The Endovascular Surgical Neuroradiology (ESN) program has been in effect since July 1, 2003. The duration of the program is two years, with the second year being ACGME accredited. Applications to the ESN fellowship program are accepted from candidates who have successfully completed Neurosurgery residencies, as well as Neuroradiology and Vascular Neurology Fellowships (following Radiology and Neurology ACGME accredited residencies). All trainees will use the first year of the program as a preparatory year, which is tailored to their particular background and needs.
In the case of the Neuroradiology trainees, a preparatory first year is offered with the general goal of expanding their exposure to diagnostic neuroangiography, and in particular broadening their exposure to clinical Neurosurgery / Neurology (including clinical signs/symptoms, natural history, treatment planning, physiological monitoring, intracranial pressure/ pathophysiology, pharmacology, and neurological intensive care management). Objectives for the first preparatory year include patient care, demonstrate ability to perform and interpret diagnostic neuroangiography, demonstrate command of imaging and clinical diagnosis of (endo) vascular disorders, and demonstrate competency in directing ward care of endovascular cases.
Interpretations of diagnostic and interventional procedures are double read by senior staff throughout the first and second year. All interpretations are performed based on digital images on workstations distributed throughout the Imaging Institute using voice recognition software to expedite reporting to the referring services. Images are stored centrally on a large digital archive, providing ready access to nearly all of the digital imaging dating back 10 years. Procedures are initially performed by the staff for teaching purposes. Subsequently, the trainee performs the procedures under direct supervision and then assumes more independence once competence is demonstrated. During the second year of ESN the Senior Staff will have the responsibility of the primary operator and the trainee serves as first assistant.
Endovascular Neurosurgery fellows and residents are responsible for reviewing diagnostic CT’s and MR’s. Diagnostic angiograms are shared between the first year neuroradiology fellow and the cerebrovascular fellows. During the second year, the fellow assumes a more proactive role, thereby performing interventional procedures. Dictations are also shared during the fellowship and are distributed by the staff.
Endovascular Neurosurgery fellows are expected to participate in clinical conferences, regular daily patient management rounds in conjunction with the NICU, Departments of Neurology, Neurosurgery, Neuropathology, Otolaryngology, Ophthalmology, General Medicine, and Pediatric subspecialties. The fellow is also expected to participate in the didactic and patient management conferences which are held with the Divisions of Neurology, Neurosurgery, Neuropathology, Vascular Surgery, Otolaryngology, and Ophthalmology on a regular basis. All clinical conferences are open to fellows; they are actively encouraged to attend all conferences but are required to attend weekly CV case conferences, weekly neurosurgery patient management, and monthly endovascular M&M as well as journal club.
The fellow is expected to prepare at least one one-hour didactic conference during the first year and to prepare two such conferences during the second year. Otherwise, the trainee’s teaching responsibilities are the one-to-one teaching of residents and medical students during the daily reading sessions. They also work with the residents on the Neuroradiology rotations to acquire interesting cases for the weekly case conference in which they are the primary presenter. One staff member is also present at each conference to aid in the discussions.
Endovascular Neurosurgery staff are actively involved in research and the neuroradiology fellow is strongly encouraged, to participate in basic and/or clinical research during the two years. They will also be strongly encouraged to present research at national meetings and to prepare manuscripts for publication during these two years.
Each trainee is evaluated by each neuroradiology staff member on a monthly basis and all forms are forwarded to the neuroradiology program director for review. Combined six-month evaluations are submitted to the Graduate Medical Education Office and are reviewed with the trainee on a semi-annual basis by the Clinical Competency Committee.
How to Apply
Please direct any questions and/or complete the fellowship application and send with current curriculum vitae, personal statement, medical school transcripts, USMLE transcript, current licensure, and 3 letters of recommendation to:
Gabor Toth, MD, FAHA
Vascular Neurology and Endovascular Neuroradiology
Cleveland Clinic Neurological Institute
9500 Euclid Avenue, S80
Cleveland, OH 44105
Lisa Kempton, MEd, RT(R)
Education Program Administrator
Cleveland Clinic Imaging Institute
9500 Euclid Ave. L10
Cleveland, Ohio 44195
Subsequent required interviews will be granted on a first come, first serve basis.