Neurosurgery
Overview
 
Neurosurgery 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
Human brain
The human brain has the same general structure as the brains of other mammals, but is over three times larger than the brain of a typical mammal with an equivalent body size. Estimates for the number of neurons in the human brain range from 80 to 120 billion...

, spine, spinal cord
Spinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...

, peripheral nerves
Peripheral nervous system
The peripheral nervous system consists of the nerves and ganglia outside of the brain and spinal cord. The main function of the PNS is to connect the central nervous system to the limbs and organs. Unlike the CNS, the PNS is not protected by the bone of spine and skull, or by the blood–brain...

, and extra-cranial cerebrovascular system.
In the United States, a neurosurgeon must generally complete four years of college, four years of medical school, a year-long internship (PGY-1) that is usually affiliated with their residency program, and five to six years of neurosurgery residency
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...

 (PGY-2-7).
Encyclopedia
Neurosurgery 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
Human brain
The human brain has the same general structure as the brains of other mammals, but is over three times larger than the brain of a typical mammal with an equivalent body size. Estimates for the number of neurons in the human brain range from 80 to 120 billion...

, spine, spinal cord
Spinal cord
The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...

, peripheral nerves
Peripheral nervous system
The peripheral nervous system consists of the nerves and ganglia outside of the brain and spinal cord. The main function of the PNS is to connect the central nervous system to the limbs and organs. Unlike the CNS, the PNS is not protected by the bone of spine and skull, or by the blood–brain...

, and extra-cranial cerebrovascular system.

In the United States

In the United States, a neurosurgeon must generally complete four years of college, four years of medical school, a year-long internship (PGY-1) that is usually affiliated with their residency program, and five to six years of neurosurgery residency
Residency (medicine)
Residency is a stage of graduate medical training. A resident physician or resident is a person who has received a medical degree , Podiatric degree , Dental Degree and who practices...

 (PGY-2-7). 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
Oncology
Oncology is a branch of medicine that deals with cancer...

, radiosurgery, neurovascular surgery, Interventional neuroradiology
Interventional neuroradiology
Interventional Neuroradiology /Neurointerventional Surgery is an Accreditation Council for Graduate Medical Education accredited medical subspecialty specializing in minimally invasive image-based technologies and procedures used in diagnosis and treatment of diseases of the head, neck, and...

, peripheral nerve, spine surgery and skull base surgery. Neurosurgeons can also pursue fellowship training in neuropathology
Neuropathology
Neuropathology is the study of disease of nervous system tissue, usually in the form of either small surgical biopsies or whole autopsy brains. Neuropathology is a subspecialty of anatomic pathology, neurology, and neurosurgery...

 and neuro-ophthalmology
Neuro-ophthalmology
Neuro-ophthalmology is the subspecialty of both neurology and ophthalmology concerning visual problems that are related to the nervous system ....

.

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 programme in a hospital or clinical setting covering a range of medical specialties including surgery. Junior doctors then apply to enter the neurosurgical 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.

Neurosurgical methods

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)
Positron emission tomography
Positron emission tomography is nuclear medicine imaging technique that produces a three-dimensional image or picture of functional processes in the body. The system detects pairs of gamma rays emitted indirectly by a positron-emitting radionuclide , which is introduced into the body on a...

, magnetoencephalography (MEG)
Magnetoencephalography
Magnetoencephalography is a technique for mapping brain activity by recording magnetic fields produced by electrical currents occurring naturally in the brain, using arrays of SQUIDs...

, and the stereotactic surgery
Stereotactic surgery
Stereotactic surgery or stereotaxy is a minimally invasive form of surgical intervention which makes use of a three-dimensional coordinates system to locate small targets inside the body and to perform on them some action such as ablation, biopsy, lesion, injection, stimulation, implantation,...

. 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.

