Division of NeurosurgeryDavid Geffen School of Medicine at UCLA

Box 956901 Los Angeles, California

90095-6901

David Geffen School of Medicine

at UCLA

Neurosurgery

Residency Program

1. Message from the Chief

2. History of the Division

4. Faculty

5. Clinical and Research Programs

7. Neurosurgical Training

13. Hospitals in Rotation

20. Additional Information

Table of Contents

The UCLA Division of Neurosurgery has a long rich history ofinnovation and neurosurgical training. From its inception, the divisionhas been at the forefront in epilepsy surgery, stereotactic surgery, andthe treatment of cerebral aneurysms with embolic materials. Today'sdivision continues to be an innovator in cerebrovascular disease, epilepsysurgery, and stereotactic surgery, but has also expanded to make significant contributions to newdevelopments in head trauma,neuronavigation, and interventionalMRI guided surgery. The division isalso developing the neurosurgicaltechnologies of the future includingclinical trials in tumor immuno-therapy and intraoperative optical imaging.

At UCLA, we are committedto maintaining the most currentneurosurgical equipment and tech-niques as well as actively pursingthe development of future trends.This environment is perfect forpreparing residents to step into thefuture as practicing neurosurgeons.We are committed, first and foremost, to resident education and havebeen able to effectively utilize the research and development at UCLAto further this goal.

The majority of UCLA Neurosurgery resident graduates go on toeither a subspecialty neurosurgical fellowship position or directly intoan academic neurosurgical position due to an environment of nationalexperts and cutting edge research. This same environment attractsacademically oriented applicants and encourages the pursuit of academicneurosurgery. I am excited to train the neurosurgery leaders of tomorrowand to have the opportunity to lead such a strong program into theTwenty-first Century.

Neil A. Martin, MDProfessor and Chief, Residency Training DirectorDivision of NeurosurgeryDavid Geffen School of Medicine at UCLA

Message from the Chief

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The David Geffen School of

Medicine at UCLA Neurosurgery

Residency Training Program began on

the main Westwood campus in 1955

with Dr. W. Eugene Stern as the first

chairman. Well regarded as an excellent

clinical training program, UCLA

helped pioneer the use of the operative

microscope, cryothalamotomy, and

embolization of intracranial

aneurysms. The university, with strong ancillary facilities, became an early

leader in the surgical treatment of epilepsy and in the development of

microvascular decompression for trigeminal neuralgia.

Dr. Donald P. Becker became the Division

Chairman in 1985. To develop a

Neurosurgery Center of Excellence, Dr.

Becker created a divisional programmatic

approach recruiting sub-specialists from

the United States and around the world.

The faculty grew, as did the caseload. This

growth resulted in two residents being

accepted into the program each year. In

addition to developing a highly academic

and active clinical service, Dr. Becker also

promoted a strong basic research foundation for the division with the purpose

of encouraging the training of academic neurosurgeons. Under Dr. Becker's

guidance, the program has grown in national prominence to the point of

being named the eighth best neurosurgery program in the country in 2002 by

the publication U.S. News & World Report.

History of the Division

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Dr. Neil A. Martin became Chief of UCLA Division of Neurosurgery

in 2001 following a lengthy tenure as a prolific faculty member. He completed

his residency training at the University of California, San Francisco and

fellowship training in neurovascular surgery at the Barrow Neurological

Institute. Dr. Martin is a strong advocate for research and academic neuro-

surgery and has, himself, published over one hundred fifty peer-reviewed

articles and chapters on topics including neurovascular surgery, neurosurgical

intensive care, and brain trauma. As a faculty member at UCLA and

Director of the Neurovascular Surgery Program, Dr. Martin has been

instrumental in the development of a cerebral blood flow laboratory, the

nationally recognized UCLA Stroke Center, and a state of the art neurosurgical

intensive care unit. He has personally been involved in the design of many

aspects of the 2004 Westwood Replacement Hospital and a hospital wide

digital record system that allows access to patient records, clinical imaging,

and real time ICU vital sign monitoring on personal digital assistant devices.

