Montefiore Einstein Department of Neurological Surgery Residency Program

While providing care for Montefiore Einstein’s more than 1.4 million patients in a department that performs more than 1,500 surgeries and procedures each year, residents gain broad surgical experience with some of the most unique and complex cases. Residents typically manage patients from low socioeconomic backgrounds who do not have access to primary care, and, in many cases, their pathology is more progressed than average upon initial presentation. Our residents join a department that is currently expanding, with the addition of new faculty and the active hiring of new attendings.

Surgical training is broad and diverse, encompassing all aspects of neurological surgery, including neuro-oncology, cerebrovascular neurological surgery, spinal neurological surgery, pediatric neurological surgery and neurocritical care, as well as functional and epilepsy surgery. Our educational program is, therefore, developed around a comprehensive surgical and educational curriculum. Educational elements include neurological surgery grand rounds; neuro-oncology, vascular and spine conferences; journal clubs; cadaveric courses; and interdisciplinary specialty conferences in both the clinical and basic neurosciences.

Our operative education is based on a groundbreaking approach to residents’ training in the operating room using innovative, educational software technology and training modalities that allow for a standardized methodology to identify individual strengths and weaknesses. From that standardized platform, we can design individualized modules that optimize surgical training to meet the required educational standards while also catering to each physician’s unique needs.

In addition to wide and extensive experience in general neurosurgical conditions, the efforts of the Department of Neurological Surgery are focused in several major programmatic areas. The faculty is organized into areas of sub-specialization, giving the resident excellent exposure to each of these disciplines, in addition to the more general neurosurgical experience. The emphasis of the training program is on providing outstanding clinical experience and expertise in all fields that are appropriate for pursuing a career in academic or clinical neurological surgery. The volume and intensity of the exposure have enabled many graduates of the program to obtain positions without taking additional fellowship training.

All aspects of cerebrovascular disease are managed at the participating hospitals. Microsurgical management of aneurysms and arteriovenous malformations is an area of major interest. In addition, interventional neuroradiology with the availability of intra-arterial embolization, angioplasty and stenting has increased our ability to manage the complex disorders that are referred to us at both hospital sites. Merritt Kinon, MD, Vijay Yanamadala, MD, and Reza Yassari, MD, are responsible for the management of intracranial and extracranial cerebrovascular disorders.

Active programs in surgery and treatment of brain tumors exist at both Montefiore and Roosevelt Hospital. These include the management of benign and malignant tumors in both adult and pediatric populations. In addition to neurosurgical management, emphasis is placed on the multidisciplinary management of these complex problems. Close interaction among neurological surgery, neuro-oncology and radiation oncology through the Tumor Board provides an opportunity for the residents to be exposed to current protocols and management strategies. The Department of Neurological Surgery is also a participant in the Montefiore Einstein Comprehensive Cancer Center. Diagnostic facilities include CT and MRI imaging and spectroscopy, as well as PET and SPECT scanning. Surgical management utilizes the latest surgical techniques, including advanced microsurgical methods, frameless stereotactic guidance, ultrasound and endoscopic visualization. Radiosurgery is also available. Patrick A. LaSala, MD, and Rick Abbott, MD, at Montefiore Einstein and Dr. LaSala, Dr. Abbott and Adesh Tandon, MD, at Roosevelt Hospital supervise the adult and pediatric tumor programs.

Patients with complex partial seizure disorders are evaluated for management and consideration for surgical treatment. Facilities for monitoring patients with implanted electrodes to aid in localization are available at both sites. PET scanning is used to complement the electrophysiologic localization of the seizure focus. Dr. LaSala and Dr. Abbott direct the adult and pediatric surgical program in epilepsy and collaborate with The Epilepsy Center of the Department of Neurological Surgery.

An extensive program in advanced techniques of spine surgery, including stabilization techniques, is available. Collaboration with orthopedics is encouraged. Merritt Kinon, MD, Vijay Yanamadala, MD, and Reza Yassari, MD, are responsible for these programs.

An integrated program in complex skull base surgery has been developed with the Department of Otorhinolaryngology. Surgical laboratory facilities are available to prepare the residents for involvement with adult and pediatric patients who have tumors and congenital abnormalities. The rotation at Roosevelt Hospital is under the direction of Garet Gordon, MD a former fellow of Montefiore Einstein. Milan K. Sen, MD, directs the efforts at Montefiore Einstein.

Andrew J. Kobets, MD and Mandana Behbahani, MD see the general range of pediatric neurosurgical cases at Children's Hospital at Montefiore, with special emphasis on craniofacial reconstruction for congenital abnormalities and brain and spinal cord tumors.

The Neurological Surgery Residency Training Program at Montefiore Einstein admits one to two residents each year for seven years of clinical and research training, challenging them with graduated responsibilities and progressive independence.

After the internship year, the clinical rotations are structured at both the junior and senior levels (two years each), followed by one year of in-depth training or research, culminating in a final year as a chief resident.

The Department of Neurological Surgery is organized along subspecialty lines with concentrated experience in the areas of cerebrovascular disease; neuro-oncology and skull-base surgery; and spinal, functional and pediatric neurological surgery. Each rotation is structured to ensure a graded and increasing level of responsibility as the resident progresses through the training.

We also offer peripheral nerve surgery rotations with the Department of Orthopedic Surgery.

In addition to clinical and surgical training, the curriculum offers educational and didactic opportunities in both informal and formal settings.

A formal weekly lecture series covers a number of important topics in preparation for the written boards. The program also includes neurological surgery grand rounds and spine and vascular conferences, as well as Tumor Board and operative conferences. The weekly resident forum meeting provides residents with a platform to discuss concerns and ideas and encourages the active involvement of residents in the programmatic and clinical curriculum.

Regular journal clubs, the Morbidity and Mortality Conference, cadaveric dissection courses and an educational program utilizing the infrastructures provided by the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS), as well as AOSpine and industry-sponsored courses, all provide well-rounded and in-depth exposure to the entire spectrum of clinical neurological surgery. In addition, all residents participate in a hospital-sponsored patient safety and medical ethics conference. Finally, our residents have the chance to gain experience in global neurological surgery through an annual neurosurgical mission program to Mongolia.