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 cyst
Colloid cyst
A colloid cyst is a cyst containing gelatinous material in the brain. It is almost always found just posterior to the foramen of Monro in the anterior aspect of the third ventricle, originating from the roof of the ventricle. Because of its location, it can cause obstructive hydrocephalus and...

s and neurocysticercosis. Endoscopic techniques can be used to assist in the evaculation of hematomas and trigeminal neuralgia.
Repair of craniofacial disorders and disturbance of cerebrospinal fluid circulation is done by neurosurgeons, and depending on the situation, plastic surgeons. Conditions such as chiari malformation, craniosynostosis, and syringomyelia are treated. This is called cranioplasty
Cranioplasty
Cranioplasty is a surgical repair of a defect or deformity of a skull. Cranioplasty is almost as ancient as trepanation. There is evidence that Incan surgeons were performing cranioplasty using precious metals and gourds...

.

Neurosurgeons are involved in Stereotactic Radiosurgery along with Radiation Oncologists for tumor
Tumor
A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...

 and AVM
AVM
AVM may refer to:*Arteriovenous malformation, a congenital disorder of the veins and arteries that make up the vascular system*Cerebral arteriovenous malformation, an abnormal connection of the veins and arteries in the brain...

treatment. Radiosurgical methods such as Gamma knife, Cyberknife
Cyberknife
The CyberKnife is a frameless robotic radiosurgery system used for treating benign tumors, malignant tumors and other medical conditions. The system was invented by John R. Adler, a Stanford University Professor of Neurosurgery and Radiation Oncology, and Peter and Russell Schonberg of Schonberg...

 and Novalis Shaped Beam Surgery are used.

Neurosurgeons have begun to utilize endovascular image guided procedures for the treatment of aneurysm
Aneurysm
An aneurysm or aneurism is a localized, blood-filled balloon-like bulge in the wall of a blood vessel. Aneurysms can commonly occur in arteries at the base of the brain and an aortic aneurysm occurs in the main artery carrying blood from the left ventricle of the heart...

s, 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.

Conditions

Other conditions treated by neurosurgeons include:
  • Spinal disc herniation
    Spinal disc herniation
    A spinal disc herniation , informally and misleadingly called a "slipped disc", is a medical condition affecting the spine due to trauma, lifting injuries, or idiopathic, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion A spinal disc herniation...

  • Cervical spinal stenosis
    Cervical spinal stenosis
    Cervical spinal stenosis is a bone disease involving the narrowing of the spinal canal at the level of the neck. It is frequently due to chronic degeneration, but may also be congenital. Treatment is frequently surgical....

     and Lumbar spinal stenosis
  • Hydrocephalus
    Hydrocephalus
    Hydrocephalus , also known as "water in the brain," is a medical condition in which there is an abnormal accumulation of cerebrospinal fluid in the ventricles, or cavities, of the brain. This may cause increased intracranial pressure inside the skull and progressive enlargement of the head,...

  • Head trauma (brain hemorrhages, skull fractures, etc.)
  • Spinal cord
    Spinal cord
    The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...

     trauma
    Physical trauma
    Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

  • Traumatic injuries
    Physical trauma
    Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

     of peripheral nerves
    Peripheral nervous system
    The peripheral nervous system consists of the nerves and ganglia outside of the brain and spinal cord. The main function of the PNS is to connect the central nervous system to the limbs and organs. Unlike the CNS, the PNS is not protected by the bone of spine and skull, or by the blood–brain...

  • Infections
  • Tumours of the spine, spinal cord
    Spinal cord
    The spinal cord is a long, thin, tubular bundle of nervous tissue and support cells that extends from the brain . The brain and spinal cord together make up the central nervous system...

     and peripheral nerves
    Peripheral nervous system
    The peripheral nervous system consists of the nerves and ganglia outside of the brain and spinal cord. The main function of the PNS is to connect the central nervous system to the limbs and organs. Unlike the CNS, the PNS is not protected by the bone of spine and skull, or by the blood–brain...

