Parent Page: Academic Departments id: 21836 Active Page: PGY-3 & PGY-4 Pediatric Neurosurgery & Research Residentsid:29498

PGY-3 & PGY-4 Pediatric Neurosurgery & Research Residents Curriculum

The PGY-3 year continues to be a heavy clinical year. They are the workhorses of the clinical service. More time is spent in the OR as a PGY-3 resident, participating as an assistant or actively observing the critical portions of complex neurosurgical procedures. During the PGY-4 year, as residents transition from junior to senior years, they are provided more time to define and strategize their individual plans for professional development as frontline clinical responsibilities begin to ease. A dedicated block of research is undertaken in the PGY-4 year. “Research” time may be utilized for basic / translational research, clinical / population health research, a clinical intensive (mini-fellowship), or pursuing a professional graduate certificate. Exposure to pediatric neurosurgery is usually achieved during these formative years in training, in addition to continued rotations at OUMC and the VA.

Pediatric neurological surgery is an important area of subspecialty knowledge and practice, both for general neurosurgeons with comprehensive practices and for those who will concentrate their practice on children. Pediatric neurosurgery includes care of infants, children and adolescents and comprises medical and surgical care of the central and peripheral nervous system, their dural and bony coverings, intracranial and cervical extracranial cerebral vasculature, and function. Pediatric neurosurgeons also offer counseling to families with in-utero diagnoses of congenital nervous system malformation. Pediatric neurosurgeons may also care for some patients with congenital nervous system disease into adulthood. Thus, many disease conditions and decisions faced by pediatric neurosurgeons. Residents rotating on the pediatric neurosurgery service have already obtained a foundation in basic neurosurgical procedures.

During that time, they will work with the attending pediatric neurosurgeons as well as myriad other clinical services in Oklahoma Children’s Hospital (OCH).

The service includes general pediatric neurosurgical clinic and multidisciplinary clinic, during which the resident may be involved in the evaluation of new referral patients and will follow-up with patients they have previously managed or operated on. The resident may also see all new consults during the day and may assume care of consults from the covering night resident each weekday morning, under the supervision of the attending surgeon. The resident will also attend didactic conferences geared towards pediatric neurosurgery.

The resident will scrub on all operative neurosurgical cases in OCH and perform all ICU and bedside procedures while in the hospital. Participation in the cases will be dictated by resident ability, case complexity, patient safety, and learning experience. It represents a significant opportunity to gain skill and confidence with complex and microsurgical cases, including craniotomy for tumor, epilepsy, vascular and other problems, endoscopy, intradural spinal operations, and hydrocephalus management.It also allows residents who do not plan to care for children upon entering practice to have some expertise in caring for adults with congenital neurosurgical disease.

The resident will be expected to continue self-directed learning, especially as related to relevant current cases.

The resident will continue to participate in department teaching conferences.

Pediatric neurosurgery raises particularly salient issues of ethics, complex systems based care, and delicate family communications.

Medical Knowledge and Patient Care

  • Describe the embryology of congenital CNS malformation
  • Describe the intra- and peri-operative physiology of the premature infant, infant and child
  • Describe the pathophysiology of congenital, post-hemorrhagic, post-infectious, post-traumatic,
  • and myelomeningocele associated hydrocephalus
  • Describe the tumor biology of CNS malignancy in children
  • Describe the pathophysiology of childhood epilepsies, cortical dysplasia and heterotopia
  • Describe the principles of safe and effective pain management in small children
  • Discuss appropriate medical, surgical, and endoscopic management of obstructive and communicating hydrocephalus
  • Discuss management of myelomeningocele patients in pre-natal, infant, child and adult age groups
  • Discuss primary and secondary management of tethered spinal cord, including diagnosis of secondary tethering in a spina bifida clinic
  • Discuss ICU management of severe traumatic brain injury in children
  • Discuss the diagnosis and management of non-accidental trauma
  • Discuss the management including ICU care, bracing, and surgery for spinal cord and column injury in infants and children
  • Discuss the management of congenital Erb' s palsy
  • Discuss the role of surgery in medically refractory epilepsy treatment in children, including resective surgery and VNS
  • Discuss intra-operative and post-operative strategies for resection and adjunctive therapy in medulloblastoma, cerebellar astrocytoma and other brain tumors
  • Discuss appropriate post-traumatic and peri-operative narcotic orders in infants and children
  • Discuss appropriate sedation agents, doses and the regulatory limits on supervised sedation in pediatric patients
  • Describe the principles of medical and surgical management of spinal cord injuries common to childhood: SCIWORA and craniocervical injury
  • Describe the treatment of Chiari I malformation and syringomyelia, including the differential diagnosis of and various direct and indirect surgical treatments for syringomyelia
  • Describe the medical and surgical management options in severe spasticity and dystonia related to cerebral palsy
  • Describe the medical and surgical management principles in patients with neurocutaneous disorders, including neurofibromatosis types I and II, hereditary hemorrhagic telangiectasia, and tuberous sclerosis.
  • Describe the medical and surgical management of patients with intracranial and intraspinal
  • Describe the medical and surgical management of CNS infections and parasitic infection
  • Identify the purposes and limitations of computer surgical navigation and intra-operative MRI in young children
  • Write appropriate PICU and post-op orders appropriate for a premature infant, infant, child, and adolescent
  • Demonstrate the proper performance of a complete and a targeted neurological examination in different age groups and circumstances:
    • Infant
    • Child
    • Adolescent
    • Developmentally delayed patient 
  • Demonstrate the ability to obtain and evaluate proper radiological studies in children:
    • MRI brain and spine
    • Cine MRI CSF flow study
    • MRA/MRV
    • CT brain and spine
    • 3D CT skull for synostosis
    • CSF shunt and baclofen pump x-ray series
    • VNS x-ray series
  • Demonstrate ability to manage, with supervision, neurosurgical emergencies in children:
    • Status epilepticus
    • Cerebral herniation
    • CNS infection
    • Unstable spine
    • Severe CNS metabolic abnormality
    • Severe CSF shunt malfunction 

