Neurosurgery

For the journal, see Neurosurgery (journal).

Neurosurgery

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Stereotactic guided insertion of
DBS electrodes in neurosurgery

Occupation
Names
Pronunciation
Occupation type
Activity sectors	Surgery
Specialty
Competencies
Education required	Doctor of Medicine, Doctor of Osteopathic Medicine (U.S. Trained Only), Bachelor of Medicine, Bachelor of Surgery

USNS Comfort (T-AH 20) Performs Surgery

NationalNeurologyHospital

Neurosurgical diagnostic device for brain surgery from DEC, with DEC PDP-8E minicomputer and oscilloscope, Museum of Science, Boston, MA

A neurosurgery team discusses a CAT scan of a patient's brain being displayed on a computer monitor at Bethesda Naval Hospital - DPLA - afa63cc94d1eff5e962e0abedec63108

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.

Glossary of neurosurgery

• Amygdalotomy - A surgical procedure involving the removal or destruction of the amygdala, often performed to treat severe psychiatric disorders and intractable epilepsy.
• Atypical trigeminal neuralgia - A form of trigeminal neuralgia that presents with a more constant, less intense pain and may not respond to treatments typical for classical trigeminal neuralgia.
• Auditory brainstem implant - A device implanted to stimulate the cochlear nucleus in the brainstem, providing a sense of sound to individuals who are profoundly deaf due to auditory nerve damage.
• Base of skull - The bottom part of the skull, encompassing various foramina through which cranial nerves and blood vessels pass. It is a common site for complex surgical approaches due to the concentration of critical structures.
• Boron neutron capture therapy - An experimental type of radiation therapy that targets cancer cells through the nuclear capture and fission reactions of boron-10.
• Brain mapping - Techniques used to identify areas of the brain responsible for specific functions, crucial in planning surgery to minimize damage to eloquent brain areas.
• Brain transplant - A theoretical procedure involving the transplantation of an entire brain into a new body. While not currently feasible, it raises significant ethical and technical questions.
• Carotid endarterectomy - A surgical procedure to remove plaque from the carotid artery, preventing stroke in patients with significant carotid artery stenosis.
• Carotid stenting - The placement of a stent within the carotid artery to open narrowed areas, improving blood flow to the brain and reducing the risk of stroke.
• Cerebral angiography - An imaging technique that uses X-rays to visualize blood vessels in the brain, often used to diagnose and treat conditions such as aneurysms and arteriovenous malformations.
• Cerebral salt-wasting syndrome - A condition characterized by inappropriate sodium and fluid loss from the body, often occurring after brain injury or during diseases affecting the central nervous system.
• Clipping (medicine) - The application of a clip to the neck of an intracranial aneurysm to prevent it from rupturing.
• Cordotomy - A neurosurgical procedure that involves severing pain-conducting pathways in the spinal cord, usually to relieve intractable pain in cancer patients.
• Corpectomy - The surgical removal of the vertebral body, typically to relieve compression on the spinal cord or nerve roots.
• Cranial auscultation - Listening to the sounds produced within the skull, an uncommon practice in modern neurosurgery but historically used to diagnose vascular disorders like aneurysms.
• Cyberknife (device) - A frameless robotic radiosurgery system used to deliver precise radiation therapy to tumors and other lesions in the brain and spine.
• Dandy's point - An anatomical landmark on the scalp used to guide the placement of ventricular catheters for cerebrospinal fluid drainage.
• Decerebellate - Referring to a postural response seen in severe brain injury, where the arms are extended and the head is arched back, indicating damage above the level of the midbrain.
• Decerebration - A condition characterized by rigid posture, clenched fists, and extended legs due to severe damage to the upper brainstem.
• Discectomy - The surgical removal of a herniated or degenerative disc in the spine to relieve pressure on nearby nerve roots or the spinal cord.
• Dura mater - The tough outer layer of the meninges that envelops the brain and spinal cord, often involved in surgical procedures to access the central nervous system.
• Dural tear - A tear in the dura mater, which can occur during neurosurgical procedures, leading to cerebrospinal fluid leaks that require repair.
• Eloquent cortex - Areas of the brain that are responsible for functions such as language, motor, sensory, or visual processing, identified during brain mapping to avoid damage during surgery.
• Endoscopic endonasal surgery - A minimally invasive surgical approach through the nasal passages to access the skull base, pituitary gland, and upper spine.
• Endovascular coiling - A minimally invasive technique used to treat intracranial aneurysms by filling them with coils to prevent blood flow and rupture.
• External ventricular drain - A temporary device placed through the skull to drain cerebrospinal fluid (CSF) from the ventricles of the brain, relieving increased intracranial pressure.
• Facetectomy - A surgical procedure that involves removing a facet joint to relieve pressure on nerve roots and the spinal cord, often performed to treat spinal stenosis.
• Failed back syndrome - A condition characterized by persistent pain following back surgery, often due to residual or recurrent disc herniation, scar tissue, or structural changes.
• Foraminotomy - A neurosurgical procedure to enlarge the vertebral foramen and relieve pressure on nerve roots caused by conditions such as herniated discs or spinal stenosis.
• Ganglionectomy - The surgical removal of a ganglion, which is a group of nerve cell bodies, commonly performed to treat chronic pain or nerve dysfunction.
• Global neurosurgery - An emerging field focused on addressing the global disparity in access to neurosurgical care, with an emphasis on low- and middle-income countries.
• Howard Dully - An individual known for undergoing a lobotomy at a young age and later speaking out about his experiences, contributing to the public's understanding of the history and impact of psychosurgery.
• Idiopathic intracranial hypertension - A condition characterized by increased intracranial pressure without a detectable cause, presenting symptoms similar to those of a brain tumor but without an actual tumor.
• Infectious intracranial aneurysm - An aneurysm caused by an infection that weakens the walls of cerebral arteries, also known as a mycotic aneurysm.
• Intervertebral disc arthroplasty - The surgical replacement of a degenerated disc with an artificial disc to alleviate chronic back pain and preserve spine mobility.
• Intracranial aneurysm - A bulge or ballooning in a blood vessel in the brain, which can leak or rupture, causing bleeding into the brain (hemorrhagic stroke).
• Intracranial pressure monitoring - The measurement of the pressure inside the skull and thus in the brain tissue and cerebrospinal fluid, important in the management of patients with severe brain injury.
• Intraoperative MRI - The use of magnetic resonance imaging during surgery to provide real-time imaging guidance, enhancing the precision of neurosurgical procedures.
• Jugular foramen - A large opening in the base of the skull that transmits the internal jugular vein and several cranial nerves, often involved in surgical approaches to treat lesions or tumors.
• Keen's point - A landmark used in neurosurgery for the placement of a ventricular drain or for orienting in procedures involving the temporal lobe.
• Kocher's point - A common entry site for ventricular catheter placement in the treatment of hydrocephalus, located approximately 11 cm from the nasion and 3 cm lateral to the midline.
• Laminectomy - A surgical procedure that involves removing part or all of the vertebral bone (lamina) to relieve compression on the spinal cord or nerve roots.
• Laminotomy - A less invasive procedure than laminectomy, involving the removal of a small portion of the lamina to relieve pressure or allow access to remove disc herniations.
• Leucotome - A surgical instrument historically used in lobotomy procedures, designed to cut brain tissue.
• Microvascular decompression - A surgical technique to relieve abnormal compression of a cranial nerve, commonly used to treat trigeminal neuralgia and hemifacial spasm.
• Migraine surgery - A series of surgical techniques aimed at reducing migraine frequency and intensity by decompressing specific nerves around the head and neck.
• Multiple subpial transection - A surgical procedure aimed at controlling seizures by making several cuts through the cerebral cortex, leaving the overall brain function intact.
• N-localizer - A device used in stereotactic neurosurgery to establish precise coordinates for the targeting of brain structures.
• Nerve allograft - A nerve transplant from a donor to the recipient, used to repair nerve damage or gaps that cannot be bridged by direct suturing.
• Neurectomy - The surgical removal of a segment of a nerve, usually performed to relieve chronic pain when other treatments have failed.
• NeuroArm - A robotic system designed specifically for microsurgery and stereotaxy in neurosurgery, enhancing the precision of surgical procedures.
• Neurofibromatosis type II - A genetic disorder characterized by the formation of noncancerous tumors in the nervous system, including the brain and spinal cord.
• Neurolysis - The surgical destruction of nerve tissue to relieve pain, often performed using chemical, thermal, or mechanical methods.
• Neurolytic block - A procedure involving the deliberate interruption of nerve signals to relieve chronic pain, typically performed using chemicals like alcohol or phenol, or through thermal ablation techniques.
• Neuronavigation - The use of advanced imaging technologies during surgery to guide the removal of brain tumors or the treatment of other intracranial conditions with high precision.
• Neuroplastic surgery - A surgical specialty focused on the restoration of form and function after neurosurgical procedures, including reconstructive techniques following brain or spinal surgery.
• Neurosurgery - The medical specialty concerned with the prevention, diagnosis, surgical treatment, and rehabilitation of disorders that affect any portion of the nervous system including the brain, spinal cord, peripheral nerves, and cerebrovascular system.
• Neurotomy - The surgical cutting or dissection of a nerve, often performed to relieve pain or reduce muscle spasticity.
• Neutron capture therapy of cancer - An experimental treatment for cancer that involves the administration of a compound containing boron to the patient, followed by exposure to a beam of neutrons. The neutrons are captured by the boron, causing it to emit radiation that kills the cancer cells.
• Parietal bone - One of the two bones forming the sides and roof of the cranium. It plays a role in various neurosurgical procedures, particularly those involving cranial vault reconstruction.