  • Intracerebral hemorrhage, such as subarachnoid hemorrhage
    Subarachnoid hemorrhage
    A subarachnoid hemorrhage , or subarachnoid haemorrhage in British English, is bleeding into the subarachnoid space—the area between the arachnoid membrane and the pia mater surrounding the brain...

    , intraparenchymal, and intraventricular hemorrhages
  • Some forms of drug-resistant epilepsy
    Epilepsy
    Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...

  • Some forms of movement disorder
    Movement disorder
    Movement disorders include:* Akathisia * Akinesia * Associated Movements * Athetosis...

    s (advanced Parkinson's disease
    Parkinson's disease
    Parkinson's disease is a degenerative disorder of the central nervous system...

    , chorea) this involves the use of specially developed minimally invasive stereotactic
    Stereotaxy
    Stereotaxy from stereo meaning solidity, and tactile meaning touch) refers to any technique that involves the recording and reproduction of three-dimensional haptic information or creating an illusion of depth to the sense of touch within an otherwise-flat surface...

     techniques (functional, stereotactic neurosurgery) such as ablative surgery and deep brain stimulation
    Deep brain stimulation
    Deep brain stimulation is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain...

     surgery
  • Intractable pain of cancer
    Cancer
    Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

     or trauma
    Physical trauma
    Trauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...

     patients and cranial/peripheral nerve pain
  • Some forms of intractable psychiatric disorders
  • Vascular malformations (i.e., arteriovenous malformation
    Arteriovenous malformation
    Arteriovenous malformation or AVM is an abnormal connection between veins and arteries, usually congenital. This pathology is widely known because of its occurrence in the central nervous system, but can appear in any location. An arteriovenous malformation is a vascular anomaly. It is a...

    s, venous angiomas, cavernous angioma
    Cavernous angioma
    Cavernous angioma, also known as cerebral cavernous malformation , cavernous haemangioma, and cavernoma, is a vascular disorder that alternately has been classified as neoplastic or hamartomatous. It is characterized by grossly dilated blood vessels with a single layer of endothelium and an...

    s, capillary telangectasias) of the brain and spinal cord
  • Peripheral neuropathies such as carpal tunnel syndrome
    Carpal tunnel syndrome
    Carpal Tunnel Syndrome is an entrapment idiopathic median neuropathy, causing paresthesia, pain, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel. The pathophysiology is not completely understood but can be considered compression...

     and ulnar neuropathy
  • Moyamoya disease

See also

  • Gazi Yasargil
    Gazi Yasargil
    Mahmut Gazi Yaşargil is a Turkish medical scientist and neurosurgeon . He is the founder of microneurosurgery. Yaşargil treated epilepsy and brain tumors with instruments of his own design...

    Known as the father of microneurosurgery
  • Harvey Cushing
    Harvey Cushing
    Harvey Williams Cushing, M.D. , was an American neurosurgeon and a pioneer of brain surgery, and the first to describe Cushing's syndrome...

    Known as the father of neurosurgery
  • Walter Dandy
    Walter Dandy
    Walter Edward Dandy, M.D. was an American neurosurgeon and scientist. He is considered one of the founding fathers of neurosurgery, along with Victor Horsley and Harvey Cushing...

    Known as one of the founding fathers of neurosurgery
  • Wilder Penfield
    Wilder Penfield
    Wilder Graves Penfield, OM, CC, CMG, FRS was an American born Canadian neurosurgeon. During his life he was called "the greatest living Canadian"...

    Known as one of the founding fathers of neurosurgery, and pioneer of epilepsy
    Epilepsy
    Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...

     neurosurgery
  • Lars Leksell
    Lars Leksell
    Lars Leksell was a Swedish physician and Professor of Neurosurgery at the Karolinska Institute in Stockholm, Sweden. He was the inventor of radiosurgery.-Life and work:...

