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Wikipedia

Neurosurgery

April 21, 2023

For the journal, see Neurosurgery (journal).

Neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peripheral nervous system.[1]

Neurosurgery
Stereotactic guided insertion of DBS electrodes in neurosurgery
Occupation
Activity sectors
Surgery
Description
Education required

or

or

Fields of
employment
Hospitals, Clinics

Education and context

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. In most countries, neurosurgeon training requires a minimum period of seven years after graduating from medical school.[2]

United States

In the United States, a neurosurgeon must generally complete four years of undergraduate education, four years of medical school, and seven years of residency (PGY-1-7).[3] Most, but not all, residency programs have some component of basic science or clinical research. Neurosurgeons may pursue additional training in the form of a fellowship after residency, or, in some cases, as a senior resident in the form of an enfolded fellowship. These fellowships include pediatric neurosurgery, trauma/neurocritical care, functional and stereotactic surgery, surgical neuro-oncology, radiosurgery, neurovascular surgery, skull-base surgery, peripheral nerve and complex spinal surgery.[4] Fellowships typically span one to two years. In the U.S., neurosurgery is a very small, highly competitive specialty, constituting only 0.5 percent of all physicians.[5]

United Kingdom

In the United Kingdom, students must gain entry into medical school. MBBS qualification (Bachelor of Medicine, Bachelor of Surgery) takes four to six years depending on the student's route. The newly qualified physician 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 neurosurgical pathway. Unlike most other surgical specialties, it currently has its own independent training pathway which takes around eight years (ST1-8); before being able to sit for consultant exams with sufficient amounts of experience and practice behind them. Neurosurgery remains consistently amongst the most competitive medical specialties in which to obtain entry.

History

Main article: History of neurology and neurosurgery

Neurosurgery, or the premeditated incision into the head for pain relief, has been around for thousands of years, but notable advancements in neurosurgery have only come within the last hundred years.[6]

 
Trepanned skull from Edinburgh

Ancient

The Incas appear to have practiced a procedure known as trepanation since before European colonization.[7] During the Middle Ages in Al-Andalus from 936 to 1013 AD, Al-Zahrawi performed surgical treatments of head injuries, skull fractures, spinal injuries, hydrocephalus, subdural effusions and headache.[8] During the Roman Empire, doctors and surgeons performed neurosurgery on depressed skull fractures.[9][10] Simple forms of neurosurgery were performed on King Henri II in 1559, after a jousting accident with Gabriel Montgomery fatally wounded him. Ambroise Paré and Andreas Vesalius, both experts in their field at the time, attempted their own methods, to no avail, in curing Henri.[11] In China, Hua Tuo created the first general anaesthesia called mafeisan, which he used on surgical procedures on the brain.[12]

Modern

History of tumor removal: In 1879, after locating it via neurological signs alone, Scottish surgeon William Macewen (1848–1924) performed the first successful brain tumor removal.[3] On November 25, 1884, after English physician Alexander Hughes Bennett (1848–1901) used Macewen's technique to locate it, English surgeon Rickman Godlee (1849–1925) performed the first primary brain tumor removal,[4][13] which differs from Macewen's operation in that Bennett operated on the exposed brain, whereas Macewen operated outside of the "brain proper" via trepanation.[14] On March 16, 1907, Austrian surgeon Hermann Schloffer became the first to successfully remove a pituitary tumor.[15]

Lobotomy: also known as leucotomy, was a form of psychosurgery, a neurosurgical treatment of mental disorders that involves severing connections in the brain's prefrontal cortex.[16] The originator of the procedure, Portuguese neurologist António Egas Moniz, shared the Nobel Prize for Physiology or Medicine of 1949.[17][18] Some patients improved in some ways after the operation, but complications and impairments – sometimes severe – were frequent. The procedure was controversial from its initial use, in part due to the balance between benefits and risks. It is mostly rejected as a treatment now and non-compliant with patients' rights.

