Neurosurgical anesthesia deals with the perioperative management of patients with neurological diseases or those at risk for neurological injury as a result of surgery. A broad background in cerebral physiology, neurological examination and diagnosis, and the effects of anesthetic agents on the nervous system is developed during the fellowship. The neuroanesthesia fellow will develop clinical skills in the perioperative management of patients with neurological disease to include anesthetic management, appropriate intraoperative monitoring, and post-anesthetic neurological critical care. Facility with intraoperative electrophysiologic monitoring of the nervous system is developed early in the training period.

The Department of Anesthesiology and Critical Care Medicine offers both clinical and research fellowships in Neuroanesthesia. One and two year positions are available. Clinically, the neuroanesthesia fellow will be exposed to all types of neurosurgical cases. The Division of Neuroanesthesia consists of 6 attending anesthesiologists, who manage over 2200 neurosurgical cases with 100 operative aneurysms and 486 brain tumors per year. There is an institutional interest in brain mapping as a diagnostic tool for severe seizure disorders. We are also a leading center in the use of hemispherectomy for the treatment of intractable seizures. The patient population varies in age from 1 day to the ninth decade. The fellow will be involved in management of all types of patients.

In the Neuroscience Critical Care Unit (NCCU), the fellow will gain experience in the daily care of complicated postoperative neurosurgical patients and learn management techniques for raised intracranial pressure, barbiturate coma, and cerebral vasospasm. Several members of the neuroanesthesia staff attend in the NCCU thus assuring a smooth and rewarding working relationship.

There are research opportunities abound in Neuroanesthesia. The members of the group are active in both clinical and basic research concerning cerebral physiology. There are currently several NIH funded projects focused on both mechanisms of cerebral blood flow and cerebral ischemia. These programs are run under the direction of the vice chairman of research Dr. Richard Traystman. Many of the faculty members in the neuroanesthesia group are actively involved in laboratory research providing for close interaction between the department's research and clinical faculty. There is ample opportunity to obtain superior research training in preparation for a career in academic anesthesia in the Neuroanesthesia Division.

The two year fellowship consists of four parts:

• Clinical OR (neuroanesthesia)
• Clinical non-OR (neuroscience intensive care)
• Basic and clinical research
• Clinical training in the use of neuro-monitoring and transcranial doppler.
• Research will comprise 50% of the fellow's time. Initially, the fellow will be co-investigator in ongoing projects before developing original research.

A one year fellowship is also offered and may be structured to suit the individual. This clinical year may comprise elements of neuro-monitoring, clinical OR, and neuroscience intensive care.