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, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.[1][2]

Education and training In the US In the United States, a neurosurgeon must generally complete four years of college, four years of medical school, a one year internship (PGY-1) that is usually affiliated with their residency program, and 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] In the U.S., neurosurgery is considered an extremely competitive specialty composed of only 0.6% of all practicing physicians and attracts only the top students of medical schools per year (with a <60% match rate and highest average USMLE scores).

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 with great amounts of experience behind them, and practice.[5]

Neurosurgical methods Neurosurgery
Intervention
ICD-10-PCS 00-01
ICD-9-CM 01–05
MeSH D019635
OPS-301 code: 5-01...5-05

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 evacuation of hematomas and trigeminal neuralgia. Repair of craniofacial disorders and disturbance of cerebrospinal fluid circulation is done by neurosurgeons, and depending on the situation, maxillofacial and 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:

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 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
Moyamoya disease