Neurosurgery

Neurosurgery (or neurological surgery) is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spine, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.^[1][2]

Education and training

In the United States

In the United States, a neurosurgeon must generally complete four years of college, four years of medical school, a year-long internship (PGY-1) that is usually affiliated with their residency program, and five to six years of neurosurgery residency (PGY-2-7).^[3] Most, but not all, residency programs have some component of basic science or clinical research. Neurosurgeons may pursue an additional training in a fellowship, after residency or in some cases, as a senior resident. These fellowships include pediatric neurosurgery, trauma/neurocritical care, functional and stereotactic surgery, surgical neuro-oncology, radiosurgery, neurovascular surgery, Interventional neuroradiology, peripheral nerve, spine surgery and skull base surgery.^[4] Neurosurgeons can also pursue fellowship training in neuropathology and neuro-ophthalmology.

In the UK

In the UK, students must gain entry into medical school. MBBS qualification (Bachelor of Medicine, Bachelor of Surgery) takes 4-6 years depending on the student's route. The newly qualified Doctor must then complete Foundation training lasting two years; this is a paid training program in a hospital or clinical setting covering a range of medical specialties including surgery. Junior doctors then apply to enter the neurological pathway. Unlike other surgical specialties, it currently has its own independent training pathway which takes around eight years (ST1-8) before being able to sit consultant exams.^[5]

Neurosurgical methods

Neuroradiology methods are used in modern neurosurgical diagnosis and treatment, including computer assisted imaging computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), magnetoencephalography (MEG), and the stereotactic surgery. Some neurosurgical procedures involve the use of MRI and functional MRI intraoperatively.

Microsurgery is utilized in many aspects of neurological surgery. Microvascular anastomosis are required when EC-IC surgery is performed. The clipping of aneurysms is performed using a microscope. Minimally invasive spine surgery utilizes these techniques. Procedures such as microdiscectomy, laminectomy, and artificial discs rely on microsurgery.^[6]

Minimally invasive endoscopic surgery is utilized by neurosurgeons. Techniques such as endoscopic endonasal surgery is used for pituitary tumors, craniopharyngiomas, chordomas, and the repair of cerebrospinal fluid leaks. Ventricular endoscopy is used for colloid cysts and neurocysticercosis. Endoscopic techniques can be used to assist in the evaculation of hematomas and trigeminal neuralgia. Repair of craniofacial disorders and disturbance of cerebrospinal fluid circulation is done by neurosurgeons, and depending on the situation, plastic surgeons. Conditions such as chiari malformation, craniosynostosis, and syringomyelia are treated. This is called cranioplasty.

Neurosurgeons are involved in Stereotactic Radiosurgery along with Radiation Oncologists for tumor and AVM treatment. Radiosurgical methods such as Gamma knife, Cyberknife and Novalis Shaped Beam Surgery are used.^[7]

Neurosurgeons have begun to utilize endovascular image guided procedures for the treatment of aneurysms, AVMs, carotid stenosis, strokes, and spinal malformations, and vasospasms. Also, nonvascular procedures such as Vertoplasty and Kyphoplasty are used by neurosurgeons. Techniques such as angioplasty, stenting, clot retrieval, embolization, and diagnostic angiography are utilized.^[8]

Conditions

Other conditions treated by neurosurgeons include:

• Spinal disc herniation
• Cervical spinal stenosis and Lumbar spinal stenosis
• Hydrocephalus
• Head trauma (brain hemorrhages, skull fractures, etc.)
• Spinal cord trauma
• Traumatic injuries of peripheral nerves
• Infections
• Tumors of the spine, spinal cord and peripheral nerves
• Intracerebral hemorrhage, such as subarachnoid hemorrhage, interdepartmental, and intracellular hemorrhages
• Some forms of drug-resistant epilepsy
• Some forms of movement disorders (advanced Parkinson's disease, chorea) – this involves the use of specially developed minimally invasive stereotactic techniques (functional, stereotactic neurosurgery) such as ablative surgery and deep brain stimulation surgery
• Intractable pain of cancer or trauma patients and cranial/peripheral nerve pain
• Some forms of intractable psychiatric disorders
• Vascular malformations (i.e., arteriovenous malformations, venous angiomas, cavernous angiomas, capillary telangectasias) of the brain and spinal cord
• Peripheral neuropathies such as carpal tunnel syndrome and ulnar neuropathy
• Moyamoya disease

See also

• Gazi Yasargil – Known as the father of microneurosurgery
• Harvey Cushing – Known as the father of neurosurgery
• Walter Dandy – Known as one of the founding fathers of neurosurgery
• Wilder Penfield – Known as one of the founding fathers of neurosurgery, and pioneer of epilepsy neurosurgery
• Joseph Ransohoff – Known for his pioneering use of medical imaging and catheterization in neurosurgery, and for founding the first neurosurgery intensive care unit.
• Lars Leksell – Swedish Neurosurgeon who developed the Gamma Knife
• Benjamin Carson – Renowned pediatric neurosurgeon at Johns Hopkins Hospital, pioneer in hemispherectomy, and pioneer in the separation of conjoined twins, joined at the head
• John R. Adler  – Stanford University neurosurgeon who invented the CyberKnife
• Wirginia Maixner - Pediatric Neurosurgeon at Melbourne's Royal Children's Hospital. Primarily known for separating conjoined Bangladeshi twins, Trishna and Krishna.
• Sid Watkins – World renowned neurosurgeon who served for 26 years as the Formula One Safety and Medical Delegate (race doctor)
• American Association of Neurological Surgeons
• Congress of Neurological Surgeons

References