History of electrodes in the brain: In 1878, Richard Caton discovered that electrical signals transmitted through an animal's brain. In 1950 Dr. Jose Delgado invented the first electrode that was implanted in an animal's brain (bull), using it to make it run and change direction.[19] In 1972 the cochlear implant, a neurological prosthetic that allowed deaf people to hear was marketed for commercial use. In 1998 researcher Philip Kennedy implanted the first Brain Computer Interface (BCI) into a human subject.[20]

A survey done in 2010 on 100 most cited works in neurosurgery shows that the works mainly cover clinical trials evaluating surgical and medical therapies, descriptions of novel techniques in neurosurgery, and descriptions of systems classifying and grading diseases.[21]

Modern surgical instruments

Modern neurosurgical instruments
  •  

    A doctor performing Stereotactic Gamma Knife Radiosurgery, a non-invasive procedure

  •  

    Puma Robotic Arm

  •  

    Aluminum headrest

The main advancements in neurosurgery came about as a result of highly crafted tools. Modern neurosurgical tools, or instruments, include chisels, curettes, dissectors, distractors, elevators, forceps, hooks, impactors, probes, suction tubes, power tools, and robots.[22][23] Most of these modern tools have been in medical practice for a relatively long time. The main difference of these tools in neurosurgery, were the precision in which they were crafted. These tools are crafted with edges that are within a millimeter of desired accuracy.[24] Other tools, such as hand held power saws and robots have only recently been commonly used inside of a neurological operating room. As an example, the University of Utah developed a device for computer-aided design / computer-aided manufacturing (CAD-CAM) which uses an image-guided system to define a cutting tool path for a robotic cranial drill.[25]

Organised neurosurgery

 
World Academy of Neurological Surgery's conference

The World Federation of Neurosurgical Societies (WFNS), founded in 1955, in Switzerland, as a professional, scientific, non governmental organization, is composed of 130 member societies: consisting of 5 Continental Associations (AANS, AASNS, CAANS, EANS and FLANC), 6 Affiliate Societies, and 119 National Neurosurgical Societies, representing some 50,000 neurosurgeons worldwide.[26] It has a consultative status in the United Nations. The official Journal of the Organization is World Neurosurgery.[27][28] The other global organisations being the World Academy of Neurological Surgery (WANS) and the World Federation of Skull Base Societies (WFSBS).

Main divisions

General neurosurgery involves most neurosurgical conditions including neuro-trauma and other neuro-emergencies such as intracranial hemorrhage. Most level 1 hospitals have this kind of practice.[29]

Specialized branches have developed to cater to special and difficult conditions. These specialized branches co-exist with general neurosurgery in more sophisticated hospitals. To practice advanced specialization within neurosurgery, additional higher fellowship training of one to two years is expected from the neurosurgeon. Some of these divisions of neurosurgery are:

  1. Vascular neurosurgery includes clipping of aneurysms and performing carotid endarterectomy (CEA).
  2. Stereotactic neurosurgery, functional neurosurgery, and epilepsy surgery (the latter includes partial or total corpus callosotomy – severing part or all of the corpus callosum to stop or lessen seizure spread and activity, and the surgical removal of functional, physiological and/or anatomical pieces or divisions of the brain, called epileptic foci, that are operable and that are causing seizures, and also the more radical and rare partial or total lobectomy, or even hemispherectomy – the removal of part or all of one of the lobes, or one of the cerebral hemispheres of the brain; those two procedures, when possible, are also very, very rarely used in oncological neurosurgery or to treat very severe neurological trauma, such as stab or gunshot wounds to the brain)
  3. Oncological neurosurgery also called neurosurgical oncology; includes pediatric oncological neurosurgery; treatment of benign and malignant central and peripheral nervous system cancers and pre-cancerous lesions in adults and children (including, among others, glioblastoma multiforme and other gliomas, brain stem cancer, astrocytoma, pontine glioma, medulloblastoma, spinal cancer, tumors of the meninges and intracranial spaces, secondary metastases to the brain, spine, and nerves, and peripheral nervous system tumors)
  4. Skull base surgery
  5. Spinal neurosurgery
  6. Peripheral nerve surgery
  7. Pediatric neurosurgery (for cancer, seizures, bleeding, stroke, cognitive disorders or congenital neurological disorders)

Commonly performed surgeries

According to an analysis by the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), the most common surgeries performed by neurosurgeons in between 2006 and 2014 were the following:[30]

Neuropathology

 
Histopathology specimen of Angiocentric glioma, higher magnification, HE stain

Neuropathology is a specialty within the study of pathology focused on the disease of the brain, spinal cord, and neural tissue.[31] This includes the central nervous system and the peripheral nervous system. Tissue analysis comes from either surgical biopsies or post mortem autopsies. Common tissue samples include muscle fibers and nervous tissue.[32][failed verification] Common applications of neuropathology include studying samples of tissue in patients who have Parkinson's disease, Alzheimer's disease, dementia, Huntington's disease, amyotrophic lateral sclerosis, mitochondria disease, and any disorder that has neural deterioration in the brain or spinal cord.[33][34]