Since his inception as Division Chief, Dr. Martin has overseen the growth of

the UCLA Spine Program including the recruitment of a minimally invasive

spine surgery expert and the expansion of the Neurosurgery Division to the

Santa Monica-UCLA Medical Center for the development of a new Spine

Center. With a new hospital and state-of-the-art

technology, Dr. Martin is committed to

keeping the UCLA Medical Center

Division of Neurosurgery at the

cutting edge of neurosurgical

science and practice.

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Ulrich Batzdorf, MDProfessorDirector, Spinal Disorder Program

Donald P. Becker, MDProfessor Director, Brain Tumor ProgramDirector, Benign & Skull Base Tumor Program

Marvin Bergsneider, MDAssociate ProfessorDirector, Hydrocephalus ProgramDirector, iMR ProgramCo-Director, Neuroendoscopy Program

Antonio De Salles, MD, PhDProfessorDirector, Stereotactic, Radiosurgery,& Functional Program

Fredric I. Edelman, MDAssociate Clinical ProfessorDirector, Peripheral Nerve Program

Avner L. Feldman, MDAssociate Clinical ProfessorDirector, Clinical Education Program

John G. Frazee, MDClinical ProfessorDirector, NeuroEndoscopy Program

Itzhak Fried, MD, PhDProfessorDirector, Adult Epilepsy ProgramCo-Director, Seizure Disorder Program

Christopher Giza, MDAssistant ProfessorPediatric Neurosurgery and Neurology

Fernando Gomez-Pinilla, PhDAssociate ProfessorNeurotrophic Factor Research

Langston Holly, MDAssistant ProfessorComprehensive Spine Program

David A. Hovda, PhDProfessorDirector, Brain Injury Research Center Program

Daniel F. Kelly, MDAssociate ProfessorDirector, Pituitary Program

Larry T. Khoo, MDAssistant ProfessorCo-Director, Comprehensive Spine Program

Jorge Lazareff, MDAssociate ProfessorDirector, Pediatric Neurosurgery Program

Stefan Lee, PhDAssistant ProfessorCo-Director, Neurotrauma Laboratories

Linda Liau, MD, PhDAssociate ProfessorDirector, Malignant Brain Tumor Program

Neil A. Martin, MDProfessor & ChiefProgram Director, Residency Training ProgramDirector, Neurovascular ProgramCo-Director, UCLA Stroke Center

Gary W. Mathern, MDAssistant ProfessorCo-Director, Pediatric Neurosurgery & Seizure Disorder Program

Duncan Q. McBride, MDAssociate ProfessorChief, Harbor/UCLA Dept. of Neurosurgery

Val Nenov, PhD, PhDAssociate ProfessorDirector, Brain Monitoring& Modeling Laboratory

Tien Nguyen, MDAssistant ProfessorHarbor/UCLA Dept. of Neurosurgery

Paul M. Vespa, MDAssociate ProfessorDirector, Neurocritical Care Program

Neurosurgery Faculty

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Clinical and Research Programs

Skull Base Surgery The Benign and Skull Base Tumor Program focuses on resection of tumors atthe skull base and makes use of advanced image guidance, minimally invasivetechniques, evoked potential monitoring, and intraoperative MRI. Over 2000cases have been done in the last decade.

Surgical EpilepsyThe Epilepsy Surgery Program is a key component of the UCLAComprehensive Epilepsy Program having treated intractable lesional andnon-lesional epilepsy over the past thirty years. Invasive electrode monitoringand pinpoint accuracy using functional MRI and brain stimulation permits ahigh cure rate and high quality of life measures.

Cerebrovascular SurgeryOver the last fifteen years, UCLA neurovascular surgeons, along withcolleagues in interventional neuroradiology and stereotactic radiosurgery,have treated more than 4000 aneurysms, arteriovenous malformations, cervicaland intracranial atherosclerosis. The use of awake carotid endarterectomy,image-guided stereotaxis, neuro-endoscopy, intraoperative angiography, andintraoperative MRI permits minimally invasive surgery with unsurpassedresults.

