...education

NEUROTOLOGY FELLOWSHIP PROGRAM —
Body of Knowledge for the Subspecialty of Neurotology
 
Neurotology training includes a knowledge of otology as defined in the basic Otolaryngology-Head and Neck Surgery Scope of Knowledge, in addition to the areas of diseases, disorders, and procedures specific to neurotology. This document describes the curriculum for neurotology training and examination.
 

1. Basic Science of Head and Neck Structures:
 

	Detailed knowledge of embryology, anatomy, physiology, histology and pathology of: Ear/temporal bone.
	Skull base.
	Petrous apex, greater and lesser wing of the sphenoid bone, foramen rotundum, foramen ovale, foramen spinosum, internal auditory canal, jugular foramen, Meckel’s Cave, superior orbital fissure, inferior orbital fissure, infratemporal fossa.
	Detailed anatomy of the Cranial Nerves, II, III, IV, V, VI, VII, VIII, IX, X, XI, XII.
	Vascular anatomy of the brainstem, cerebellum, pons and temporal lobe, including: Inferior petrosal sinus, superior petrosal sinus, cavernous sinus, AICA, PICA, vein of Labbe.
	Anatomy of brainstem, cerebellum, temporal lobe, 4th ventricle, forament of Luschka.
	Other nerve system structures related to the head and neck.

2. Neurophysiology (peripheral and central) of:
 

	Central auditory pathways.
	Central vestibular pathways.
	Vestibulo-ocular reflex, characteristics of central and vestibular nystagmu

3. General knowledge of embryology, anatomy, physiology, histology & pathology of:

5. Diagnostic & Assessment Procedures

6. Proper historical interview, technique, indications, limitations, and normal
pathological findings of:

7. Indications, limitations, and normal and pathological findings of:
 

Imaging studies (e.g., computed tomography, magnetic resonance imaging with and without contrast, magnetic resonance angiography, nuclear medicine, angiography, interventional radiology, carotid artery balloon occlusion testing with SPECT scanning, PET scanning of the temporal bone, skull base and intracranial anatomy).

8. Diseases, Disorders and Conditions

9. Etiology, diagnostic criteria, historical features, differential diagnosis, prognosis,medical/surgical management, common and unusual complications, and impact on all spheres of functioning:

13. Basic Concepts Associated with Surgery:

	Preoperative care (e.g., antiembolism measures for prolonged procedures, catecholamine and secreting tumors, blood transfusion).
	Anesthesia (e.g., neuroanesthesia, phenobarbital coma, hypocarbia, diuresis). Intraoperative monitoring (e.g., cranial nerves VII, VIII {BSER, EAP}, IX, X, XI, XII).
	Cerebrospinal fluid management (e.g., intraoperative and postoperative lumbar drains).
	Flaps (e.g., regional muscle flaps, myocutaneous, free tissue transfer).

	Management of complications (e.g., cerebrospinal fluid leak, dural repair, subdural hematoma, epidural hematoma, intracranial hemorrhage, hydrocephalus, stroke, intraoperative or postoperative seizure, hearing loss, dysequilibrium, oscillopsia, headache, cranial nerve paralysis, meningitis, diplopia, vertigo, steroid psychosis).
	Basic techniques (e.g., harvest of nerve graft from neck or sural nerve, intracranial and intratemporal neural anastomoses, decompression of cranial nerve, ultrasonic aspiration,focused radiation therapy.
	Postoperative care (e.g., neurointensive care, neuronursing care, DI (Diabetes Incipitus).

	SIADH (Syndrome of Inappropriate Diuretic Hormone).
	Multidisciplinary planning (e.g., neuroradiology, interventional radiology, neuroanesthesiology, neurology, neurosurgery).
	Stereotactic radiosurgery for skull base neoplasms.

14. Specific Surgical Procedures

15. Indications, contraindications, risks/benefits, and complications of:

	Middle cranial fossa approach (e.g., facial nerve decompression, vestibular nerve section, acoustic tumor excision, repair of spontaneous, traumatic, or iatrogenic CSF leak and/or encephalocele, drainage of petrous apex abscess, vestibular neurectomy, repair superior semicircular canal dehiscence).
	Excision petrous apex tumors.
	Translabyrinthine approach (e.g., facial nerve decompression and repair, vestibular nerve section, acoustic tumor excision and other CPA lesions, repair of CSF leak and/or encephalocele, meningioma, vestibular neurectomy).

	Transcochlear approach (e.g., acoustic tumor excision, other cranial nerve tumors, drainage of petrous apex abscess, drainage of cholesterol granuloma, meningioma).
	Retrosigmoid/suboccipital approach (e.g., acoustic tumor and other CPA lesions, vestibular nerve section, vascular decompress V, VII, VIII, meningioma).
	Infratemporal fossa approach (e.g., glomus jugulare, neuroma IX, X, XI, XII, meningioma).

	Lateral skull base approach (e.g., clivus chordoma, petroclival meningioma, parasellar tumors, neuroma cranial nerve V, cavernous sinus lesions, chondrosarcoma).
	Cochlear implant/brainstem auditory implant.
	Total and lateral temporal bone resection.

	Labyrinthectomy.
	Endolymphatic sac surgery.
	Subtotal petrosectomy
	Posterior lateral craniotomy.

16. Habilitation/Rehabilitation Approaches

17. Basic Otolaryngology – Head and Neck Training as well as neurotology training should include the following: