 Hours

5 SEQs 50 Marks
 100 MCQs 200 Marks

Paper II 250 Marks 3 Hours

5 SEQs 50 Marks
100 MCQs 200 Marks

Only those candidates, who pass in theory papers, will be eligible to appear in
the Clinical, TOACS/OSCE & ORAL .

Clinical, TOACS/OSCE & ORAL 500 Marks

Four short cases 200 Marks

One long case: 100 Marks
TOACS/OSCE & ORAL 200 Marks

Continuous Internal Assessment 100 Marks

MS Neurosurgery
Thesis Examination
Total Marks: 400
All candidates admitted in MS Neurosurgery course shall appear in Final
thesis examination at the end of 5th year of the MS programme. The
examination shall include thesis evaluation with defense.