Pediatric NeurosurgeryPediatric Neurosurgery is a multidisciplinary program providing compre-hensive services to children suffering from epilepsy, brain tumors, hydro-cephalus, spinal malformations, neurovascular disorders, and craniofacialdisorders.

Functional Neurosurgery and Stereotactic RadiosurgeryUCLA is the first center in the United States to use a dedicated NovalisVarian SR600 unit for Shaped Beam Surgery, stereotactic radiosurgery, andradiotherapy. This permits much less radiation to surrounding normal tissuethan other methods. We have over ten years of experience with deep brainstimulation and other techniques for Parkinson’s disease and other move-ment disorders.

Spinal SurgeryThe Comprehensive Spine Program uses minimally invasive techniqueslike endoscopic laminectomy, as well as complex reconstructive spinalinstrumentation, to treat cervical, thoracic, lumbar, and sacral spine due todegenerative, congenital, traumatic, neoplastic or infectious origins. Wefeature a thirty-year experience in treating syringomyelia, spinal cordtumors, arteriovenous malformations, and other complex spinal disorders.

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Clinical and Research Programs (cont.)

Peripheral Nerve SurgeryThe Peripheral Nerve Surgery program boasts a twenty five-year experience intreating surgical disorders of the brachial plexus, lumbosacral plexus, andperipheral nerves that originate from injuries, compression syndromes, andtumors. MR neurography, endoscopic surgery, outpatient surgery, and directednerve blocks are a few of the advanced treatments available.

Brain Trauma and Neurocritical CareThe UCLA Brain Injury and Neuro-critical Care Program provides comprehensivecare for brain trauma, subarachnoid and stroke patients. We feature a state-of-the-art neuro-intensive care, continuous EEG and TCD monitoring, brain oxygenmonitoring, and positron emission tomography. An internationally recognizedprogram in basic and clinical research has focused on development of newtreatments for brain injuries for the past fifteen years.

Malignant Brain Tumor Program The Malignant Brain Tumor Program offers a thirty-year experience in thecomprehensive, multidisciplinary approach to malignant brain tumors. A teamof neurosurgeons, neuro-oncologists, radiation oncologists, neuropathologists,and interventional neuroradiologists conducts advanced treatment plans andresearch protocols.

Neuro-endoscopyNeuro-endoscopy utilizes small endoscopes to perform many microsurgicaloperations on the brain and spine. Disorders such as hydrocephalus, thirdventricular tumors, intracerebral hemorrhage, herniated discs, and pituitarytumors have been treated using endoscopy at UCLA for the past ten years.

Pituitary SurgeryThe UCLA Pituitary Tumor and Neuroendocrine Program features minimallyinvasive techniques to treat pituitary tumors. A fifteen-year experience hasmolded a diverse team of specialists in Neurosurgery, Endocrinology,Radiosurgery, Neuro-Ophthalmology, and intraoperative MRI to treat pituitarytumors.

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The rotations of the UCLA neurosurgery residency have beendesigned and organized to maximize resident education while providingenough flexibility for the individual resident to explore specific neurosurgicalinterests. The rotation schedule is built around a set progression of four tosix-month clinical neurosurgical rotations. The sequence of rotations has beendeveloped to allow the resident gradually increasing levels of responsibilityand technical skill in various clinical situations. Following the second year,the two to three residents in the same class are staggered by four to six months,with one following the other in clinical neurosurgical rotations, so the exacttime in which each resident does each rotation may vary by four to six months.

First and Second Years

The rotation schedule begins with the internship year. This year isimportant in developing basic patient care concepts and surgical skills thatapply across multiple subspecialties as well as introducing the trainee to theexpectations and responsibilities accompanying surgical training. Each internrotates on several general surgery and surgery subspecialty services. Of specialinterest to the neurosurgical intern are the two neurosurgery rotations, one atUCLA and one at the VA. The UCLA rotation is important in learning the careof neurosurgery inpatients and understanding the organization and culture of

the service. The VA rotation is anopportunity to gain more neuro-surgery operative experience. Theother notable intern rotation istrauma surgery during which theneurosurgery intern gains skillsand knowledge concerning thetrauma suite and care of the traumapatient that will serve h/him wellin h/his second year. The interncall schedule is in-house Q3 to Q6depending on the rotation.