History

While pathology has been studied for millennia only within the last few hundred years has medicine focused on a tissue- and organ-based approach to tissue disease. In 1810, Thomas Hodgkin started to look at the damaged tissue for the cause. This was conjoined with the emergence of microscopy and started the current understanding of how the tissue of the human body is studied.[35]

Neuroanesthesia

Neuroanesthesia is a field of anesthesiology which focuses on neurosurgery. Anesthesia is not used during the middle of an "awake" brain surgery. Awake brain surgery is where the patient is conscious for the middle of the procedure and sedated for the beginning and end. This procedure is used when the tumor does not have clear boundaries and the surgeon wants to know if they are invading on critical regions of the brain which involve functions like talking, cognition, vision, and hearing. It will also be conducted for procedures which the surgeon is trying to combat epileptic seizures.[36]

History

The physician Hippocrates (460–370 BCE) made accounts of using different wines to sedate patients while trepanning. In 60 CE, Dioscorides, a physician, pharmacologist, and botanist, detailed how mandrake, henbane, opium, and alcohol were used to put patients to sleep during trepanning. In 972 CE, two brother surgeons in Paramara, now India, used "samohine" to sedate a patient while removing a small tumor, and awoke the patient by pouring onion and vinegar in the patient's mouth. The combination of carbon dioxide, hydrogen, and nitrogen, was a form of neuroanesthesia adopted in the 18th century, and introduced by Humphry Davy.[37]

Neurosurgery methods

Neurosurgery
ICD-10-PCS00-01
ICD-9-CM01–05
MeSHD019635
OPS-301 code5-01...5-05
[edit on Wikidata]

Neuroradiology methods are used in modern neurosurgery diagnosis and treatment. They include computer assisted imaging computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), magnetoencephalography (MEG), and stereotactic radiosurgery. Some neurosurgery procedures involve the use of intra-operative MRI and functional MRI.[38]

In conventional open surgery the neurosurgeon opens the skull, creating a large opening to access the brain. Techniques involving smaller openings with the aid of microscopes and endoscopes are now being used as well. Methods that utilize small craniotomies in conjunction with high-clarity microscopic visualization of neural tissue offer excellent results. However, the open methods are still traditionally used in trauma or emergency situations.[15][22]

Microsurgery is utilized in many aspects of neurological surgery. Microvascular techniques are used in EC-IC bypass surgery and in restoration carotid endarterectomy. The clipping of an aneurysm is performed under microscopic vision. Minimally-invasive spine surgery utilizes microscopes or endoscopes. Procedures such as microdiscectomy, laminectomy, and artificial disc replacement rely on microsurgery.[23]

Using stereotaxy neurosurgeons can approach a minute target in the brain through a minimal opening. This is used in functional neurosurgery where electrodes are implanted or gene therapy is instituted with high level of accuracy as in the case of Parkinson's disease or Alzheimer's disease. Using the combination method of open and stereotactic surgery, intraventricular hemorrhages can potentially be evacuated successfully.[24] Conventional surgery using image guidance technologies is also becoming common and is referred to as surgical navigation, computer-assisted surgery, navigated surgery, stereotactic navigation. Similar to a car or mobile Global Positioning System (GPS), image-guided surgery systems, like Curve Image Guided Surgery and StealthStation, use cameras or electromagnetic fields to capture and relay the patient's anatomy and the surgeon's precise movements in relation to the patient, to computer monitors in the operating room. These sophisticated computerized systems are used before and during surgery to help orient the surgeon with three-dimensional images of the patient's anatomy including the tumor.[39] Real-time functional brain mapping has been employed to identify specific functional regions using electrocorticography (ECoG)[40]

Minimally invasive endoscopic surgery is commonly utilized by neurosurgeons when appropriate. Techniques such as endoscopic endonasal surgery are used in pituitary tumors, craniopharyngiomas, chordomas, and the repair of cerebrospinal fluid leaks. Ventricular endoscopy is used in the treatment of intraventricular bleeds, hydrocephalus, colloid cyst and neurocysticercosis. Endonasal endoscopy is at times carried out with neurosurgeons and ENT surgeons working together as a team.[41]

