Neurosurgery

From Wikipedia, the free encyclopedia
  (Redirected from Neurosurgeon)
Jump to: navigation, search
For the journal, see Neurosurgery (journal).
Neurosurgery
Parkinson surgery.jpg
Stereotactic guided insertion of DBS electrodes in neurosurgery
Occupation
Activity sectors
Surgery
Description
Education required

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]

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.

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, Interventional neuroradiology, peripheral nerve, spine surgery and skull base surgery.[3] 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).

United Kingdom[edit]

In the United Kingdom, 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 and practice behind them.[4]

Neurosurgical methods[edit]

Neurosurgery
Intervention
ICD-10-PCS 00-01
ICD-9-CM 0105
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.[5]

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.[6]

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.[7]

    Most neurosurgery consists of spinal surgery including cervical, thoracic and lumbar surgery.  Indications for surgery are spinal cord compression from trauma or arthritis or spondylosis.  Patients may have gait difficulty, balance issues, numbness and tingling in hands or feet, for cervical cord compression.  Spondylosis is spinal disc degeneration and arthritis that compresses the spinal canal resulting in bone spurring and disc herniation.  A drill and special instruments are used to drill the arthritis out of the spinal canal.  Disk herniations from spinal vertebral disks are removed by Kerrison instruments and the remander of the disk is left.  This is called a lumbar laminectomy and discectomy.  Laminectomies are cutting part of the bone of the spine or the lamina to make room for the compressed nerve.

Conditions[edit]

Other conditions treated by neurosurgeons include:

See also[edit]

References[edit]

External links[edit]