The second year is devoted entirely to the neurosurgery service at the Westwood Campus. During this year, the neurosurgery residentshares responsibility with the attending surgeon for the intensive care unitpatients, consults (including trauma and other emergency room consult),and the pediatric patients. Residents also gain a great deal of operativeexperience in this year. It is common for second year residents to operatemost or all working days of the week. A resident will typically participatein over 300 cases in the second year with gradually increasing involvementin each case until the resident, working under the attending surgeon, is in charge of the majority of trauma patients and [other] straightforward cases.To insure that this does not detract from the important critical care and

Neurosurgical Training

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trauma education, there are daily neuro critical care rounds and weeklyneurosurgery trauma rounds. The second year call schedule is in-houseQ3 – Q4.

On a rotational basis, each second-year resident, with direct attendingoversight, has sole responsibility for the neurosurgery pediatric/spine/functional services, the tumor/epilepsy services, and the vascular service. Thisperiod of time in the second year is specifically for learning neurosurgical andpatient care skills in each of these neurosurgery subspecialty services.

Third and Fourth Years

The third, and sometimes half of the fourth, year is spent on non-neurosurgical rotations or research. These non-neurosurgical rotations andthe research opportunities at UCLA will be discussed later. Every attempt ismade to place the residents in non-neurosurgical rotations immediately afterthe second year rather than directly into a research rotation so that the residentshave time to develop research project proposals and apply for grants ifapplicable. This is resident dependent and can be negotiated by residentswho are industrious in research planning during the second year. The residentwill typically have responsibility for Q6 in-house call during six months ofthis period.

The fourth year or half of fourth and fifth years are spent in twosenior rotations of six months each, first at Harbor and then at UCLA. AtHarbor, the senior works closely in a team with the chief resident supervisingtwo interns and running the neurosurgery service. During this rotation, thesenior resident is in the operating room on three scheduled days a week and,under the supervision of the attending surgeon, participates on all emergencysurgical procedures together with the chief resident. The senior residentgains more operative skills and learns how to supervise lower level traineesin an environment that is not as busy as UCLA. As senior resident at UCLA,the resident is in the operating room almost every day and is responsible,together with the junior resident, for reviewing every consult with the attendingsurgeon. The senior resident at UCLA is the first assistant surgeon, workingdirectly under the attending surgeon, in the majority of cases in which s/heparticipates, and s/he teaches the junior residents basic neurosurgicaltechniques including trauma surgery. This rotation can be busy but is essentialin making the transition to mature decision-making and proficiency in surgicalskills required of a chief resident. The senior resident will typically participatein over one hundred surgical cases at Harbor and around two hundred casesat UCLA. The resident's in-house call responsibilities for the entire residencyare completed by the time the senior rotations begin. The senior resident atHarbor is first back-up call from home two out of three nights; and, the seniorresident at UCLA is first back-up call from home for the entire six-monthrotation except for days off.

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Chief Years

There is a six-month block for non-neurosurgical rotations, research,or elective rotations after the senior year. This block is followed by the threechief rotations at the VA, Harbor and UCLA and usually with a break of sixmonths. The chief resident rotation at the VA is much like a private practice.The chief has one intern and is solely responsible for running the serviceproviding the first opportunity for independent decision-making concerningpatient care and the indications for surgery. The chief resident under theguidance of the attending staff makes decisions for clinic patients andinpatients and is the primary surgeon under the attending surgeon in almostall of the cases. The chief resident at the VA is first back-up call from homefor the entire six-month period, but calls are infrequent and emergencies arerare.