Repair of craniofacial disorders and disturbance of cerebrospinal fluid circulation is done by neurosurgeons who also occasionally team up with maxillofacial and plastic surgeons. Cranioplasty for craniosynostosis is performed by pediatric neurosurgeons with or without plastic surgeons.[42]

Neurosurgeons are involved in stereotactic radiosurgery along with radiation oncologists in tumor and AVM treatment. Radiosurgical methods such as Gamma knife, Cyberknife and Novalis Radiosurgery are used as well.[43]

Endovascular surgical neuroradiology utilize endovascular image guided procedures for the treatment of aneurysms, AVMs, carotid stenosis, strokes, and spinal malformations, and vasospasms. Techniques such as angioplasty, stenting, clot retrieval, embolization, and diagnostic angiography are endovascular procedures.[44]

A common procedure performed in neurosurgery is the placement of ventriculo-peritoneal shunt (VP shunt). In pediatric practice this is often implemented in cases of congenital hydrocephalus. The most common indication for this procedure in adults is normal pressure hydrocephalus (NPH).[45]

Neurosurgery of the spine covers the cervical, thoracic and lumbar spine. Some indications for spine surgery include spinal cord compression resulting from trauma, arthritis of the spinal discs, or spondylosis. In cervical cord compression, patients may have difficulty with gait, balance issues, and/or numbness and tingling in the hands or feet. Spondylosis is the condition of spinal disc degeneration and arthritis that may compress the spinal canal. This condition can often result in bone-spurring and disc herniation. Power drills and special instruments are often used to correct any compression problems of the spinal canal. Disc herniations of spinal vertebral discs are removed with special rongeurs. This procedure is known as a discectomy. Generally once a disc is removed it is replaced by an implant which will create a bony fusion between vertebral bodies above and below. Instead, a mobile disc could be implanted into the disc space to maintain mobility. This is commonly used in cervical disc surgery. At times instead of disc removal a Laser discectomy could be used to decompress a nerve root. This method is mainly used for lumbar discs. Laminectomy is the removal of the lamina of the vertebrae of the spine in order to make room for the compressed nerve tissue.[46]

Surgery for chronic pain is a sub-branch of functional neurosurgery. Some of the techniques include implantation of deep brain stimulators, spinal cord stimulators, peripheral stimulators and pain pumps.[47]

Surgery of the peripheral nervous system is also possible, and includes the very common procedures of carpal tunnel decompression and peripheral nerve transposition. Numerous other types of nerve entrapment conditions and other problems with the peripheral nervous system are treated as well.[48]

Conditions

Conditions treated by neurosurgeons include, but are not limited to:[49]

Recovery

Postoperative pain

Pain following brain surgery can be significant and may lengthen recovery, increase the amount of time a person stays in the hospital following surgery, and increase the risk of complications following surgery.[50] Severe acute pain following brain surgery may also increase the risk of a person developing a chronic post-craniotomy headache.[50] Approaches to treating pain in adults include treatment with nonsteroidal anti‐inflammatory drugs (NSAIDs), which have been shown to reduce pain for up to 24 hours following surgery.[50] Low-quality evidence supports the use of the medications dexmedetomidine, pregabalin or gabapentin to reduce post-operative pain.[50] Low-quality evidence also supports scalp blocks and scalp infiltration to reduce postoperative pain.[50] Gabapentin or pregabalin may also decrease vomiting and nausea following surgery, based on very low-quality medical evidence.[50]

