Neurosurgery

For the journal, see Neurosurgery (journal).

Neurosurgery

Stereotactic guided insertion of DBS electrodes in neurosurgery
Occupation
Activity sectors	Surgery
Specialty	{{#statements:P1995}}
Description
Education required	Doctor of Medicine, Doctor of Osteopathic Medicine (U.S. Trained Only), Bachelor of Medicine, Bachelor of Surgery
Fields of employment	Hospitals, Clinics

Neurosurgery, also known as neurological surgery, occupies a unique niche in the vast expanse of medical specialties. The intricate nature of the nervous system combined with advances in medical technology and knowledge has established neurosurgery as a distinct and crucial field. Neurosurgery deals with disorders affecting the nervous system and encompasses a range of conditions from tumors to trauma, and from infections to inborn malformations.

Definition

Neurosurgery (or neurological surgery) is the medical specialty that primarily focuses on the prevention, diagnosis, treatment, and rehabilitation of disorders impacting any portion of the nervous system. This includes the brain, spinal cord, peripheral nerves, and the extra-cranial cerebrovascular system.

Education and Training

The journey to become a neurosurgeon is long and demanding, requiring intense training and dedication. It necessitates years of education, followed by specialized training, often involving research components and super-specializations.

In the US

In the United States, an aspirant must first complete four years of undergraduate education, typically followed by four years in medical school. After earning a medical degree, they undergo a one-year internship, which is generally affiliated with their subsequent residency program. The neurosurgery residency itself is intensive and lasts for five to seven years. During this time, many residency programs incorporate elements of basic science or clinical research, and some even offer an internal Ph.D. track. After residency, many neurosurgeons opt to further their expertise through fellowship training in specialized areas such as pediatric neurosurgery, neuro-oncology, and neurovascular surgery.

In terms of competitiveness, neurosurgery stands out in the U.S. accounting for only 0.6% of all practicing physicians. The field is sought after by top-tier medical students, resulting in a match rate of less than 60%.

In the UK

The path in the UK starts with gaining entry into medical school to achieve the MBBS qualification (Bachelor of Medicine, Bachelor of Surgery). Depending on the student's chosen route, this can take 4–6 years. After qualifying, they embark on a two-year Foundation training program, covering a myriad of specialties including surgery. Following this, junior doctors apply for the independent neurological training pathway, which takes roughly eight years before they can practice as consultants.

Neurosurgical Methods

Advancements in technology and medical imaging have paved the way for more accurate and less invasive neurosurgical procedures. Some of the cornerstone methods include:

• Computer Assisted Imaging Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Positron Emission Tomography (PET)
• Magnetoencephalography (MEG)
• Stereotactic Surgery

Modern neurosurgery often incorporates intraoperative MRI and functional MRI to improve surgical accuracy.

• Microsurgery, a technique utilizing advanced microscopy, is also integral in various neurosurgical procedures, including aneurysm clipping and minimally invasive spine surgeries like microdiscectomy and laminectomy.
• Endoscopic surgery has revolutionized many procedures, such as endoscopic endonasal surgery for pituitary tumors, craniopharyngiomas, and the repair of cerebrospinal fluid leaks.
• Furthermore, Stereotactic Radiosurgery, a collaborative effort with Radiation Oncologists, is used for treating tumors and AVMs. This involves techniques like the Gamma knife, Cyberknife, and Novalis Shaped Beam Surgery.
• Endovascular image-guided procedures are also gaining prominence for the treatment of conditions like aneurysms, AVMs, and strokes. These involve techniques such as angioplasty, stenting, and clot retrieval.

Conditions Treated

Neurosurgeons diagnose and manage a vast array of conditions, ranging from infections like Meningitis to structural abnormalities like Spinal disc herniation. They treat traumatic injuries of the brain, spinal cord, and peripheral nerves, manage tumors of the nervous system, and address vascular malformations like arteriovenous malformations.

Neurosurgery also plays a vital role in managing drug-resistant epilepsy, advanced Parkinson's disease, and certain psychiatric disorders. Surgical interventions can be crucial for patients with intractable pain due to cancer or trauma.

Prominent Neurosurgeons

Throughout the history of medicine, the field of neurosurgery has been graced with pioneering figures who have made significant contributions to the specialty. Some of these individuals are:

• Harvey Cushing – often referred to as the father of modern neurosurgery.
• Gazi Yaşargil – recognized as the father of microneurosurgery.
• Ludvig Puusepp – celebrated as one of the founding fathers of modern neurosurgery and acknowledged as the world's first professor of neurosurgery.
• Walter Dandy – renowned as one of the foundational figures of modern neurosurgery.
• Hirotaro Narabayashi – a pioneer in the field of stereotaxic neurosurgery.
• Wilder Penfield – another luminary known as one of the founding fathers of modern neurosurgery and a forerunner in epilepsy neurosurgery.
• Joseph Ransohoff – celebrated for introducing medical imaging and catheterization to neurosurgery and establishing the first neurosurgery intensive care unit.
• Robert F. Spetzler  – noted as the world's most prolific vascular neurosurgeon and the esteemed director of the Barrow Neurological Institute.
• Lars Leksell – the brilliant Swedish neurosurgeon who invented the Gamma Knife.
• Benjamin Carson – a globally acknowledged pediatric neurosurgeon at Johns Hopkins Hospital, recognized for his pioneering work in hemispherectomy and his expertise in separating craniopagus twins.
• John R. Adler – esteemed neurosurgeon from Stanford University credited with the invention of the CyberKnife.
• Wirginia Maixner – the distinguished pediatric neurosurgeon at Melbourne's Royal Children's Hospital. Gained international acclaim for successfully separating conjoined Bangladeshi twins, Trishna and Krishna.
• Sid Watkins – a globally recognized neurosurgeon who dedicated 26 years as the Formula One Safety and Medical Delegate.
• Alfredo Quinones-Hinojosa – currently serves as the Director of the Brain Tumor Surgery Program at Johns Hopkins Bayview Medical Center.
• Frank Henderson Mayfield – his invention, the Mayfield skull clamp, revolutionized neurosurgery.

Prominent Neurosurgical Associations

• American Association of Neurological Surgeons: A leading association dedicated to advancing the specialty of neurological surgery in order to promote the highest quality of patient care.
• Congress of Neurological Surgeons: An esteemed organization focused on enhancing health and improving lives through the advancement of neurosurgical education and scientific exchange.

List of Neurosurgeons (USA)

• Alabama
• Alaska
• Arizona
• Arkansas
• California
• Colorado
• Connecticut
• Delaware
• Florida
• Georgia
• Hawaii
• Idaho
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Louisiana
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Mississippi
• Missouri
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Carolina
• South Dakota
• Tennessee
• Texas
• Utah
• Vermont
• Virginia
• Washington
• West Virginia
• Wisconsin
• Wyoming

US territories

• American Samoa
• Guam
• Northern Mariana Islands
• Puerto Rico
• U.S. Virgin Islands
• District of Columbia

External Links

• American Association of Neurological Surgeons
• Congress of Neurological Surgeons
• The Brain that Changed Everything by Luke Dittrich - Esquire, November 2010

Resources

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