The chief resident at Harbor has similar responsibilities as the VAchief resident but with some key differences. The neurosurgical team is larger,the hospital is a level one trauma center so it is usually a busier service, andthe chief resident has responsibility for teaching the senior neurosurgeryresident on h/his service both surgical techniques and patient care. At thispoint, the chief resident's level of proficiency allows h/him to do the mostcomplex cases with guidance from the attending surgeon and to take thesenior resident through cases appropriate to the senior level. The chief residentis second back-up call from home two of three nights and first back-up callthe third night. The chief resident typically becomes involved any time apatient goes to the operating room.

The chief resident rotation at UCLA is the final rotation. During thisrotation, the chief resident has the opportunity to lead a large team at a majormedical center including neurosurgery residents at the senior and junior levels,two surgical interns, nurse practitioners, ICU fellows, and rotating medicalstudents. At this point, the chief resident is able to fine tune his surgical skillsand obtain experience in surgeries only seen at a tertiary medical center witha large regional referral base. With rare exceptions, the chief resident is thefirst assistant to the attending surgeon on all cases in which he or she partici-pates. Teaching responsibilities at this level include medical student, intern,and junior resident teaching during rounds and teaching the junior residentsbasic opening and closing skills in the operating room. Graduating chiefresidents have typically completed over one thousand cases during theirresidency. The chief resident is second back-up call for the four-monthrotation, but is seldom called unless there is an interesting case in which he orshe may want to participate.

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brain tumor immunotherapy, now in clinical trials, was developed. There isan active cerebral blood flow laboratory with ongoing projects in subarachnoidhemorrhage and ischemia. Clincal and basic science studies of epilepsyinclude cerebral microdialysis during phase two monitoring and seminalstudies of hippocampal physiology using animals and human surgicalspecimens. The neuroendocrine program is actively investigating the impactof head trauma on pituitary function.

Two new state of the art laboratories have been developed with thecollaboration of industry. Within the Division of Neurosurgery, the skull baseand spine laboratory has all the equipment of a full operating room includingBrainLAB neuronavigation. This laboratory has been used for investigationof novel cranial base approaches, endoscopy research, and research of the useof neuronavigation for spinal instrumentation. The laboratory is currentlybeing equipped for research on minimally invasive spine surgery. TheDepartment of Surgery has recently opened a new laboratory dedicated toresearch and training of minimally invasive and robotically assisted surgery.

The UCLA Brain Research Institute is a multidisciplinary researchinstitute interested in normal and pathologic brain development and function.Opportunities exist for residents, with a well-developed research plan, tocollaborate with the Brain Research Institute or virtually any department inthe university for their research time.

Elective Rotations

There is usually a six-month rotation, not specifically designated forone of the rotations outlined above, within each resident's rotation schedule.The resident has the opportunity to select a specific educational opportunityfor this time period as long the goals and responsibilities of the six-monthsare explicitly outlined in writing. Usually, residents use this time to continueworking on a successful research project or to do clinical work with anindividual attending or group of attendings in a specific subspecialty of inter-est. Additionally, this has been a time when residents have done an electiverotation at Santa Monica-UCLA Medical Center in spine surgery and spinalinstrumentation. Because the Division of Neurosurgery at UCLA has nation-ally recognized experts in nearly every neurosurgical subspecialization,fellowship rotations at outside institutions are not encouraged. However, thedivision recognizes that individual residents may want to gain an outsideperspective on a surgical subspecialty; therefore, residents who obtain theirown funding for this period are usually granted permission to do a six-monthrotation in a nationally recognized subspecialty fellowship.

Non-Neurosurgical Clinical Rotations

There are several clinical rotations required or recommended forboard certification that are included in the resident's schedule between theneurosurgical rotations outlined above. These rotations are a three-monthneurology rotation, two months of neuroradiology, and two months of neuro-pathology. There is also a two-month rotation in radiosurgery, stereotactic,and functional neurosurgery including experience in surgery for movementdisorders and pain. This is a neurosurgical rotation but is scheduled indepen-dently from the other neurosurgical rotations because many of the proceduresoccur at the UCLA Outpatient Center allowing for more focused learning ofthese techniques by the resident.

Research

Residents have a minimum of one year of research time either in oneblock or split into two six-month periods. Individual residents may choose todo more research time by utilizing non-clinical elective rotations in the lateryears for research. The research block typically occurs after the second year.