  • Demonstrate the ability to evaluate patients for CSF shunt infection and/or failure
  • Demonstrate the ability to evaluate pediatric neurotrauma patients
  • Demonstrate the ability to perform basic bedside and ICU procedures in children:
    • CSF shunt tap
    • ICP monitor
    • Ventriculostomy
    • Lumbar puncture/Lumbar drain placement
  • Demonstrate the ability to position, prepare and drape pediatric patients, including infants, for insertion of CNS implanted devices (including CSF shunt)
  • Demonstrate the ability to handle tissue and choose appropriate instrumentation and suture material for the very small infant or child
  • Demonstrate appropriate placement of cranial immobilization devices, including Mayfield pins, in young children
  • Demonstrate the ability to participate in the multi-disciplinary management of craniosynostosis patients, including peri-operative planning and management, and postoperative care.
  • Be able to perform with supervision:
    • Craniotomy for supratentorial lesion (tumor, cysts, epilepsy, etc.)
    • Craniotomy for infratentorial lesions (tumor, Chiari, etc.)
    • VP/VA/LP shunts
    • Baclofen pump insertion
    • Craniofacial reconstruction other craniosynostosis surgeries
    • Repair myelomeningocele, encephalocele
    • Detether spinal cord
    • Endoscopic III ventriculostomy
    • Basic dorsal spinal stabilization
    • Dorsal approaches to spinal cord lesions (tumors, cysts, etc.) 


  • Demonstrate care and compassion for pediatric neurosurgical patients and their families
  • Demonstrate respect for patients and colleagues from diverse cultural, ethnic and religious
  • Demonstrate honesty in all professional interactions
  • Demonstrate punctuality for scheduled conferences and rounds
  • Provide consultation to the ED and other services in timely fashion and/or arrange for back-up consultation if unavailable
  • Comply with all GME and Departmental regulations regarding duty hour restrictions and report personal schedule in timely and accurate fashion
  • Accurately self-report fatigue in situations that may compromise safety and/or patient care

Interpersonal and Communication Skills

  • Demonstrate the ability to communicate complex care plans to families
  • Demonstrate the ability to provide sensitive, accurate and complete information and consent regarding a surgical procedure or other intervention, particularly in difficult situations: 
    • Parents consenting on behalf of young minor
    • Consent via a translator
    • Consent with non-traditional religious or cultural boundaries
  • Demonstrate the ability to communicate effectively with nurses in PICU, NICU and Ward, Pediatric Neurosurgery Nurse Practitioners and peers on other services
  • Provide complete and effective sign out and sign in with on call neurosurgery residents covering the service
  • Demonstrate the ability to interact supportively with infants and young children using non-verbal and play-related techniques
  • List ACOG and AAP guidelines for folic acid supplementation in menarchal females.
  • Communicate effectively with other members of the neurosurgery team.

Practice Based Learning

  • Prepare and present cases from the Pediatric Neurosurgical Service at Departmental M & M conference
  • Describe the outcomes of neurosurgical intervention in infants and children through longitudinal follow-up of all service patients for 12 months and, if possible, prepare a report of one patient outcome variable from the pediatric neurosurgical practice. Published work is encouraged. 

Systems Based Practice

  • Describe the nature of complex interdisciplinary team management in "Disease-focused Care" in a children’s' hospital.
  • Manage communication with the PICU and Pediatric Trauma teams regarding co-care patients
  • Interact with Pediatric Neurosurgical Nurse Practitioners, Physical Therapists and Social Workers in planning longitudinal care of pediatric neurosurgery patients.
  • Describe regulatory issues regarding notification and work-up of non-accidental trauma