go to: http://residents.neurosurgery.mgh.harvard.edu
Guide for Residents,
Interns, and Students
Massachusetts General Hospital
is intended primarily for the internal use of students, interns,
and residents rotating on the MGH neurosurgical service. Others
are welcome to browse with knowledge of that fact.
RESIDENCY PROGRAM AT MASSACHUSETTS GENERAL HOSPITAL
The length of the Training Program is six years.
This includes five years of residency and 12-18 months of expanded
training. Six to twelve months of the expanded training year is
spent in research and six months in
clinical activity as Assistant in Neurosurgery at the MGH. The five
years of Residency Training include seven six-month clinical rotations
and 18 months of laboratory research. The mandatory research period
is a single
time block between the Senior clinical rotations. There is an additional
six months of research, either coincident with that time block or
just before the first clinical rotation. There are no clinical responsibilities
during the research period.
We accept two Residents per year. The clinical
rotations start on a staggered basis, every six months (January
1 and July 1). The Resident who begins on January 1, spends the
six months from July to December in research. With the exception
of a three-month rotation at Boston Children's Hospital at the Junior
Resident level, all clinical assignments are at the MGH. The sequence
of rotations is designed to provide the trainee with clinical experience
of graded and increasing complexity with responsibilities appropriate
to their level of training. In addition to their responsibilities
for in-patient and Emergency Ward care, all residents on clinical
rotations participate in the Neurosurgical Outpatient Clinic one
day a week. The in-hospital night call schedule is every third night.
This is shared by all residents on clinical rotations.
For purposes of coordinating Neurosurgical Service
activities Visiting Staff members are assigned to a clinical team
(East or West). The order of resident assignments is such that he/she
rotates through all Service teams, thus coming under the supervision
of every member of the Visiting Staff. In the final six months of
the Chief Resident year, the trainee is directly supervised by the
Chief of Service, Dr. Bob Carter, MD, PhD. Thereafter, the graduating Resident
completes his/her six months of extended clinical training with
a Staff appointment at the MGH. During that period, he/she is in
charge of the North neurosurgical team.
II. DESCRIPTION OF CLINICAL ROTATIONS
In the following sequence, only one resident
is assigned to each position at a given time.
1. NEUROLOGY (MGH, 6 months): The trainee shares clinical responsibilities
with MGH Neurology residents at the Junior level, taking part in
the activities and conferences of that service. This includes familiarization
with EEG and other electrodiagnostic techniques.
2. NORTH TEAM JR. (MGH 6 months): This rotation is the trainee's
initial exposure to clinical neurosurgery. He/she assists the recently
graduated Junior Staff neurosurgeon (during the latter's period
of extended training), learning fundamental diagnostic and operative
skills and taking part in the daily care of patients assigned to
this team. Clinical responsibilities, including Emergency Ward coverage,
are carried out under
the supervision of the Junior Attending neurosurgeon and other MGH
Staff including Sr. Residents.
3. EAST TEAM JR. (MGH 6 months): The trainee shares clinical responsibilities
with the East Senior Resident caring for patients under the direct
supervision of the responsible Staff neurosurgeon.
4. CHILDREN'S HOSPITAL ROTATION (3 months): The MGH participates
in an exchange with the Children's Hospital Medical Center whereby
our Year 2 trainees spend three months at that institution as junior
5. SPINE/EMERGENCY WARD SR. (MGH 6 months): This rotation provides
the trainee with concentrated, systematic exposure to the management
of spinal disorders. He/she is under the supervision of our senior
spine specialist, Dr. Borges, assisting in the operative and outpatient
care of his patients. The resident also supervises Emergency Ward
coverage during the day and shares in other routine patient care
responsibilities. During this rotation, the trainee participates
in the activities of the MGH Neuropathology Department, attending
teaching conferences and performing dissections.
6. EAST SR. (MGH, 6 months): The trainee is now able to assume a
larger role in operative and non-operative management of more complex
clinical problems under the supervision of Visiting Staff neurosurgeons
on the East Team. The trainee works closely with his/her East Jr.
counterpart, overseeing their work and doing clinical teaching.
The operative experience is extensive with a special emphasis on
vascular problems such as aneurysms, arteriovenous malformations,
and occlusive cerebrovascular disease.