Residents are encouraged to explore their individual researchinterests during this time. Each resident is required to write a formal researchproposal prior to the start of the project and submit a minimum of one paperto a national peer-reviewed journal following the rotation. Residents are

encouraged to apply for researchgrants; however, obtaining aresearch grant is not required fordoing the research rotation.

There are several research pro-grams with total funding by theNIH and other sources of millionsof dollars within the Division ofNeurosurgery. Many opportunitiesto collaborate with other laboratoriesthroughout UCLA, an institutionknown for its cutting edge neuro-science, also exist. The Brain Injury

Research Center is the largest research program within the Division ofNeurosurgery. This research program has robust funding and many basicscience and clinical investigators. There are both clinical and basic scienceresearch projects that include topics of post-concussive hyperglycolysis andexcitotoxicity.

The division has an active brain tumor research laboratory in which

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Operative Experience

UCLA and its’ affiliated hospitals provide the neurosurgical residents with more than a sufficient number of cases for their training. Witha strong community and referral base of unique and interesting cases, theoperative experience continues to grow. The graph below demonstrates thenumber of major operative neurosurgery cases at UCLA and affiliated hospitals.

The following graph is a breakdown of a recent graduate's residencyoperative caseload. Of these cases, the resident claimed 75% as primarysurgeon. This case distribution and level of involvement is exemplary of theexperience gained by UCLA neurosurgery residents.

30%

21%12%

8%

8%

6%4%

3% 1% 7% Spine

Tumor

Vascular

Pediatric

Trauma

CSF Shunt

Epilepsy

Stereotactic

Peripheral Nerve

Other

0

500

1000

1500

2000

2500

Num

ber

of C

ases

1998 1999 2000 2001 2002Academic Year

Santa MonicaVAHarborUCLA

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Conferences

Wednesdays are set aside for conferences. The residents typicallyoperate in the morning, and then leave surgery in the afternoon to attendconferences. Mandatory weekly conferences include a morning clinicalconference in which cases and operations are presented and discussed, neuro-trauma/neuro critical care conference, and clinical ward teaching rounds.

Following these conferences, there are a variety of other mandatory weeklyconferences including neuroradiology, neuropathology, basic science neuro-surgery board preparation course, clinical specialty conference, and journalclub. In addition, visiting professors are invited to the division several times ayear for a Clinical Neurosurgery Symposia. Typically two talks are given andclinical cases discussed with the residents over the course of the day. QualityAssurance Conference is held once a month during the morning conferencetime.

Resident Evaluations

The faculty evaluate the residents two times a year. Each facultymember completes an independent, written evaluation of each resident. Agroup of three faculty members, including the division chief, review all theevaluations and compile them into a single statement that is discussed withthe resident during a biannual meeting with the residency director.

The residents anonymously review the program and faculty annuallyfollowing a written format. The residents participate in a retreat once ortwice a year to provide feedback about the program in a group format. Thisretreat is conducted to continually improve the learning environment in thedivision.

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Hospitals

David Geffen School of Medicine at UCLA

The David Geffen School of Medicine at UCLA main campus islocated in the beautiful community of Westwood, contiguous with the UCLAmain campus. The 644 bed medical center is a major tertiary referral centerfor the West Coast. U.S. News & World Report has rated UCLA as "Best inthe West" among major medical centers and fifth in the country for overallmedical and surgical subspecialty programs.

All major neurosurgical subspecialties are well represented at themain campus. The medical center has all the latest advances in neurosurgicaltechnology including two intraoperative MR suites, BrainLAB neuronavigation,and Novalis stereotactic radiosurgery equipment allowing the residents to betrained in cutting edge technology.

UCLA has developed a regional stroke center that takes a multi-disciplinary approach to neurovascular disease, incorporating neurovascularsurgery, world-class interventional neuroradiology, and neurology. Numerousskull base procedures are performed, sometimes in coordination withcolleagues in head and neck surgery and opthomology. There are severalclinical and research programs dealing with malignant, benign, pituitary, andmetastatic brain tumors within the division.

