Teo Aesculap Fellowship

Background information

Subspecialisation within neurosurgery is still in its infancy

Most neurosurgeons have been trained and practice all facets of neurological surgery. However, within the large academic neurosurgical departments of developed countries there is a trend towards subspecialisation. Indeed, paediatric neurosurgery in the United States now has its own board, which requires its members to have at least 12 months of fellowship training and to pass a separate board exam. Similarly, the disciplines of vascular, functional, spinal, oncological and skull base neurosurgery are becoming more defined and complex often necessitating fellowship training.
The concept of minimally invasive neurosurgery originated with the keyhole craniotomy for intracranial pathology. Complications from the approach alone seemed unacceptable and from the desire to reduce the risk of craniotomy came this new discipline. Arguably the greatest breakthrough in minimally invasive techniques was the application of endoscopy to neurosurgery. The endoscope has revolutionised the treatment of patients with hydrocephalus, brain tumours, aneurysms, pituitary tumours and any intraventricular pathology. The 2 subspecialties of neuroendoscopy and paediatric neurosurgery are intimately related because more than 30% of paediatric cases involve conditions of cerebrospinal fluid dynamics or intraventricular pathology. Indeed, in order to practice contemporary paediatric neurosurgery one must be comfortable with all the aspects of endoscopy. 

Other tools that have made neurosurgery less invasive and equally, or more, effective are radiosurgery, frame-based and frameless stereotaxy and advances in technology such as ultrasonic aspirators, laser fibres and microsurgical instrumentation.

Program outline

Clinical fellowship in minimally invasive neurosurgery and paediatric neurosurgery

Location

• Prince of Wales Private Hospital (Primary Site), Australia
• Prince of Wales Hospital, Australia
• Sydney Children's Hospital, Australia

Period of training

6 months

Supervisor

Charles Teo MBBS, FRACS

Relieving supervisors

• Bernard Kwok MBBS, FRACS
• Ralph Mobbs MBBS, FRACS
• Marc Coughlan MBBS, FRACS

Conditions

• The fellow must have at least 4 years of basic neurosurgical training.
• The fellowship is a funded position.
• The fellow will not detract from the training of the rotational trainee. In situations where there is conflict the registrar will have first choice over the fellow. This situation should not arise as the fellow will be mostly based at the Prince of Wales Private Hospital where the rotational registrar is strongly discouraged from performing clinical duties.

Goals and objectives

The applicant after completion of fellowship will be trained in the following disciplines

Paediatric neurosurgery

The fellow will be comfortable with the diagnosis and management of all paediatric neurosurgical diseases including head and spine trauma, hydrocephalus and other problems of CSF dynamics, paediatric brain tumours, the tethered cord, spina bifida, craniofacial anomalies and other congenital abnormalities of the neuraxis. He/she will be particularly familiar with the application of endoscopy to paediatric neurosurgery.

Neuroendoscopy

The fellow will be familiar with the various types of endoscopes and be able to assess the differences in their capabilities, know when to use a flexible or a rigid scope, how to handle the various endoscopic instruments and fixation devices and set up the video chain in order to visualise, as well as record, procedures. He/she will appreciate the various aspects of setting up the operating suite and positioning the patient optimally. The fellow will appreciate the applications, the techniques, results and complications of endoscopy. He/she will be able to remove intraventricular tumours, such as colloid cysts, perform third ventriculostomy in all clinical settings, simplify complex hydrocephalus, manage arachnoid cysts and other extra-axial cysts, use the endoscope to assist in visualisation of extra-axial tumours and vascular malformations, remove pituitary tumours and other skull base lesions, both extra and intradural, purely endoscopically, perform endoscopic biopsy of tumours and evacuation of clots both intraventricular and intracerebral, perform microvascular decompression and other endoscopic procedures.

Other minimally invasive techniques

The fellow will be familiar with the selection of patients for and be able to perform different keyhole craniotomies e.g. the supraorbital craniotomy for parasellar and suprasellar pathology, the retrosigmoid keyhole craniectomy for diseases in the cerebellopontine angle and the subtemporal craniectomy for lesions in the middle cranial fossa and upper clivus.

Clinical and educational activities

General duties

The fellow will be expected to perform all aspects of patient care. He/she will assess and admit patients through the emergency department as well as those admitted electively, organise preoperative investigations, manage the postoperative care of patients and be on-call for their patients 24 hours a day. The fellow will NOT detract from the experience of the rotational registrar who will have priority over the fellow at times when clinical responsibilities may overlap.

General duties

The fellow will be expected to participate in clinical research and produce at least one publication for a peer-reviewed journal. The time for this educational activity will be mostly on Fridays.

Assessment

The fellow will be continually assessed throughout the term of training. He/she will then be assessed at the completion of the fellowship by a board, consisting of the supervisor, at least one of the relieving neurosurgical supervisors and at least one of the three hospitals' medical/clinical directors. Certificate of Training will then be issued after a consensus and submission of a manuscript for publication.

Application process

If you are interested in applying for a position in our clinical fellowship program, send us an e-mail stating why you would be the best candidate. In addition, please include the following materials with your application.

• A detailed CV
• Certified copies of your undergraduate and postgraduate qualifications
• Two written references