The residency program is based at Saint Barnabas Medical Center (SBMC) in Livingston, New Jersey and is affiliated with Hackensack University Medical Center (HUMC), a 775 bed facility in Hackensack, New Jersey. These two hospitals combine for over 2,500 major neurosurgical procedures per year covering the full spectrum of neurological diseases. There is a general adult neurosurgery service and pediatric neurosurgery at both hospitals. The general neurosurgery service has subdivisions of general, vascular and endovascular surgery, epilepsy, functional, brain tumors and a complex spine surgery. The epilepsy surgery center with 16 monitored beds at Saint Barnabas Medical Center under the direction of Dr. Werner Doyle who is also an Associate Professor of Neurosurgery at New York University Langone Medical Center and at the forefront of epilepsy research. Eight epileptologists make this one of the largest in the state. At HUMC the epilepsy program which is certified as level 4 includes ten epileptologists. It treats some 600 patients per year and approximately 60 major epilepsy cases are performed there. The section of functional neurosurgery at SBMC is mainly related to pain procedures and is part of the Pain Institute under the direction of Dr. R. Pak, D.O. who also teaches osteopathic principles to the residents. He and Dr. Conyack, D.O. perform approximately 1,400 procedures per year in addition to the major procedures. The functional subdivision at HUMC in addition to pain procedures includes deep brain stimulation for Parkinson’s disease and movement disorders. SBMC is currently in the process of establishing its own movement disorder and deep brain stimulation program. Both hospitals have dedicated neuroradiology service with modern angiography-endovascular suites and there are six interventional endovascular neurosurgeons at Saint Barnabas Medical Center and three at Hackensack University Medical Center. The Radiology departments have several CT scans, modern MRI machines, PET scan and nuclear medicine sections. There is a dedicated Neurosurgical ICU at both hospitals with full time intensivists. At SBMC and HUMC there are fully established Neuropathology services with Pathology residency program at SBMC. There is a Radiation Oncology Service with stereotaxic radiosurgery capabilities. At both institutions the Neurosurgical service together with a radiation oncologists and a nuclear physicist form a stereotaxic radiosurgery group using the LINAC system. There is a Gamma knife machine at HUMC. There are several medical Neuro-oncologists on the staff at SBMC and there is a full Neuro-oncology service at HUMC both adult and pediatric. Saint Barnabas Medical Center does not have a trauma service and Hackensack has a level II trauma service. This provides for adequate exposure to trauma. Further experience in the management of head/multiorgan trauma can be obtained through elective rotation. HUMC is applying for designation of Level I Trauma Center.
The residents interact with members of other residency programs including General Surgery, Medicine, Ob/Gyn, ENT, Anesthesia, Pathology, Radiology, Pediatrics and Emergency Medicine. They participate in teaching medical students from NYCOM, Rutgers Medical School and St. George’s University in Grenada. As part of their training, neurosurgical residents examine all consults and all patients undergoing surgery in which they participate. They assume increasingly more active role in surgery, commensurate with their level of training. Neurosurgical residents also participate in the care of patients in private offices with the appropriate attendings. In both hospitals there is a large pediatric neurosurgery service with several fellowship trained pediatric neurosurgeons. There is a Free standing NACHRI approved Children’s Hospital at HUMC. Together, the pediatric neuro-surgeons at the two hospitals treat most pediatric neurosurgical cases in the State of New Jersey. In addition to routine cases, they perform complex brain surgery using stereotaxic navigational systems and endoscopic techniques. Intraventricular procedures either open or endoscopic are part of the spectrum of pediatric cases as is craniofacial surgery.
The residents can participate in clinical research. There is currently a protocol for clinical measurements of intraventricular CSF Ca++ and K+ activities as a way of predicting patients survival after major strokes, SAH and head trauma. There is also an approved protocol to develop a simple computer program for localizing brain lesions from MR coordinates and ultrasound. At HUMC there is a fully staffed and equipped animal laboratory under the direction of a veterinarian. In addition to surgical protocols where residents learn basic surgical techniques during their first two years of training, there is also microneurosurgical curriculum teaching usage of microscope and microsurgical technique for residents during their senior years. Amongst the tools and equipment, there is Zeiss microscope and a complete set of neurosurgical tools including bipolar cautery and Midas Rex drill. All residents will spend time there before graduating. There is also gross anatomical lab there where residents can dissect cadavers in training courses for peripheral nerve surgery and spinal surgery instrumentation. There is a cadaver course sponsored by the Stryker company where residents learn basic surgical techniques and spine instrumentation. There is a special Neurosurgical Education Fund established from private donations that has adequate funds to support these endeavors as well as residents participation in various conferences and training courses. During their training, the residents can request “mini fellowships” at renown institutions that perform procedures not available at either of the hospitals. In 2012/2013, the Chief Resident spent six weeks at the New York Presbyterian Hospital with Dr. Theodore Schwartz learning the technique of expanded endovasal transphenoidal surgery. The residency program has a reciprocal arrangement with the IIIrd Medical Faculty of Charles University in Prague, Czech Republic and the Chief Resident spends six to eight weeks there in the last months of his/her training which is paid for from the Education Fund. The residents are required to participate in academic endeavors and two abstracts have been accepted for the AANS meeting in 2014, three for the AOS meeting and one for oral presentation at the joint AANS/Congress of Neurological Surgeons Spine Section meeting. Residents are encouraged to continue their education in the form of a fellowship. All four residents that graduated from our program, three were accepted at well regarded programs, one at Cooper Medical for trauma and two at Cleveland Clinic for endovascular surgery and pediatric neurosurgery respectively and one at the Swedish Spine Institute in Seattle. All residents are required to take several “in house” multiple choice in service exams in addition to the National In Service exam given by the ACOS.
As described above the large clinical volume, highly trained faculty and academic facilities including the animal lab and clinical research provide basis for an excellent training institution. The program has been recently inspected and approved for the next five (5) years by the ACOS and the Neurology and Neurosurgery Programs at both the Saint Barnabas Medical Center and the Hackensack University Medical Center where the residency is based have been recently named as one of the 50 best hospitals in the nation in those specialties by the U.S. News and World Report magazine.
The residents receive in their first year a loan of a pair of surgical telescopes which becomes their property upon graduation. The residents take call from home or the hospital depending on volume of cases and cover only the hospital (SBMC, HUMC) where they are assigned for the month, never both. The on-call schedule complies with the 80hr/week rule which is strictly observed. Both hospitals are located within 5 and 15 miles respectively from Manhattan with great cultural opportunities available. There are rental apartments for the residents near SBMC which is located in a pleasant suburban area with great schools and recreational opportunities.
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