7. WEST CHIEF RESIDENT (MGH, 6 months): The responsibilities of
this rotation are similar to those of the East Sr. resident except
that they work with members of the Visiting Staff. There is an emphasis
on technically difficult tumors of the skull base, working under
the guidance of Dr. Ojemann, the associate Chief of Service. The
operative cases are typically of a complex and sophisticated nature,
commensurate with the resident's level of progress. At this level
and beyond, there is important responsibility for teaching other
residents and supervising their clinical work.
8. CHIEF RESIDENT FOR THE CHIEF OF SERVICE (MGH 6 months): The resident
now works under the supervision of the Chief of Service, Dr. Zervas,
assisting in the care of his patients.
9. NORTH ATTENDING (ASSISTANT IN NEUROSURGERY MGH) (6 months): During
this interval of expanded clinical experience, the trainee has an
appointment as a member of the hospital staff and is responsible
for the comprehensive care of patients on the North Team. This period
allows the finishing Resident to expand their clinical experience
in a relatively autonomous setting, while providing for oversight
and instruction by more senior staff neurosurgeons. Formal supervision
is provided by the Neurosurgical Visiting Staff who hold teaching
rounds on a weekly basis. These rounds are regularly attended by
members of the Resident Staff and rotating medical students. In
addition to these formal rounds, the North Attending and his assistants
meet frequently on an informal basis with Visiting Staff members
for case management and teaching discussions.
III. TRAINING IN NEUROSCIENCES
The initial rotation in Neurology introduces
the trainee to the fundamentals of EEG and clinical neurophysiology.
This provides a basis for later exposure to the neurophysiologic
techniques used intraoperatively (e.g. cortical mapping; epilepsy
localization; peripheral nerve/spinal cord/cerebral monitoring).
We also encourage our residents to attend the intensive two week
Neuroscience Course held yearly at The Woods Hole Oceanographic
During the Spine/EW rotation, the trainee regularly
attends neuropathology conferences, reviews pathologic specimens,
and performs anatomic dissections under the supervision of a staff
the residency, there is an emphasis on gaining proficiency in neuroradiology.
The resident is expected to be familiar with the radiographs of
patients, in whose care he/she is involved, and to attend clinical
conferences at which x-rays are read and reviewed. There is also
the opportunity to attend regularly scheduled conferences in the
MGH Neuroradiology Department.
IV. TEACHING CONFERENCES
The following is a list of the regular teaching
sessions and neurosurgical conferences.
- Luncheon Conference
with Chief of Service. Problem cases and those of particular teaching
value presented. Current resident issues also discussed.
- Morbidity and
Mortality Conference. Weekly 1-1½ hrs.
- Journal Club.
Weekly ½ hr. required.
Conference. Weekly 1 hr.
- Chief of Service
Breakfast Meeting. Weekly 3/4 hr. Discussion of resident and Service
affairs and problems.
Grand Rounds. Weekly 1 hr. Neurology Grand Rounds. Weekly 1 hr.
Conference. Weekly 1 hr. Residents review teaching material and
weekly pathology specimens with a staff neuropathologist.
Teaching Conference. Weekly 1 hr. Review of neuroradiology teaching
material with senior staff neuroradiologist.
- North Service
Visit Rounds. Weekly 1-1½ hrs. North Attending and Visiting Staff
member meet to review selected cases under the care of the North
- Vascular Conference.
Weekly 2 hrs.
- Problem Case
Review Conference. Monthly 2 hr. Held at MGH and attended by New
England Area neurosurgeons for discussion of problematic or interesting
V. UNDERGRADUATE TEACHING
The Neurosurgical Service at Massachusetts General
Hospital, in affiliation with Harvard Medical School, offers clerkships
to qualified medical students by individual arrangement. Students
considered are generally fourth year medical students and have already
had formal exposure to clinical neurology and/or related subjects.
In addition, some experience in general surgery is useful, though
not required. The duration of the clerkship is for four weeks only.
The Neurosurgical Service, with 1500 admissions
and 850-900 outpatient visits a year, has an average daily census
of 40-50 patients. One hundred to one hundred thirty surgical procedures
are performed each month. This gives the student ample exposure
to a wide variety of clinical problems. The student is actively
involved in the daily care of neurosurgical patients under direct
supervision of the Attending and Senior Resident Staff. This includes
participating in daily rounds, assessing selected instructive cases,
assisting in or observing operative procedures, and attending the
Neurosurgical Outpatient Clinic. The student learns to manage emergency
problems through exposure in the very active Emergency Ward. Finally,
he or she attends the formal teaching conferences, which are held
on a regular basis. The principal purpose of the clerkship is to
acquaint the student with common neurosurgical problems, including
their appropriate assessment and management. Students who have an
interest in some particular aspect of neurosurgery, such as brain
tumors, cerebrovascular disorders, functional neurosurgery, spinal
problems, or pediatric neurosurgery can arrange to concentrate in
these or other areas.
