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A Year in Perspective: PGY-7

Thomas Beaumont, MD, PhD

My senior year on service was a tremendous period of growth. I was able to solidify my ability to perform several general operations and had the opportunity to do countless other high-level cranial and spinal cases. Although there were many memorable cases, a few come to mind.

The first was a young patient who had a large extra- and intra-dural clival chordoma. We removed the tumor in a staged procedure, first with an endoscopic transnasal transclival approach. Entering the prepontine cistern through the nose with an endoscope was memorable, as was inspecting the occipitocervical junction. The second stage was performed in delayed fashion, and entailed a far lateral craniotomy to complete resection of intradural tumor that had encased the vertebral arteries.

At St. Louis Children’s Hospital, I had the opportunity to meet an extremely bright and motivated young man known for his remarkable scholastic achievement. He had a biopsy-proven teratoma of the pineal region and had undergone chemotherapy and radiation. The tumor demonstrated persistent growth on imaging. Following multiple preoperative clinic visits to counsel the patient and family, we removed the tumor from a supracerebellar infratentorial approach. The position of the tumor was suboptimal for this approach, not to mention his prior radiotherapy. Even so, it was by far our best option. After six challenging hours of microdissection, we achieved gross total removal. The patient went home three days postop and made a full recovery.

Another memorable case was that of a healthy young man who experienced progressive hemiparesis and foot drop from a pontomedullary cavernous malformation. The patient’s condition improved after steroids and we attempted nonoperative management. Unfortunately there was an additional hemorrhage with further progression of his neurological deficit, indicating the need for surgery. We approached through lateral suboccipital craniotomy with C1 laminectomy and partial condylectomy. After finding a path between PICA and the brainstem, a lateral medullary myelotomy was performed allowing complete excision of the lesion. At four week follow-up, the patient was ambulating without assistance and demonstrated marked improvement in his upper extremity strength and hypoglossal nerve function.

With each of these and many other cases during my senior year, the strength of the Wash U program became very clear. I had not only participated in similar cases, but had also picked up different styles, technical nuances and surgical intuition. It’s as though I became an amalgamation of those who had trained me. Perhaps because of the intensity of the training? Perhaps because of the continual exposure to all aspects of neurosurgery from many different perspectives? With the large number of faculty, we are constantly exposed to different approaches to taking care of even simple neurosurgical problems. Whether we are discussing nuances in the operating room, the most recent data on treatment strategies during case conferences or potential research projects, there is constant educational content and mentoring.

I chose Wash U for three main reasons. First, I wanted an intensive, high volume program where I could develop excellent clinical and technical skills in all aspects of neurosurgery. Secondly, as an MD/PhD I sought a program that was not only dedicated to resident education and clinical training, but also academics and translational neuroscience. Lastly, it was clear to me that the program and faculty at Wash U were deeply invested in the cultivation of their residents.

Fun interests: Mountaineering, sailing, flying, food and wine