Neurosurgery

From Wikipedia, the free encyclopedia

(Redirected from Neurosurgeons)
For the medical journal, see Neurosurgery (journal).
Neurosurgery

Stereotactic guided insertion of DBS electrodes in

neurosurgery
Occupation
Activity
sectors

Surgery

Description
Education
required

Bachelor of Medicine, Bachelor

of Surgery (M.B.B.S.)
withFellowship of the Royal

College of Surgeons (F.R.C.S.)

or

Master of Surgery (M.S.)

Doctor of Medicine (M.D.)

Doctor of Osteopathic
Medicine(D.O.)

or

or

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, spinal cord,peripheral nerves, and extra-cranial cerebrovascular
system.[1]
Contents
[hide]

1 Education and training

o 1.1 United States
o 1.2 United Kingdom

2 Main divisions of neurosurgery

3 Neuropathology

4 Neuroanesthesia

5 Neurosurgery methods

6 Conditions

7 See also

8 References

9 External links

Education and training[edit]

In different countries, there are different requirements for an individual to legally practice
neurosurgery, and there are varying methods through which they must be educated. In most
countries neurosurgeon training is a minimum period of 7 years after graduating from medical
school.
United States[edit]
In the United States, a neurosurgeon must generally complete four years of college, four years of
medical school, and seven years of residency (PGY-1-7).[2] 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, SkullBase Surgery, peripheral nerve and spine surgery.[3] In the U.S., neurosurgery is considered a
highly competitive specialty composed of 0.6% of all practicing physicians.
United Kingdom[edit]
In the United Kingdom, students must gain entry into medical school. MBBS qualification
(Bachelor of Medicine, Bachelor of Surgery) takes 46 years depending on the student's route.
The newly qualified physician 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 neurosurgical pathway. Unlike most
other surgical specialties, it currently has its own independent training pathway which takes
around eight years (ST1-8); before being able to sit for consultant exams with sufficient amounts
of experience and practice behind them. Neurosurgery remains consistently amongst the most
competitive medical specialties to obtain entry into.[4]
Main divisions of neurosurgery[edit]
General neurosurgery involves most neurosurgical conditions including neuro-trauma and other
neuro-emergencies such as intracranial hemorrhage. Most level 1 hospitals have this kind of
practice.
Specialized branches have developed to cater to special and difficult conditions. These
specialized branches co-exist with general neurosurgery in more sophisticated hospitals. To
practice these higher specialization within neurosurgery, additional higher fellowship training of
12 years is expected from the neurosurgeon. Some of these divisions of neurosurgery are:
1. Vascular and endovascular neurosurgery
2. Stereotactic,functional and epilepsy neurosurgery

3. Oncological neurosurgery
4. Skull-Base Surgery
5. Spine neurosurgery
6. Peripheral nerve surgery
7. Pediatric neurosurgery
Neuropathology[edit]
The pathology confronted by neurosurgeons could be either congenital, acquired, traumatic, due
to infection, or neoplastic or degenerative conditions. Conditions like congenital hydrocephalus,
pediatric tumors and myelomeningocele are encountered in children. Trauma with head or spine
injury and bleeds due to arteriovenous malformation are encountered in young adults.
Degenerative spine disease, aneurysm bleeds and Parkinson's disease are encountered in much
older patients. The science of neuropathology is a well developed branch of pathology.
Neuroanesthesia[edit]
Neuroanesthesia is a highly developed science that is linked to neurosurgery. This branch of
medicine plays a very important part in day-to-day neurosurgery.
Neurosurgery methods[edit]
Neurosurgery
Intervention
ICD-10-PCS

00-01

ICD-9-CM

0105

MeSH

D019635

OPS-301 code:

5-01...5-05

For a satisfactory neurosurgery outcome a reasonable pre-operative diagnosis is essential.

Neuroradiology plays a key role not only in diagnosis but also in the operative phase of
neurosurgery.
Neuroradiology methods are used in modern neurosurgery diagnosis and treatment. They
include computer assisted imaging computed tomography (CT), magnetic resonance imaging
(MRI), positron emission tomography (PET), magnetoencephalography (MEG), and