• Patient registration - The process of recording patient details in a hospital or clinic, which in neurosurgery includes important information relevant to surgical planning and follow-up care.
• Pediatric neurosurgery - A subspecialty of neurosurgery focusing on the diagnosis and treatment of brain, spinal cord, and peripheral nerve disorders affecting infants, children, and adolescents.
• Phonemic neurological hypochromium therapy - A fictitious term and not recognized in the field of neurosurgery or medicine. Always consult reliable sources for accurate medical information.
• Post-vagotomy diarrhea - A possible complication following vagotomy, a surgical procedure that involves cutting the vagus nerve to reduce stomach acid secretion, which can affect gastrointestinal function.
• Primary central nervous system lymphoma - A rare form of non-Hodgkin lymphoma that starts within the central nervous system (CNS), including the brain, spinal cord, or meninges, and requires specialized neurosurgical management.
• Pseudomeningocele - An abnormal collection of cerebrospinal fluid that forms under the skin, typically as a complication of spinal surgery or injury, resembling a meningocele but lacking the meningeal membrane.
• Pseudosubarachnoid hemorrhage - An imaging artifact that appears similar to subarachnoid hemorrhage on CT scans but is caused by other conditions, such as diffuse cerebral edema. It requires careful interpretation to avoid misdiagnosis.
• Psychosurgery - A branch of neurosurgery that involves the surgical treatment of mental disorders. Its use has significantly declined with advances in psychiatric medication and therapy.
• Radiosurgery - A non-invasive treatment method that uses precise, focused radiation beams to treat tumors and other abnormalities in the brain and other parts of the body, without the need for incisions.
• Rhizotomy - A surgical procedure to sever nerve roots in the spinal cord, primarily performed to relieve chronic pain or to reduce muscle spasticity in conditions such as cerebral palsy.
• Spinal cord stimulator - A device implanted in the body to deliver electrical pulses to the spinal cord, used to manage chronic pain conditions when other treatments have failed.
• Stereotactic surgery - A minimally invasive form of surgical intervention that uses a three-dimensional coordinate system to locate small targets inside the body and to perform action such as ablation, biopsy, lesion, injection, stimulation, implantation, etc.
• Stereotaxic atlas - A reference book or digital application that provides detailed anatomical images or diagrams of the brain, used in stereotactic surgery for precise navigation and planning.
• Subarachnoid hemorrhage - Bleeding into the subarachnoid space between the arachnoid membrane and the pia mater covering the brain, often caused by the rupture of a cerebral aneurysm, and requiring urgent neurosurgical intervention.
• SurgiScope - A computer-assisted surgical system that combines imaging, surgical planning, and microscope visualization to assist neurosurgeons during complex procedures.
• Tessys method - A minimally invasive surgical technique for treating herniated lumbar discs, utilizing an endoscopic approach to remove disc material and relieve nerve compression.
• Translabyrinthine approach - A surgical technique used to access the internal auditory canal and cerebellopontine angle for the treatment of acoustic neuromas and other lesions, involving the removal of part of the temporal bone.
• Transsphenoidal surgery - A minimally invasive surgical approach to remove pituitary tumors through the sphenoid sinus, without opening the skull, commonly used in the treatment of pituitary adenomas.
• Transverse sinuses - Major venous channels found in the dura mater of the brain, which play a critical role in the drainage of blood from the brain back to the heart. They are often involved in neurosurgical procedures related to cerebrospinal fluid diversion or venous sinus thrombosis.
• Traumatic pneumorrhachis - The presence of air within the spinal canal, typically resulting from trauma. It is a rare condition that can be identified on imaging studies and may require neurosurgical evaluation.
• Vagotomy - A surgical procedure that involves cutting the vagus nerve to reduce acid secretion in the stomach, historically used for treating peptic ulcers but can lead to various gastrointestinal symptoms, including post-vagotomy diarrhea.
• Vascular bypass - A surgical procedure in neurosurgery where an alternate pathway is created to reroute blood flow around a blocked or narrowed artery in the brain, commonly used to treat conditions such as moyamoya disease.
• Vasospasm - The narrowing of blood vessels, which can occur after a subarachnoid hemorrhage and lead to reduced blood flow to the brain, potentially causing delayed cerebral ischemia. Its management is a critical aspect of neurosurgical care for affected patients.
• Vertebral fixation - A type of spinal surgery that involves the stabilization of vertebrae by using surgical hardware like screws, rods, or plates, often performed to treat fractures, deformities, or instability in the spine.
• White matter dissection - A technique used in neuroanatomy and neurosurgery to study the pathways of white matter tracts in the brain, important for understanding brain connectivity and planning surgical interventions that minimize damage to critical brain functions.

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