Neuropathology

Goals and Objectives

  • PGY-4: The aim of the rotation in Neuropathology is to provide the resident with the knowledge, skills, and attitudes that will allow him or her to deal effectively with the nervous system component of an autopsy, and with neurosurgical specimens. The resident is expected to identify the limits of his or her diagnostic ability, and to consult appropriately.
  • PGY-5 year is one of senior leadership and the resident should be able to assume responsibility for organizing the service and supervising junior residents and students. The resident should have mastery of the information contained in standard texts and be prompt in using the literature to solve specific problems. The resident will be responsible for presentations at conferences and for teaching junior residents and students on a routine basis. The PGY 5 should begin to have an understanding of the role of the practitioner in an integrated health care delivery system and to be aware of the issues in health care management facing patients and physicians.

Medical Knowledge

Specific Goals And Objectives

Autopsy Pathology
  1. Residents should be able to summarize the clinical history from a chart, and identify the specific questions to be answered by the autopsy.
  2. Residents should be able to remove the brain, spinal cord, eyes, peripheral nerves, and muscles by themselves; promptly and without causing damage.
  3. Residents should be able to name every grossly visible structure of the brain and spinal cord and their major vessels. They should be able to indicate the general function of the different parts of the brain.
  4. Residents must be aware of circumstances (such as a subarachnoid hemorrhage) in which special procedures are called for before fixation of the brain, and be prepared to act accordingly. They should be familiar with the risks associated with conventional infectious agents and prions, and with the procedures used to reduce this risk.
  5. Residents should be able to select and take appropriate samples for histological examination.
  6. Residents must be able to recognize the histological appearance of all parts of the brain or spinal cord.
  7. Residents must be able to obtain a diagnosis in all common lesions and to classify less common lesions in the appropriate group.
  8. Residents must be able to correlate pathological findings with clinical signs and symptoms, and to write a brief summary explaining how the autopsy results relate to the clinical history.
Surgical Pathology
  1. Residents must be able to handle neurosurgical specimens appropriately, including obtaining smears, frozen sections, preparing tissue for culture or flow cytometry, and fixing samples for electron microscopy.
  2. Residents must be able to provide an appropriate gross and microscopic description of surgical specimens.
  3. Residents must be familiar with the technical principles involved in special stains in neuropathology, as well as their diagnostic significance.
  4. Residents should be able to identify the use and pitfalls of the different antigenic markers utilized in immunoperoxidase and immunofluorescence procedures.
  5. Residents should be able to interpret the microscopic findings in light of clinical and radiological information, and to incorporate this process into a written comment.
  6. Residents must be able to achieve an appropriate diagnosis in all common conditions, and to recognize uncommon conditions.
  7. Residents should be familiar with normal and abnormal CSF cytology.

General Goals And Objectives

  1. Residents should be able to obtain high quality photographs of gross and microscopic specimens.
  2. Residents should be able to present their findings in a manner appropriate for pathologists and clinicians.
  3. Residents should be able to describe major mechanisms of disease affecting the nervous system and muscle.
  4. Residents must be able to interact with other pathologists, technologists, and staff in a professional and courteous manner.
Communicator
  1. Be able to report gross and microscopic description of the brain in autopsy cases.
  2. Participate in departmental rounds and presentations.
Collaborator
  1. Be aware of potential interactions with other agencies and other physicians
Manager
  1. Become aware of tissue handling, transport and storage issues in neuropathology
Health Advocate
  1. Be aware of infectious disease control in neuropathology.
Scholar
  1. Understand basic neurobiology as it pertains to neuropathologic specimens
  2. Be aware of special investigative techniques pertinent to neuropathology
Professional
  1. Maintain collegial relationship with peers and staff

Neuropathology Rotation- Expectations for Anatomic Pathology Residents

Be present. Any absences should be communicated to the neuropathology staff in a timely fashion.

Expectations will be assigned and assessed based on the resident's level of training and performance.

Maintain a log of cases encountered during your rotation. Include a summary of clinical and pathological case data with clinic-pathological correlation, as well as recording any questions or learning points that arose, to act as guides for further study.

Attend frozen sections. Prior to the frozen sections, residents are expected to review the daily O.R schedules each morning, anticipate which neurosurgical cases will likely require frozen sections and obtain relevant history and imaging for those cases. Observe and subsequently assist (when appropriate) the preparations of smears and frozen sections, and participate in the process of formulation of intra-operative consultative diagnoses.

Gross select neuropathology cases, so as to become familiar with general grossing principles as they relate to common neuropathological specimens (such as brain biopsies of neoplastic and non-neoplastic entities; resections of gliomas, meningiomas, metastases, peripheral nerve sheath tumours, vascular malformations)

Attend daily signout with the neuropathologist on service.

In discussion with the neuropathologist on service, take responsibility for assigned cases; this will be based on the resident's level of training and performance. Assigned tasks may include obtaining relevant history and imaging, reviewing slides prior to attending signout, presenting case at signout with a prepared description of the findings and provisional diagnosis / differential diagnosis +/- planning and ordering ancillary workups, showing cases to off-service residents and medical students, triaging cases, writing up reports (including synoptic reporting when appropriate), and obtaining intra-departmental consultations*.                                                                                                                                                              (* Always check with the neuropathologist on service prior to performing this task independently)

Attend weekly Neuropathology QA rounds (Tuesday mornings 9 am)

If unknown cases provided in advance of a teaching session, preview the cases.

Attend brain cutting sessions.. This can include hospital autopsy brains (at TOH and CHEO) and forensic autopsy brains. For TOH cases, the resident will be responsible for reviewing and documenting the clinical history, including brain/spine imaging as well as for preparing the materials for the brain cutting session in collaboration with the Pathology Assistant.

Attend multidisciplinary neuro-oncology rounds at TOH and CHEO, when feasible. If provided with the list of cases to be discussed, review the pathology reports for these patients ahead of time.

Attend conferences involving neuropathologists as opportunities arise. Examples could include Muscle Biopsy rounds, select Neuroscience rounds, Neuropathology rounds for Pediatric Neurology Academic Half-Day.

Present select cases encountered during your rotation at academic half-day (Black Box rounds)

 

Created May 2020

 

Recommended Reading


A minimal reading list would include a neuroanatomy textbook, such as:

  • Kiernan and Barr, The Human Nervous System, 6th Edition, 1996
  • Nieuwenhuys R, Voogd J, van Huijzen C: The human central nervous system, a synopsis and atlas. 4th ed 2016 ISBN978-3-662-52682-8


A neuropathology textbook, such as:

  • Gray F, Duyckaerts C, de Girolami U; Escourolle and Poirier's manual of basic neuropathology, 6th ed 2018, ISBN 978-0-1906-7501-1
  • Ellison D and Love S: Neuropathology, A reference text of CNS pathology 3rd edition, 2013 ISBN 978-0-7234-3746-8
  • Hilton, Davi, Shivane and Aditya: Neuropathology Simplified: A Guide for Clinicians and Neuroscientists Springer; 2015 edition (Feb. 28 2015)

A surgical neuropathology textbook, such as:

  • Louis DN etal: WHO Classification of Tumours of the Central Nervous System, 2016 ISBN 978-92-832-4492-9
  • Burger P etal: Diagnostic pathology - Neuropathology, 2nd ed 2016, ISBN 978-0-323-44592-4
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