CNS Rotation
Residents will rotate with Dr. Mehta to evaluate adult and pediatric patients with CNS conditions, including benign and malignant tumors, functional disorders such as trigeminal neuralgia and non-tumor conditions treated with radiotherapy, such as arteriovenous malformations. These patients will be seen primarily in a multidisciplinary context, together with adult and pediatric neurosurgeons, medical oncologists, radiologists, pathologists, endocrinologists, opthalmologists, rehab physicians and other support personnel. The rotation will provide opportunities in enhancing the multidisciplinary knowledge in the management of these conditions. Since the vast majority of patients are treated with advanced radiotherapy techniques such as 3-D radiotherapy, image-fusion based treatment planning, radiosurgery, fractionated stereotactic radiotherapy, etc, residents will have ample opportunity, and are highly encouraged, to become proficient in the application of these technologies. In order to truly appreciate the multidisciplinary management of these patients, all patients with new CNS conditions seen at UWH are discussed at the weekly combined modality Neuro-Oncology Conference, attendance at which is required; this will include neuroradiology and neuropathology review every week. Additional optional learning opportunities include participation and/or observation at the weekly Monday afternoon Brain Cutting Autopsies at the VAH, under the direction of Dr. Shariar Salaamat; attendance at the Neuropathology for Residents course taught by Dr. Salaamat; observation of angiographic procedures with Dr. Strother and observation of neurosurgical procedures with Dr. Badie.
Typically, in an average 3-month rotation, residents will have contact with approximately 40-80 new CNS problems, and over 100 follow-up contact opportunities. In addition, in an average 3-month time span, residents will have the opportunity to participate in over 2 dozen 3-D and image-fusion treatment planning procedures, 20 radiosurgery cases and 20 fractionated stereotactic radiotherapy procedures.
Goals and Objectives
Observe and understand the etiology, epidemiology, molecular genetics, pathophysiology, clinical presentation, natural history, treatment options, risks and benefits of various options and long-term sequalae of treatment, including functional and neurocognitive outcome for patients with various CNS conditions as listed above. Understand the educational, social, societal, quality of life and cost-effectiveness issues surrounding the management of the above patients. Understand the multimodality approaches to these conditions, and learn an appropriate physician behavior pattern that optimizes multidisciplinary interaction. Become proficient in the technical aspects of radiotherapeutic management of CNS conditions, including routine radiotherapy, as well as specialized applications such as 3-D radiotherapy, the use of multimodality imaging through image fusion, stereotactic radiosurgery, fractionated stereotactic radiotherapy, craniospinal set-ups, IMRT (once implemented) and Tomotherapy (once implemented). It is also expected that a basic foundation in the radiobiologic concepts underpinning these approaches will be developed. The ocular melanoma service is housed under the CNS service. Learn to evaluate these patients in a multimodal fashion with Drs. Chandra and Lucarelli in Opthalmology; learn the natural history, treatment options, risks and benefits and sequale of therapy for these patients. Understand the principles of plaque brachytherapy and participate in the application of these devices. Expect to perform six procedures in a 3-month time period. Become proficient in the application of palliative radiation therapy techniques, including, but not limited to brain metastases, leptomeningeal dissemination, cord-compression, cauda-equina syndromes, nerve root entrapment syndromes, etc. Understand the relative merits and application of other palliative modalities in this context. Learn to make appropriate decisions regarding resource utilization for these patients. Learn the value of and utilize Hospice services appropriately for such patients. Understand and appreciate the opportunities for clinical and translational research in this patient population.