    Swedish Neurosurgeon who developed the Gamma Knife
  • Benjamin Carson Renowned pediatric neurosurgeon at Johns Hopkins Hospital
    Johns Hopkins Hospital
    The Johns Hopkins Hospital is the teaching hospital and biomedical research facility of Johns Hopkins University School of Medicine, located in Baltimore, Maryland . It was founded using money from a bequest by philanthropist Johns Hopkins...

    , pioneer in hemispherectomy
    Hemispherectomy
    Hemispherectomy is a very rare surgical procedure where one cerebral hemisphere is removed or disabled. This procedure is used to treat a variety of seizure disorders where the source of the epilepsy is localized to a broad area of a single hemisphere of the brain...

    , and pioneer in the separation of conjoined twins
    Conjoined twins
    Conjoined twins are identical twins whose bodies are joined in utero. A rare phenomenon, the occurrence is estimated to range from 1 in 50,000 births to 1 in 100,000 births, with a somewhat higher incidence in Southwest Asia and Africa. Approximately half are stillborn, and a smaller fraction of...

    , joined at the head
  • John R. Adler
    John R. Adler
    John R. Adler M.D. is a neurosurgeon, the Dorothy and Thye King Chan Endowed Professor of Neurosurgery at Stanford University School of Medicine and Vice Chair for Innovation and Technology in the Department of Neurosurgery at Stanford University School of Medicine.Clinically, Dr. Adler...

     Stanford University
    Stanford University
    The Leland Stanford Junior University, commonly referred to as Stanford University or Stanford, is a private research university on an campus located near Palo Alto, California. It is situated in the northwestern Santa Clara Valley on the San Francisco Peninsula, approximately northwest of San...

     neurosurgeon who invented the CyberKnife
    Cyberknife
    The CyberKnife is a frameless robotic radiosurgery system used for treating benign tumors, malignant tumors and other medical conditions. The system was invented by John R. Adler, a Stanford University Professor of Neurosurgery and Radiation Oncology, and Peter and Russell Schonberg of Schonberg...

  • Wirginia Maixner
    Wirginia Maixner
    Wirginia June Maixner is an Australian neurosurgeon and the director of neurosurgery at the Royal Children's Hospital in Melbourne, Australia...

     - Pediatric Neurosurgeon at Melbourne's Royal Children's Hospital
    Royal Children's Hospital
    The Royal Children's Hospital is a major children's hospital in Melbourne, Australia.As the major paediatric hospital in Victoria, the Royal Children's Hospital and offers a full range of clinical services, tertiary care and health promotion and prevention programs for children and adolescents...

    . Primarily known for separating conjoined Bangladesh
    Bangladesh
    Bangladesh , officially the People's Republic of Bangladesh is a sovereign state located in South Asia. It is bordered by India on all sides except for a small border with Burma to the far southeast and by the Bay of Bengal to the south...

    i twins, Trishna and Krishna.
  • Sid Watkins
    Sid Watkins
    Eric Sidney Watkins OBE, FRCS is a world-renowned English neurosurgeon.Watkins served twenty-six years as the FIA Formula One Safety and Medical Delegate, head of the Formula One on-track medical team, and first responder in case of a crash.He is commonly known within the Formula One fraternity as...

    World renowned neurosurgeon who served for 26 years as the Formula One
    Formula One
    Formula One, also known as Formula 1 or F1 and referred to officially as the FIA Formula One World Championship, is the highest class of single seater auto racing sanctioned by the Fédération Internationale de l'Automobile . The "formula" designation in the name refers to a set of rules with which...

     Safety and Medical Delegate (race doctor)
  • American Association of Neurological Surgeons
    American Association of Neurological Surgeons
    The American Association of Neurological Surgeons is a professional body based in the United States with more than 8,000 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public...

  • Congress of Neurological Surgeons
    Congress of Neurological Surgeons
    The Congress of Neurological Surgeons is a professional body representing neurosurgeons, neurosurgical residents, medical students, and allied health professionals...

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