The epilepsy surgery program has a strong foundation in both adultand pediatric populations spanning decades of experience and includingmultiple N.I.H. funded research projects. Many stereotactic surgeries areperformed at UCLA including stereotactic radiosurgery and movement disorder

surgeries. The spine program is involved in all aspects of operative spinalpathology including spinal instrumentation and minimally invasive spinal surgery. In addition, UCLA has very active pediatric neurosurgery, neuro-endoscopy, hydrocephalus, and pain surgery programs to round out theresident education.

UCLA is a Level-One Trauma Center and a major center for neuro-trauma research with significant funding from the N.I.H. and the State ofCalifornia. Because of strict regional trauma center territories, this does nottranslate into a greater volume of head trauma, but it does mean that there isbetter care for the head trauma patient and more support available to theresidents in caring for the head trauma patient.

UCLA Replacement Hospital

Following the 1994 Northridge earthquake, UCLA was given a statemandate as well as state and federal funds for building a new hospital. The2004 UCLA Westwood Replacement Hospital across the street from theoriginal hospital is a state-of-the-art facility that incorporates the mostadvanced concepts in inpatient care. The hospital is designed for 590 beds,each in a private room. Almost all of the rooms are able to be converted intoan ICU, monitored, or unmonitored inpatient bed as hospital needs changeon a daily basis. There is an invasive floor that integrates the operatingrooms, including an interventional MR operative suite and interventionalradiology suites. The new computerized medical record system is accessibleto handheld personal digital assistant devices.

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resident. Several unique disease entities are encountered at Harbor not seenas often at other institutions; one such pathology is central nervous systeminvolvement by cysticercosis. Treatment of these patients is often complexand frequently requires neuroendoscopy or other innovative techniques intheir management.

West Los Angeles V.A. Medical Center

The West Los Angeles Veterans Administration Medical Center is a288 bed hospital located two miles west of the main UCLA Medical Centerand is the southwest referral center in neurosurgery for the VeteransAdministration. Cases are referred from around Southern California andoccasionally from out of state. The medical center has active clinical trials inthe treatment of movement disorders with deep brain stimulation.

The six-month period as chief resident at the VeteransAdministration Hospital helps the resident hone skills in spine surgery,including complex spinal instrumentation. Approximately 60% of the 150-350 surgical procedures performed annually at the V.A. are spine cases. Thegenerally older patient population of the V.A. gives additional experience inthe difficult management of chronic back problems, degenerative disk disease,and movement disorders.

Neuroendoscopy also has had an important role in the trainingprogram at the V.A. Residents obtain experience in endoscopic navigationfrom intraventricular exploration in hydrocephalus to transnasal trans-sphenoidal exploration during pituitary adenoma resection.

Harbor - UCLA Medical Center

Residents receive excellent training in a county hospital environmentat Harbor-UCLA Medical Center, a 530 bed hospital located in the South Baycommunity of Torrance, 22 miles south of the main UCLA Medical Center.Approximately 200-400 operations and 100-300 procedures are performedannually at Harbor. This caseload is quite diverse as to the types of cases withapproximately 50% intracranial, 40% spine, and 10% shunts, peripheral nerve, etc.

Longitudinal patient care is an advantage of the Harbor rotationsince residents evaluate patients pre-operatively in the clinic or the emergencyroom, make the diagnosis, participate in the surgery and inpatient hospitalcare, and follow-up post-operatively in clinic to evaluate the patient'sprogress.

Residents receive strong training in neurovascular surgery, neuro-endoscopy, and spinal instrumentation. There is particularly strong trainingin intracranial aneurysm surgery. Neurosurgery actively collaborates with theendocrine division in the treatment of pituitary tumors giving residents a firmfoundation in the transnasal transsphenoidal approach. Head injury protocolsare coordinated with the main UCLA campus as part of the N.I.H. fundedclinical research. The head trauma experience is plentiful without being over-whelming. As Harbor is a Level-One Trauma Center, the responsibility oftrauma patient care is shared with a dedicated trauma surgery team from theHarbor General Surgery Residency Program.

The county hospital environment also develops decision-makingskills and autonomy by helping to season residents in their six-month seniorrotations, and by polishing their skills during their six-month rotation as chief

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Santa Monica - UCLA Medical Center

Santa Monica-UCLA Medical Center is a 337 bed, acute care medicalcenter located four miles west of the main UCLA Medical Center. In 1995,UCLA Healthcare acquired the medical center; and, today it serves as thecornerstone of UCLA Healthcare's Primary Care Network, providing high-quality primary and specialty care to the Westside community.

In 2000, the Division of Neurosurgery at UCLA began shifting someof its spine surgery practice to Santa Monica-UCLA Medical Center. This wasdone to expand the program and facilitate access to more patients in theWestside community. Currently, the division does over sixty cases a year atthe Santa Monica-UCLA Medical Center including basic spine surgery, spinalinstrumentation, and minimally invasive spine surgery. This number continuesto grow. Resident involvement typically occurs during a clinical electiverotation block during which a resident may choose to gain more focusedexperience in spine surgery.

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Santa Monica - UCLA Replacement Hospital

In a similar situation to the Westwood Campus, UCLA received astate mandate as well as state and federal funds to replace the Santa MonicaHospital after the Northridge earthquake. The result is the 2005 SantaMonica-UCLA Replacement Hospital, a 266 bed hospital constructed onthe same site as the original Santa Monica-UCLA Medical Center. This hospitalwill function in collaboration with the Los Angeles Orthopaedic Hospital thatwill relocate its inpatient services to Santa Monica-UCLA Medical Center. Witha combination of orthopaedic and neurosurgical services, Santa Monica-UCLAMedical Center is the headquarters of UCLA's developing multidisciplinaryspine surgery program.

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For further information regarding the residency program, please contact:

Administrative DirectorDivision of Neurosurgery Education ProgramDavid Geffen School of Medicine at UCLABox 957039Los Angeles, California 90095-7039

Telephone 310.794.7362FAX 310.267.2707

Questions / Further InformationAdditional Information

Recreation

Los Angeles is conveniently located near a variety of sports, recre-ation, and cultural opportunities. Big Bear Mountain, a two-hour drive fromL.A., offers excellent conditions for skiing or snowboarding. The PacificOcean, five miles west of the UCLA campus, offers opportunities in a widevariety of water sports. Weekend trips to Santa Barbara, Catalina Island,Palms Springs, and Mexico are very short drives. There are year-round con-certs at the Dorothy Chandler Pavilion, the New Disney Concert Hall, andUCLA's Royce Hall and seasonal outdoor concerts at the Hollywood Bowl.Numerous amusement parks, movie studios, and sporting events are alsoclose by for entertaining visiting family and friends.

Housing

Low rent, university owned housing is available for house staff andfaculty. The Westwood neighborhood in which UCLA is located and theentire west side of Los Angeles remain some of the nicest neighborhoods inthe Los Angeles region. There are many apartments within walking distanceof the university and medical center.

Miscellaneous

Residents are given four weeks of vacation per year except in thesecond and third years in which they receive two and six weeks of vacationrespectively. Contingent on the yearly budget, the division has traditionallyprovided the individual incoming junior residents with a gift of operativemagnification loupes. Also, the division has generously provided residentswith a holiday gift of book funds to be used to build each resident’s personalneurosurgical library.

Residents begin taking the American Board of Neurological Surgerywritten exam for self-assessment in their third year and usually take the examfor credit in their fifth year. The division typically sends each resident to aformal board preparation course on the year that s/he takes the written neu-rosurgery board exam for credit. Almost all of the residents from the UCLADivision of Neurosurgery have obtained scores well above the fiftieth per-centile on the national neurosurgery board exam in the year that they took itfor credit.

The majority of resident graduates from the UCLA Division ofNeurosurgery have gone into academic practices. There is a concentration ofresident graduates in California, but many graduates have taken positions incommunities throughout the United States and some internationally.