Program Descriptor
Fellowship in Clinical Pediatric Neurosurgery
The Hospital for Sick Children
The Hospital for Sick Children (HSC) was founded in 1875. It is the prime paediatric referral centre in the Greater Toronto Area (population 4 million) and, it enjoys a unique agreement with the other teaching hospitals and the Faculty of Medicine at the University of Toronto (UofT). All children with paediatric neurosurgical disorders are admitted to the HSC neurosurgical service.
Our Division
The Division of Neurosurgery at HSC is the largest such paediatric neurosurgical facility in North America. Each year, an average of 1,200 children are admitted to the neurosurgical division, where a total of 700 operative procedures are performed. The neurosurgical division at HSC not only looks after patients from the metropolitan area, but also caters to the rest of the Province of Ontario as well as other parts of Canada. In addition patients with difficult pediatric neurosurgical problems are referred from the United States, South America, Europe and Asia.
Our Attending Neurosurgeons
The five attending neurosurgeons - Drs Peter B. Dirks, James M. Drake, Abhaya Kulkarni, James T. Rutka and Dr. Michael Taylor - all hold positions within the Department of Surgery of the Faculty of Medicine at the University of Toronto (see Website: brodel.med.utoronto.ca) They practice full time and are based in offices within HSC.
Our Inpatient Unit
The Division of Neurosurgery at HSC has 27 beds in a neurosurgical unit which admits patients up to 18 years of age and is shared with the trauma, ophthalmology and neurology services. In addition, paediatric neurosurgical patients are looked after in the specialized neonatal intensive care unit as well as a paediatric critical care unit. The neurosurgical service is actively supported by skilled neuroanaesthetists, neuroradiologists, neuro-ophthalmologists, neuropathologists, intensivists and neonatologists as well as social workers and physiotherapists assigned to the neurosurgical service.
Our Operating Suite
The neurosurgical operating room in the Atrium (opened in 1993) is equipped with the latest technological devices which are necessary to perform sophisticated neurosurgery. In addition to this dedicated theatre there is a craniofacial operating room where techniques are combined with a craniofacial surgeon. Elective operative procedures are carried out 5 days each week. Approximately 100 children with brain tumors are operated upon annually, 100 with various forms of spinal dysraphism, 60 with craniofacial and synostotic abnormalities, 60 for head traumas, 50 for epileptic surgery and 300 for CSF diversionary shunts. There are 5 out-patients clinics weekly, in which 2,500 children are reviewed each year. The spina bifida clinic is held once monthly at an associated children's rehabilitation facility.
Our University Affiliation
The Division of Neurosurgery at HSC is one of several such units associated with the neurosurgical training program at the University of Toronto. In addition to the informality of bedside and theatre teaching, the neurosurgical fellow is exposed to the didactic instruction of weekly clinical rounds and a residents' seminar based on techniques for passage of the examination of the Royal College of Physicians and Surgeons of Canada and the American Board of Neurological Surgery. Each week there are neurosurgical rounds, including morbidity and mortality sessions, combined neurology/neurosurgery rounds, tumor board and epilepsy rounds. There is also a monthly journal club.
Our Data Retrieval System and Lab Facilities
The Division of Neurosurgery has a computerized data retrieval system which provides the opportunity for one to prepare and publish reviews on paediatric neurosurgical topics. The Hospital for Sick Children has an affiliated Research Institute where neuroscientists are actively involved in a variety of projects. The Research Institute has an animal operating facility and two laboratories devoted to neurosurgical projects on hydrocephalus and to neuro-oncology.
Our Visiting Professorships
The University of Toronto provides for several visiting professorships including one devoted to paediatric neurosurgery. In addition, visitors from around the world spend time as observers on the neurosurgical unit and take part in various teaching sessions.
Our Resident Program
The University of Toronto neurosurgical training program provides two residents on six-monthly rotations to the Division of Neurosurgery at HSC. These residents who are at varying levels of their training have only had adult clinical experience before arriving at HSC for their exposure to paediatric neurosurgery. In addition to the University of Toronto residents, self-funded residents from other training programs, often based in the United States, come for periods of three to six months to gain exposure in paediatric neurosurgery. Medical students do spend electives on paediatric neurosurgery but on an intermittent basis.