Notable neurosurgeons

See also

References

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April 21, 2023
neurosurgery, journal, journal, neurological, surgery, known, common, parlance, brain, surgery, medical, specialty, concerned, with, surgical, treatment, disorders, which, affect, portion, nervous, system, including, brain, spinal, cord, peripheral, nervous, s. For the journal see Neurosurgery journal Neurosurgery or neurological surgery known in common parlance as brain surgery is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain spinal cord and peripheral nervous system 1 NeurosurgeryStereotactic guided insertion of DBS electrodes in neurosurgeryOccupationActivity sectorsSurgeryDescriptionEducation requiredDoctor of Medicine M D or Doctor of Osteopathic Medicine D O with Residency in Neurosurgeryor Bachelor of Medicine Bachelor of Surgery M B B S with Residency in Neurosurgery or Fellowship of the Royal College of Surgeons F R C S or Master of Surgery M S Magister Chirurgiae M Ch Fields ofemploymentHospitals Clinics Contents 1 Education and context 1 1 United States 1 2 United Kingdom 2 History 2 1 Ancient 2 2 Modern 2 3 Modern surgical instruments 3 Organised neurosurgery 4 Main divisions 4 1 Commonly performed surgeries 5 Neuropathology 5 1 History 6 Neuroanesthesia 6 1 History 7 Neurosurgery methods 8 Conditions 9 Recovery 9 1 Postoperative pain 10 Notable neurosurgeons 11 See also 12 ReferencesEducation and context EditIn different countries there are different requirements for an individual to legally practice neurosurgery and there are varying methods through which they must be educated In most countries neurosurgeon training requires a minimum period of seven years after graduating from medical school 2 United States Edit In the United States a neurosurgeon must generally complete four years of undergraduate education four years of medical school and seven years of residency PGY 1 7 3 Most but not all residency programs have some component of basic science or clinical research Neurosurgeons may pursue additional training in the form of a fellowship after residency or in some cases as a senior resident in the form of an enfolded fellowship These fellowships include pediatric neurosurgery trauma neurocritical care functional and stereotactic surgery surgical neuro oncology radiosurgery neurovascular surgery skull base surgery peripheral nerve and complex spinal surgery 4 Fellowships typically span one to two years In the U S neurosurgery is a very small highly competitive specialty constituting only 0 5 percent of all physicians 5 United Kingdom Edit In the United Kingdom students must gain entry into medical school MBBS qualification Bachelor of Medicine Bachelor of Surgery takes four to six years depending on the student s route The newly qualified physician 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 neurosurgical pathway Unlike most other surgical specialties it currently has its own independent training pathway which takes around eight years ST1 8 before being able to sit for consultant exams with sufficient amounts of experience and practice behind them Neurosurgery remains consistently amongst the most competitive medical specialties in which to obtain entry History EditMain article History of neurology and neurosurgery Neurosurgery or the premeditated incision into the head for pain relief has been around for thousands of years but notable advancements in neurosurgery have only come within the last hundred years 6 Trepanned skull from Edinburgh Ancient Edit The Incas appear to have practiced a procedure known as trepanation since before European colonization 7 During the Middle Ages in Al Andalus from 936 to 1013 AD Al Zahrawi performed surgical treatments of head injuries skull fractures spinal injuries hydrocephalus subdural effusions and headache 8 During the Roman Empire doctors and surgeons performed neurosurgery on depressed skull fractures 9 10 Simple forms of neurosurgery were performed on King Henri II in 1559 after a jousting accident with Gabriel Montgomery fatally wounded him Ambroise Pare and Andreas Vesalius both experts in their field at the time attempted their own methods to no avail in curing Henri 11 In China Hua Tuo created the first general anaesthesia called mafeisan which he used on surgical procedures on the brain 12 Modern Edit History of tumor removal In 1879 after locating it via neurological signs alone Scottish surgeon William Macewen 1848 1924 performed the first successful brain tumor removal 3 On November 25 1884 after English physician Alexander Hughes Bennett 1848 1901 used Macewen s technique to locate it English surgeon Rickman Godlee 1849 1925 performed the first primary brain tumor removal 4 13 which differs from Macewen s operation in that Bennett operated on the exposed brain whereas Macewen operated outside of the brain proper via trepanation 14 On March 16 1907 Austrian surgeon Hermann Schloffer became the first to successfully remove a pituitary tumor 15 Lobotomy also known as leucotomy was a form of psychosurgery a neurosurgical treatment of mental disorders that involves severing connections in the brain s prefrontal cortex 16 The originator of the procedure Portuguese neurologist Antonio Egas Moniz shared the Nobel Prize for Physiology or Medicine of 1949 17 18 Some patients improved in some ways after the operation but complications and impairments sometimes severe were frequent The procedure was controversial from its