University of Cincinnati CAST Neurotrauma Fellowship

Introduction

This 12-month Neurotrauma Fellowship provides subspecialty training to provide surgical, leadership, and research expertise in Neurotrauma. 

This Neurotrauma fellowship is designed for Neurosurgery PGY-7 or post-residency graduates. 

Requirements for entering the fellowship: 

1. completion of 3-6 months of critical care rotations during junior residency 
2. completion of requirements for graduation (for PGY-7 applicants) 
3. completion of a US ACGME neurosurgery residency preferred (for post-residency applicants) 

Core Learning Objectives

1. To become an expert in the clinical management of complex neurotrauma patients (TBI and SCI), consisting of expert surgical technique, neurocritical care management, and evidence-based medicine
2. To learn how to propose and administer a successful neurotrauma quality improvement program
3. To understand the coding, billing, and financial aspects of sustaining a successful neurotrauma practice
4. To understand the regulations surrounding ACS Level I trauma status and the neurosurgeon’s role
5. To understand the importance of continued research, with an emphasis on clinical trials, to advancing the subspecialty of neurotrauma 

Learning and Teaching Environment

UC Medical Center (UCMC) provides care for over 1200 neurotrauma (brain and spine injury) patients each year. UCMC is the region’s only Level 1 Trauma Center with a catchment area of over 2.9 million individuals. The patients treated at UCMC range from milder injuries to those requiring surgery. Severely injured neurotrauma patients receive specialty ICU care in UCMC’s state-of-the-art Neuroscience Intensive Care Unit (NSICU). The NSICU unit is staffed by 5 full-time neurology-trained neurointensivists and 5 Emergency Medicine trained neurointensivists. The NSICU boasts state-of-the-art technology across its 20 dedicated beds and 8 flexible care beds, including capabilities to perform continuous EEG monitoring (cEEG) 24/7 and extensive network connectivity for multimodality neuromonitoring with time-locked cEEG and intracranial measurements with 4 dedicated Moberg Component Neuromonitoring System units and networked physiology display for remote review. Both 1.5T and 3T MRI are available for clinical and research use and are located within adjacent buildings. Working with the Department of Neurosurgery, the NSICU has developed a comprehensive neuromonitoring protocol for patients with severe brain injuries, such as TBI. The NSICU uses multi-lumen bolts to facilitate insertion of intracranial pressure and brain tissue oxygenation catheters, cerebral blood flow catheters, cerebral microdialysis and intracranial (depth and subdural) EEG electrodes. The collaborative effort between UC Department of Neurosurgery (Dr. Laura Ngwenya, Fellowship director), and the NSICU team (Drs. Brandon Foreman and Simona Ferioli, fellowship faculty) has developed a translational platform for multimodality clinical care and for the diagnosis and monitoring of spreading depolarizations. UCMC leads the national Spreading Depolarizations clinical trials, with international expert Dr. Jed Hartings. Our experience in multimodality monitoring is unique, one of the few academic neurocritical care units that provides comprehensive monitoring, and the only neurocritical care unit in the United States with recognized expertise in detecting and treating spreading depolarizations. Thus, in addition to the high volume of complex surgical cases, neurotrauma fellows will receive training in management of patients utilizing advanced multimodal neuromonitoring tools.

Fellows will be exposed to inpatient and outpatient TBI and SCI patients and will be an integral part of the patient care team, including surgery, non-operative management, and coordinating continuity of care. In addition to daily patient rounds, weekly clinic, and Department of Neurosurgery Grand Rounds, the Neurotrauma Fellow will also participate in Neurotrauma and Neurocritical Care specific didactics, research teams, and seminars.

Additionally, there are many active clinical trials and basic science neurotrauma research opportunities available on campus. Fellows are expected to participate and contribute to neurotrauma-focused manuscripts. Interested fellows, with pre-approval, can elect to spend additional research time cultivating their academic interests.

Neurotrauma Fellowship Faculty

Laura Ngwenya, MD, PhD, Assoc. Professor of Neurosurgery; Fellowship Director (Neurotrauma center director, TBI)

Justin Virojanapa, DO – Asst. Professor of Neurosurgery (spine)

Rani Nasser, MD – Assoc. Professor of Neurosurgery (spine) 

Graham Garrison, MD - Asst. Prof of Neurology and Rehabilitation Medicine (rehabilitation)