Interested students should apply in writing to
David Berti, Exchange Clerk Program, Registrar's Office, Harvard
Medical School, 25 Shattuck Street, Boston, MA 02115. Housing accommodation
and parking is not routinely available, and must be arranged by
VI. MAJOR RESEARCH PROJECTS
Trainees within the Neurosurgical Service have
access to any of the laboratories within the Harvard University
System. These include all of the major current areas of research
in neurobiology, as well as cell and
Within the Department of Neurosurgery itself,
the research activities can be grouped in 5 major areas:
Cerebral Blood Vessels
Blood vessels are being studied from several
perspectives. A major research program concerns the biology of cerebral
stroke. Research in this area includes studies on imaging of cerebral
blood flow with a variety of
modern imaging techniques. A basic laboratory program studies in
vitro systems toward the goal of learning what might protect nervous
tissue from interruptions of its supply of glucose and oxygen. Neuroprotective
agents such as cooling and neurotransmitter antagonists are currently
under study. In addition, laboratory studies aimed at extending
the in vitro studies to the in vivo situation are carried out. Commonly
ischemia is caused in a neural region, and agents that might reduce
the severity of the infarct are tested. These studies have led to
introduction of certain therapeutic maneuvers in the operating room,
notably mild cooling in patients whose cerebral circulation must
be interrupted for surgical reasons.
A major research area concerns the biology of
headache. In the laboratory, the innervation of the blood vessels
has been intensively studied. The sequence of events attending migraine
have been delineated
using extravasation of tracers as a marker. A new series of anti-migraine
drugs is being developed and tested both in vitro and in vivo.
A major laboratory studies cerebral vasospasm.
In the laboratory, isolated dog arteries are perfused in vitro and
the factors that constrict and relax them are studied. In vivo,
vasospasm may be experimentally induced in dogs by subarachnoid
injection of blood. This provides a model in which to test potential
maneuvers aimed at reducing the spasm. Recently, a major collaboration
with the MGH Laser Laboratories has resulted in a potential new
therapeutic invention. High intensity laser pulses are applied at
the site of spasm. In dogs, these succeed in relaxing the vessel.
Phase 1 trials of this intervention are being planned.
Neural Growth and Regeneration
A major long-term goal for Neurosurgery is the
restoration of damage of function that has been lost due to damage
to the nervous system. Two research areas aim toward that goal.
Work carried out in collaboration with the Department
of Neurology involves the attempt to implant cultured neurons into
the brains of animals following experimentally induced brain damage.
The basal ganglia are the
focus of this work and dopamine-releasing neurons are being implanted
into the brain following experimental lesions of the dopamine-containing
brain neurons. Similar strategies can be applied to other brain
On the more fundamental level, we are trying
to learn the factors that promote the growth of neurons. This is
being carried out using cultured cells. A new factor released by
immortalized cultured glia has been discovered. It promotes a neurite
outgrowth from a variety of projection neurons. Current studies
are aimed at identifying and cloning the factor.
The natural history of brain tumors is being
studied in collaboration with the Department of Pathology. This
work focuses on the mutation or series of mutations that occur in
glioblastomas. This work concentrates on the
use of PPCR methodologies to amplify the DNA of biopsy specimens
and of archival neuropathology slides. The latter are particularly
useful since the outcome is known. A series of mutations have been
found to occur in
naturally occurring brain tumors. Many tumors have a mutation of
the p53 gene. Another common mutation is amplification of the EGFR
(epidermal growth factor receptor) gene.
A second area of brain tumor research is the
use of retroviral therapy against glioblastomas. The goal is to
use retroviruses to introduce into the tumors genes that would either
kill the tumor cells, later their pattern of growth, or sensitize
them to chemotherapeutic agents. One such trial involves the introduction
of a gene for thymidine kinase. A number of analogous manipulations
are being tested both vitro and in rats.
