Neurosurgery

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Insertion of an electrode during neurosurgery for Parkinson's disease.
Insertion of an electrode during neurosurgery for Parkinson's disease.

Neurosurgery is the surgical discipline focused on treating those central, peripheral nervous system and spinal column diseases amenable to mechanical intervention. "Brain surgery" is commonly used, much like rocket science, to refer to a task requiring significant knowledge and skill.

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[edit] Definition and scope

According to the U.S. Accreditation Council of Graduate Medical Education (ACGME),[1]

“ Neurological Surgery is a discipline of medicine and that specialty of surgery which provides the operative and nonoperative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes that modify the function or activity of the nervous system, including the hypophysis: and the operative and nonoperative management of pain. As such, neurological surgery encompasses the surgical, nonsurgical and stereotactic radiosurgical treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain, meninges, skull base, and their blood supply, including the surgical and endovascular treatment of disorders of the intracranial and extracranial vasculature supplying the brain and spinal cord; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those that may require treatment by heat fixation, instrumentation, or endovascular techniques; and disorders of the cranial and spinal nerves throughout their distribution. ”

[edit] History

Unearthed remains of successful brain operations, as well as surgical implements, were found in France at one of Europe's noted archaeological digs. The success rate was remarkable, even circa 15,000 B.C.[citation needed]

Pre-historic evidence of brain surgery was not limited to Europe. Pre-Incan civilization used brain surgery as an extensive practice as early as 2,000 B.C. In Paracas, Peru, a desert strip south of Lima, archeologic evidence indicates that brain surgery was used extensively. Here, too, an inordinate success rate was noted as patients were restored to health. The treatment was used for mental illnesses, epilepsy, headaches, organic diseases, osteomylitis, as well as head injuries.

Brain surgery was also used for both spiritual and magical reasons; often, the practice was limited to kings, priests and the nobility.

Surgical tools in South America were made of both bronze and man-shaped obsidian (a hard, sharp-edged volcanic rock).

Africa showed evidence of brain surgery as early as 3,000 B.C. in papyrus writings found in Egypt. "Brain," the actual word itself, is used here for the first time in any language. Egyptian knowledge of anatomy may have been rudimentary, but the ancient civilization did contribute important notations on the nervous system.

Hippocrates, the father of modern medical ethics, left many texts on brain surgery. Born on the Aegean Island of Cos in 470 B.C., Hippocrates was quite familiar with the clinical signs of head injuries. He also described seizures accurately, as well as spasms and classified head contusions, fractures and depressions. Many concepts found in his texts were still in good stead two thousand years after his death in 360 B.C.

Ancient Rome in the first century A.D. had its brain surgeon star, Aulus Cornelius Celsus. Hippocrates did not operate on depressed skull fractures; Celsus often did. Celsus also described the symptoms of brain injury in great detail.

Asia was home to many talented brain surgeons: Galenus of Pergamon, born in Turkey, and the physicians of Byzance such as Oribasius (4th century) and Paul of Aegina. An Islamic school of brain surgery also flourished from 800 to 1200 A.D., the height of Islamic influence in the world. Abu Bekr Muhammed el Razi, who lived from 852 to 932 in the Common Era, was perhaps the greatest of Islamic brain surgeons. A second Islamic brain surgeon, Abu l'Qluasim Khalaf, lived and practiced in Cordoba, Spain, and was one of the great influences on western butt surgery.

The Christian surgeons of the old Ages were clerics, well educated, knowledgeable in Latin, and familiar with the realm of medical literature. Despite the church's ban on study of anatomy, many churchmen of great renown (advisors and confessors to a succession of Popes) were outstanding physicians and surgeons. Leonardo da Vinci's portfolio containing hundreds of accurate anatomical sketches indicates the intense intellectual interest in the workings of the human body despite the Church's own brain surgery.

[edit] Risks

There are many risks to neurosurgery. Any operation dealing with the brain or spinal cord can cause paralysis (systemic), brain damage, infection, psychosis, or even death.

[edit] Conditions

Neurosurgical conditions include primarily brain, spinal cord, vertebral column and peripheral nerve disorders.

Conditions treated by neurosurgeons include:

[edit] Job field

In the United States neurosurgical training is very competitive and grueling. It usually requires six to eight years of residency after completing medical school, plus the option of a fellowship for subspecialization (lasting an additional one to three years). Most applicants to neurosurgery training programs have excellent medical school grades and evaluations, have published scientific and/or clinical research, and have obtained board scores in the 95th percentile or higher. Resident work hour limits are set at 88 hours per week for many programs, although many neurosurgical programs have had problems meeting these new work hour limits due to the small size of residency programs, the high volume of neurosurgical patients, and the need to provide constant coverage in the emergency room (ER), operating room (OR), and intensive care unit (ICU).

All neurosurgical residency programs have some form of research included in the training. Most programs include one year of research time, which can be clinical, translational, or basic science research. Some programs offer two or more years of research, and may offer the ability to complete a second degree, such as a PhD, MPH, Masters of Science, etc.

On average 50-60% of medical students applying to neurosurgery match into a residency program (about 80% of US senior medical student applicants).[2]

[edit] Career

The average compensation for a neurosurgeon ranges from US $250,000-$500,000 annually. MGMA data from 2001 for US neurosurgeons show an average of $410k in private practice, $275k in academics, and $438k for all neurosurgeons at least 3 years out of training.

[edit] See also

[edit] References

  1. ^ "Program Requirements for Residency Education in Neurological Surgery". Retrieved on 2008-03-15.
  2. ^ 2008 Match List for Neurological Surgery. Retrieved on 2008-03-15.

[edit] External links

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Health science > Medicine
Specialties
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Subspecialties
Diagnostic
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Surgery, Nervous system: neurosurgical procedures (ICD-9-CM V3 01-05)
Skull, brain, and cerebral meninges
Spinal cord and spinal canal
Cranial and peripheral nerves
Sympathetic nerves or ganglia
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Neuroscience