initial use in part due to the balance between benefits and risks It is mostly rejected as a treatment now and non compliant with patients rights History of electrodes in the brain In 1878 Richard Caton discovered that electrical signals transmitted through an animal s brain In 1950 Dr Jose Delgado invented the first electrode that was implanted in an animal s brain bull using it to make it run and change direction 19 In 1972 the cochlear implant a neurological prosthetic that allowed deaf people to hear was marketed for commercial use In 1998 researcher Philip Kennedy implanted the first Brain Computer Interface BCI into a human subject 20 A survey done in 2010 on 100 most cited works in neurosurgery shows that the works mainly cover clinical trials evaluating surgical and medical therapies descriptions of novel techniques in neurosurgery and descriptions of systems classifying and grading diseases 21 Modern surgical instruments Edit Modern neurosurgical instruments A doctor performing Stereotactic Gamma Knife Radiosurgery a non invasive procedure Puma Robotic Arm Aluminum headrest The main advancements in neurosurgery came about as a result of highly crafted tools Modern neurosurgical tools or instruments include chisels curettes dissectors distractors elevators forceps hooks impactors probes suction tubes power tools and robots 22 23 Most of these modern tools have been in medical practice for a relatively long time The main difference of these tools in neurosurgery were the precision in which they were crafted These tools are crafted with edges that are within a millimeter of desired accuracy 24 Other tools such as hand held power saws and robots have only recently been commonly used inside of a neurological operating room As an example the University of Utah developed a device for computer aided design computer aided manufacturing CAD CAM which uses an image guided system to define a cutting tool path for a robotic cranial drill 25 Organised neurosurgery Edit World Academy of Neurological Surgery s conference The World Federation of Neurosurgical Societies WFNS founded in 1955 in Switzerland as a professional scientific non governmental organization is composed of 130 member societies consisting of 5 Continental Associations AANS AASNS CAANS EANS and FLANC 6 Affiliate Societies and 119 National Neurosurgical Societies representing some 50 000 neurosurgeons worldwide 26 It has a consultative status in the United Nations The official Journal of the Organization is World Neurosurgery 27 28 The other global organisations being the World Academy of Neurological Surgery WANS and the World Federation of Skull Base Societies WFSBS Main divisions EditGeneral neurosurgery involves most neurosurgical conditions including neuro trauma and other neuro emergencies such as intracranial hemorrhage Most level 1 hospitals have this kind of practice 29 Specialized branches have developed to cater to special and difficult conditions These specialized branches co exist with general neurosurgery in more sophisticated hospitals To practice advanced specialization within neurosurgery additional higher fellowship training of one to two years is expected from the neurosurgeon Some of these divisions of neurosurgery are Vascular neurosurgery includes clipping of aneurysms and performing carotid endarterectomy CEA Stereotactic neurosurgery functional neurosurgery and epilepsy surgery the latter includes partial or total corpus callosotomy severing part or all of the corpus callosum to stop or lessen seizure spread and activity and the surgical removal of functional physiological and or anatomical pieces or divisions of the brain called epileptic foci that are operable and that are causing seizures and also the more radical and rare partial or total lobectomy or even hemispherectomy the removal of part or all of one of the lobes or one of the cerebral hemispheres of the brain those two procedures when possible are also very very rarely used in oncological neurosurgery or to treat very severe neurological trauma such as stab or gunshot wounds to the brain Oncological neurosurgery also called neurosurgical oncology includes pediatric oncological neurosurgery treatment of benign and malignant central and peripheral nervous system cancers and pre cancerous lesions in adults and children including among others glioblastoma multiforme and other gliomas brain stem cancer astrocytoma pontine glioma medulloblastoma spinal cancer tumors of the meninges and intracranial spaces secondary metastases to the brain spine and nerves and peripheral nervous system tumors Skull base surgery Spinal neurosurgery Peripheral nerve surgery Pediatric neurosurgery for cancer seizures bleeding stroke cognitive disorders or congenital neurological disorders Commonly performed surgeries Edit According to an analysis by the American College of Surgeons National Surgical Quality Improvement Program NSQIP the most common surgeries performed by neurosurgeons in between 2006 and 2014 were the following 30 Anterior cervical discectomy and fusion ACDF Craniotomy for brain tumor CBT Discectomy Laminectomy Posterolateral lumbar fusion PLF Neuropathology Edit Histopathology specimen of Angiocentric glioma higher magnification HE stain Neuropathology is a specialty within the study of pathology focused on the disease of the brain spinal cord and neural tissue 31 This includes the central nervous system and the peripheral nervous system Tissue analysis comes from either surgical