Intraoperative Monitoring and Imaging
A major area of clinical research concerns surgery
for epilepsy. Candidates for epilepsy surgery are intensively studied
by electrophysiological and imaging techniques. Electrophysiologically,
implanted electrodes are used to monitor seizure activity in awake
patients. PET imaging is used to localize motor and language areas.
New technology allows superimposition of the PET images with MRI
scans, providing sharply defined landmarks during surgery. A further
area of exploration is the use of virtual imaging in the operating
Within the Department of Neurosurgery there are
also laboratories of fundamental neurobiology. These are concerned
with various aspects of neuroanatomy and neurophysiology.
One area of focus is the cell biology of the
retina. The retina is used as a model system for studies of how
small neural networks operate computationally upon their inputs.
This laboratory uses anatomical methods and combined anatomy/physiology
studies of in vitro retinas.
Another area of research concerns the biology
of membrane proteins, particularly the Na,K-ATPase. These studies
are aimed at understanding the heterogeneity of the Na,K-ATPases
in the brain and their regulation.
- Primary areas
of neurosurgery (very roughly)
- North (general
neurosurgery, trauma, spine, pediatrics, emergency ward)
- East (vascular,
stereotactic, functional, epilepsy, and trigeminal neuralgia)
- West (brain
tumors, skull base, spine)
- South (pituitary
- Coverage Responsibilites
and post-operative Routines
on the organization of the Service
- General Surgery
Rotator (page operator will know as the "North Neurosurgery
- Neurology Rotator
(page operator will know as the "West Neurosurgery Junior
(covered by East
Service for call purposes unless South Resident is on call)
Senior Resident (Spine /Neuropathology):
9:00 AM Cox one
conference room, Brain Tumor Board Conference (no pathology)
2:00 PM White-12 Library Movement disorders pre-surgical Conference
4:00 PM WACC-7 Endocrine conference room Neuroendocrine/Pituitary
11:30 AM MEEI third
floor conference room, Brain Tumor Board Conference
7:15 AM Basement
Cafeteria Chief's breakfast (once a month)
12:30 PM Mixter Library (Edwards-4), lunch with Dr. Zervas , case
5 PM Ellison-12 conference room joint orthopedic/neurosurgical Spine
Conference (biweekly, confirm with Dr. Borges's office, 726-6156)
7:00 AM Quality
Assurance Conference, Ether Dome, Bulfinch-4
8 AM Ether Dome, Grand Rounds.
9:00 AM Mixter Library (Edwards-4), Journal Club.
10:00-12:30, WACC-835 NORTH SERVICE CLINIC: REQUIRED !!!
5 PM Ellison 12 Conference Room, Visit Rounds, case presentations.
6 PM Blake-1 Auditorium Skull Base Surgery Rounds with otolaryngology,
(first and third Thursdays of each month--confirm with Dr. Barker's
7:00 AM White-2
reading room, Vascular conference, case presentaions
10:00 AM Blake-1
Auditorium Interesting Case Conference on the first Saturday of
each month during the academic year. Area neurosurgeons are encouraged
to present cases for discussion at this conference.
COVERAGE Head CT 6-6760
The neurology resident
rotating on the West service will cover the emergency room from
5pm to 6:30am on a rotating basis with the junior neurosurgical
residents. Coverage from 6:30am to 5pm is by the North junior. However,
if he/she is in the OR then the person on call that night covers.
If that person is also in the OR then the neurology rotating resident
will cover. If, however, the neurology rotator is post-call or in
clinic then the neuropathology resident covers. The types of EW
evaluations are: TRAUMA, consults, and direct referrals from an
outside hospital to either a specific staff member or to the North
Service (if no other attending has been arranged in advance).
There is currently
an EW beeper, which is to be passed to the person covering the EW.
The EW resident
who sees the patient is responsible for the complete admission note
and orders. The resident to whose service the patient is being admitted
should be called and filled in once this is completed.
work-ups are done by the residents on the service of the admitting
physician. This includes junior and senior/chief residents. If these
residents are in the O.R. then the person covering the emergency
room is responsible. As always, any resident out of the O.R. may
be recruited by this person as necessary (preferably in order of
increasing seniority). Our pride and reputation as a service hinge
remarkably on an enthusiatic availability to answer EW and GATA
Consults (in-patient) are performed by the North Junior and
should be referred to him or her. At night the Senior resident on
call is responsible for all in-patient consults.