the stereotactic radiosurgery. Some neurosurgery procedures involve the use of intra-operative
MRI and functional MRI.
In conventional open surgery the neurosurgeon opens the skull, uses a large opening to access
the brain. Technique of using smaller openings and using microscopes and endoscopes were
developed later. With this smaller openings and high clarity microscopic visualization of neural
tissue excellent results can be obtained. But, the open methods are still used in trauma or
emergency situations[10] Principles of Neurosurgery-Rengachari, Ellenbogen, [11] Neurotrauma and Critical Care of the Brain-Jallo, Loftus .'
Microsurgery is utilized in many aspects of neurological surgery. Microvascular techniques are
used in EC-IC by-pass surgery and in restoration carotid endarterectomy. The clipping of an
aneurysm is performed under microscopic vision. Minimally invasive spine surgery utilizes
microscopes or endoscopes. Procedures such as microdiscectomy, laminectomy, and artificial
disc replacement rely on microsurgery.[5]
Using Stereotaxy neurosurgeons can approach a minute target in the brain through a minimal
opening. This is used in functional neurosurgery where electrodes are implanted or gene therapy
is instituted with high level of accuracy as in the case of Parkinson's disease or Alzheimer's
disease. Then in the combination method of open and stereotactic surgery intraventricular
hemorrhages could be evacuated successfully.[6]
Minimally invasive endoscopic surgery is utilized by neurosurgeons. Techniques such
as endoscopic endonasal surgery is used in pituitary tumors, craniopharyngiomas, chordomas,
and the repair of cerebrospinal fluid leaks. Ventricular endoscopy is used in the treatment of
intraventricular bleeds, hydrocephalus, colloid cysts and neurocysticercosis. Endonasal
endoscopy at times is carried out with neurosurgeons and ENT surgeons as a team.
Repair of craniofacial disorders and disturbance of cerebrospinal fluid circulation is done by
neurosurgeons, and at times teaming up with maxillofacial and plastic surgeons. Cranioplasty for
craniosynostosis is performed by pediatric neurosurgeons with or without plastic surgeons.
Neurosurgeons are involved in Stereotactic Radiosurgery along with Radiation Oncologists
in tumor and AVMtreatment[13]Intracranial Stereotactic Radiosurgery-Lunsford, Sheehan, [14]Spine Radiosurgery-Gerszten, Ryu.
Radiosurgical methods such asGamma knife, Cyberknife and Novalis Shaped Beam Surgery are
used.[7]
Endovascular Neurosurgery utilize endovascular image guided procedures for the treatment
of aneurysms, AVMs, carotid stenosis, strokes, and spinal malformations, and vasospasms.
Techniques such as angioplasty, stenting, clot retrieval, embolization, and diagnostic
angiography are endovascular procedures.[8]

A common procedure performed in neurosurgery is the placement of Ventriculo-Peritoneal Shunt

(VP Shunt). In pediatric practice this is for congenital hydrocephalus. The commonest indication
in adults is Normal Pressure Hydrocephalus (NPH).
Neurosurgery of the spine covers cervical, thoracic and lumbar spine. Some indications for spine
surgery are spinal cord compression from trauma, arthritis or spondylosis. In cervical cord
compression patients may have gait difficulty, balance issues, numbness and tingling in hands or
feet. Spondylosis is spinal disc degeneration and arthritis that compresses the spinal canal
resulting in bone spurring and disc herniation. Power drills and special instruments are used to
correct any compression to the spinal canal. Disk herniations of spinal vertebral disks are
removed by Kerrison pitiutary rongeurs. This is called a discectomy. Laminectomy is
removing Lamina portion of the vertebra of the spine to make room for the compressed nerve
tissue. Minimally invasive, radiology assisted spine surgery include vertebroplasty and
kyphoplasty where some kinds of spinal fractures are managed[12] Essentials of Spinal Cord Injury-Fehlings, Vaccaro,
Boakye et al
.
Pain surgery handled by the neurosurgeons include implantation of deep brain stimulators, spinal
cord stimulators and pain pumps [9] Functional Neurosurgery-Starr, Barbaro, Larson. Surgery of the peripheral
nervous system include carpal tunnel decompression and peripheral nerve transposition.
Conditions[edit]
Other conditions treated by neurosurgeons include:

Meningitis and other central nervous system infections including abscesses

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

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 surgeryand 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

Moyamoya disease

See also[edit]

Sir Victor Horsley known as the first neurosurgeon

Hermann Schloffer invented transsphenoidal surgery in 1907

Harvey Cushing known as the father of modern neurosurgery

Gazi Yaargil known as the father of microneurosurgery

Ludvig Puusepp known as one of the founding fathers of modern neurosurgery, world's
first professor of neurosurgery

Walter Dandy known as one of the founding fathers of modern neurosurgery

Hirotaro Narabayashi a pioneer of stereotaxic neurosurgery

Alim-Louis Benabid known as one of the developers of deep brain stimulation surgery
for movement disorder

Wilder Penfield known as one of the founding fathers of modern 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

Robert F. Spetzler The most prolific vascular neurosurgeon in the world and director of
the Barrow Neurological Institute

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 craniopagus 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)

Frank Henderson Mayfield invented the Mayfield skull clamp

Ayub K. Ommaya invented the Ommaya reservoir

American Association of Neurological Surgeons

Congress of Neurological Surgeons

Polyaxial screw

References[edit]
1. Jump up^ AANS Patient Information
2. Jump up^ ABNS.org
3. Jump up^ http://www.aans.org/medical_students/questions.asp
4. Jump up^ "The society of British neurological surgeons". Retrieved 2011-03-11.
[dead link]

5. Jump up^ Cyber Museum of Neurosurgery

6. Jump up^ http://www.world-sci.com/read.aspx?id=135
7. Jump up^ Stereotactic Radiosurgery Program | UCLA Neurosurgery
8. Jump up^ Neuroradiology Information for Patients & Referring Physicians