1) Always accept
outside emergency referrals of a neurosurgical nature, with
the exception of multi-trauma (which is referred to the Surgical
Senior Resident in the Emergency Ward--they also accept all referrals)
and as noted below- Obtain the patient's name and pertinent info,
hospital name and number, referring physician's name, estimated
time of departure. Remember to request the FILMS!
from Dr. Zervas are to accept all neurosurgical pateints regardless
of bed availablity in the ICUs or the EW, without giving the referring
physician any runaround. For primary intracranial hemorrhages
it is often appropriate to discuss matters with neurology or if
the hemorrhage is supratentorial and small to arrange for them to
come directly to neurology. (Ideally just accept the patient, then
they will ask you about mannitol, dilantin, steroids, etc. In general,
do not use steroids in trauma (except spinal cord injury which requires
the methylprednisolone protocol). Do administer mannitol (50-100
gm i.e. 1gm/kg bolus) and hyperventilate (pCO2 27-32) in cases with
mass effect/global neurologic deficits, only if this will not significantly
delay the transfer (i.e. sometimes it will take an hour to intubate
the patient ). Dilantin (1g iv over 30-60") is given in cases
with supratentorial contusions and/or SAH, but again this should
not delay transfer. Specifically ask that sedation and muscle relaxants
be withheld when possible. For helicopter rides they will need these,
however, as the transport may not be safely done without total control
of the patient. In this case recommend dilantin load strongly.
Spine trauma patients
with para- or quadra-paresis need a foley and a nasogastric tube
Acute spine trauma
(or question of stability) without a neuro deficit goes to orthopedics
(by long tradition) [unless an MGH neurosurgery attending has already
accepted the patient].
referrals alternate between orthopedics and neuro-med. The EW front
desk (4-4100) knows who is on as should the page operator.
hemorrhage (SAH) refer to later section.
2) Call EW triage
4-4141 with the info for transfer.
3) If it sounds
like the patient will need ICU care, you may call the Neuro ICU
charge nurse "just to let them know" at 6-8071 and see
if a bed in the ICU or intermediate will be available depending
on your suspicion on what the patient will need, i.e. arterial
line, ventriculostomy, etc. require ICU; If no neuro ICU bed is
available and the patient needs ICU care try the GRACU (6-8905),
then the RICU (6-8975) (The fellow in these units usually doles
out the beds, but you may start with the charge nurse or the resident).
4) Notify the
Senior Resident about the expected transfer. If needed, also notify
the visit. [After going over the case with the Senior resident
the visit will decide if the patient is to be admitted.]
5) In cases
of multi-trauma the referring EW will usually contact the General
Surgeon in the EW. Make sure that they are informed about and involved
in any transfer involving trauma.
The initial neuro
exam is done immediately and the time of the
exam should be noted. The key features of the exam include:
1) General Findings:
palpation of the head for lacerations and fractures, inspection
of ears and nose for blood or CSF, examine fundi/discs, note presence/absence
of Racoon's eyes or battle signs (denoting basilar skull fracture),
palpate the neck and back for tenderness, hematoma etc., listen
to carotids for bruit, extremity trauma as well as general state
hemodynamic stability, temperature etc. should be noted briefly.
2) Neuro Findings:
A. Mental Status
should be noted to the extent possible, e.g. comatose, obtunded,
somnolent, confused, agitated, cooperative, orientation, speech,
B. Cranial Nerve
exam, which in a comatose patient is limited to only pupils, oculocephalics
(once C-spine is cleared) or calorics (once TM's are cleared), corneals,
facial grimace to supra-orbital compression, gag and cough.
C. Motor/ Sensory/Cerebellar
exams in an awake patient.
D. In the more
likely setting for a trauma eval. the only form of motor and sensory
exam will amount to a Glasgow Coma Scale:
Eyes Opening Spontaneous 4
To verbal command 3
To pain 2
No response 1
Best Motor Response Obeys verbal command 6
Localizes pain 5
No response 1
Best Verbal Response Oriented, converses 5
Disoriented, converses 4
Inappropriate words 3
No response 1
E. Reflexes: deep
tendon & Babinski, Note in spine trauma: Hoffman, abdominal,
cremasteric, bulbocavernosus & clonus.
Often times the
patient will be referred to a private attending and will be known
to have a SAH prior to your evaluation and may even come with an
angiogram demonstrating the anuerysm(s). Other times you will be
the one taking the referral from an outside hospital. In any case,
always question the assessment made at the outside institution until
you have confirmed it to your own satisfaction, e.g. headaches
are not usually evaluated most efficiently by the neurosurgical
service. But always try to get the referring physician in touch
with the appropriate service.
attending on call should be informed of all SAH admissions, for
unassigned patients this is usually taken care of by the North Service
attending. If Drs. Cosgrove, Chapman, Borges, or Ojemann are on
call the vascular attending (Dr. Ogilvy) may be consulted directly.
Grading of SAH
0 unruptured aneurysm
1 asymptomatic or mild HA and nuchal rigidity
2 moderate to severe HA, nuchal rigidity, +/- cranial nerve palsy (eg. III, IV, VI),
3 mild focal deficit, lethargy or confusion
4 stupor, moderate to severe hemiparesis, early decerebrate rigidity
5 deep coma, decerebrate rigidity, moribund appearance
The initial evalualtion
of a SAH patient is similar to the trauma neuro-evaluation. Another
feature with these patients is that they often have cardiac problems,
either associated with the SAH or prior history. They will frequently
be hypertensive and one of the first therapeutic moves is to place
an arterial line and control their blood pressure with nipride or
TNG. All patients are treated with Nimodipine 60 mg. po q4 hrs.
x 21 days. Central lines are also needed for i.v. b.p. meds.
If airway protection
is an issue make it so that it is no longer an issue; that is, intubate
once the baseline exam is obtained and make sure RICU knows to carefully
control the BP during intubation. The other measures include: dilantin
load (1 gm IV routinely); mannitol, if the scan shows hydrocephalus
and the patient is obtunded, to temporize before a ventriculostomy
can be placed; decadron (4-10 mg IV) for headache and pre-op preparation.
All Grade I through
III patients should have 4-vessel cerebral angiograms as soon as
possible, if they are stable. This can be arranged through Neuroradiology
(6-8320) during the day and by paging the fellow on-call at nights
(6-1818). Before this stage you should have reviewed the case with
the attending on the case to make the decision regarding going ahead
with an angio. In addition, he may want to perform a ventriculostomy
or repeat CT etc. before commiting the patient to a long procedure.
who are Grade IV + may be good candidates for EVD (external ventricular
drainage) if the CT demonstrates hydrocephalus. If the grade improves
to Grade III or better then an urgent angiogram is still indicated
as surgery would be done urgently. If there is no improvement then
the angiogram can be done in a less urgent manner and the specifics
of timing must be addressed with the attending.
and Post-Op Routines
Write a pre-op
note in the chart with the following sort of format as a checklist:
- Labs (lytes,
BUN, Cr, CBC, plts, PT/PTT, and anticonvulsant level)
- T+C 2 units
(for big vascular cases 4 units)
Write pre-op orders:
- NPO after midnight
- thigh high TEDS
and airboots on call to OR (for ambulatory patients).
- Void on call
- Pre-op meds
such as steroids (e.g. 10 mg p.o. at night--10 mg i.v. on call),
cimetidine (e.g. 400 mg p.o. at night--300 mg i.v. on call), anticonvulsants,
sleep med, antibiotic on call (e.g. 1 gm Ancef or Vancomycin on
- IVF if scheduled
as second case
Write a post-op
check on every patient, with a format similar to a progress note.
- VS and I/O's
- Wound check,
- Neuro exam
- All procedures
(arterial line, lumbar puncture, central line, lumbar drain, ventriculostomy,
bolt, etc.) should be documented in red ink. Signed consent is
required (except in cases of emregency when patient unconscious/incompetent
and no N.O.K. available-document your attempt to contact them).
In the case of central venous lines & Swan-Ganz catheters,
CXR results should also be noted in the chart.
- The senior resident
is available to instruct and/or oversee any procedure.
service is organized in a heirarchical fashion. Residents are encouraged
to utilize this chain of command (which is occassionally followed
to the chief of the service) for questions or supervision whenever
needed. Use of these resources allows us to acheive our combined
goals of optimal patient care and education.
Also see the MGH
History of Neurosurgery
or the MGH
Neurosurgery Alumni Homepage
or the Guide for Intern, Residents, and
or Neurosurgical Education Links
or Other WWW Resources of Neurosurgical Interest.