biopsies or post mortem autopsies Common tissue samples include muscle fibers and nervous tissue 32 failed verification Common applications of neuropathology include studying samples of tissue in patients who have Parkinson s disease Alzheimer s disease dementia Huntington s disease amyotrophic lateral sclerosis mitochondria disease and any disorder that has neural deterioration in the brain or spinal cord 33 34 History Edit While pathology has been studied for millennia only within the last few hundred years has medicine focused on a tissue and organ based approach to tissue disease In 1810 Thomas Hodgkin started to look at the damaged tissue for the cause This was conjoined with the emergence of microscopy and started the current understanding of how the tissue of the human body is studied 35 Neuroanesthesia EditNeuroanesthesia is a field of anesthesiology which focuses on neurosurgery Anesthesia is not used during the middle of an awake brain surgery Awake brain surgery is where the patient is conscious for the middle of the procedure and sedated for the beginning and end This procedure is used when the tumor does not have clear boundaries and the surgeon wants to know if they are invading on critical regions of the brain which involve functions like talking cognition vision and hearing It will also be conducted for procedures which the surgeon is trying to combat epileptic seizures 36 History Edit The physician Hippocrates 460 370 BCE made accounts of using different wines to sedate patients while trepanning In 60 CE Dioscorides a physician pharmacologist and botanist detailed how mandrake henbane opium and alcohol were used to put patients to sleep during trepanning In 972 CE two brother surgeons in Paramara now India used samohine to sedate a patient while removing a small tumor and awoke the patient by pouring onion and vinegar in the patient s mouth The combination of carbon dioxide hydrogen and nitrogen was a form of neuroanesthesia adopted in the 18th century and introduced by Humphry Davy 37 Neurosurgery methods EditNeurosurgeryICD 10 PCS00 01ICD 9 CM01 05MeSHD019635OPS 301 code5 01 5 05 edit on Wikidata Neuroradiology methods are used in modern neurosurgery diagnosis and treatment They include computer assisted imaging computed tomography CT magnetic resonance imaging MRI positron emission tomography PET magnetoencephalography MEG and stereotactic radiosurgery Some neurosurgery procedures involve the use of intra operative MRI and functional MRI 38 In conventional open surgery the neurosurgeon opens the skull creating a large opening to access the brain Techniques involving smaller openings with the aid of microscopes and endoscopes are now being used as well Methods that utilize small craniotomies in conjunction with high clarity microscopic visualization of neural tissue offer excellent results However the open methods are still traditionally used in trauma or emergency situations 15 22 Microsurgery is utilized in many aspects of neurological surgery Microvascular techniques are used in EC IC bypass surgery and in restoration carotid endarterectomy The clipping of an aneurysm is performed under microscopic vision Minimally invasive spine surgery utilizes microscopes or endoscopes Procedures such as microdiscectomy laminectomy and artificial disc replacement rely on microsurgery 23 Using stereotaxy neurosurgeons can approach a minute target in the brain through a minimal opening This is used in functional neurosurgery where electrodes are implanted or gene therapy is instituted with high level of accuracy as in the case of Parkinson s disease or Alzheimer s disease Using the combination method of open and stereotactic surgery intraventricular hemorrhages can potentially be evacuated successfully 24 Conventional surgery using image guidance technologies is also becoming common and is referred to as surgical navigation computer assisted surgery navigated surgery stereotactic navigation Similar to a car or mobile Global Positioning System GPS image guided surgery systems like Curve Image Guided Surgery and StealthStation use cameras or electromagnetic fields to capture and relay the patient s anatomy and the surgeon s precise movements in relation to the patient to computer monitors in the operating room These sophisticated computerized systems are used before and during surgery to help orient the surgeon with three dimensional images of the patient s anatomy including the tumor 39 Real time functional brain mapping has been employed to identify specific functional regions using electrocorticography ECoG 40 Minimally invasive endoscopic surgery is commonly utilized by neurosurgeons when appropriate Techniques such as endoscopic endonasal surgery are used in pituitary tumors craniopharyngiomas chordomas and the repair of cerebrospinal fluid leaks Ventricular endoscopy is used in the treatment of intraventricular bleeds hydrocephalus colloid cyst and neurocysticercosis Endonasal endoscopy is at times carried out with neurosurgeons and ENT surgeons working together as a team 41 Repair of craniofacial disorders and disturbance of cerebrospinal fluid circulation is done by neurosurgeons who also occasionally team up with maxillofacial and plastic surgeons Cranioplasty for craniosynostosis is performed by pediatric neurosurgeons with or without plastic surgeons 42 Neurosurgeons are involved in stereotactic radiosurgery along with radiation oncologists in tumor and AVM treatment Radiosurgical methods such as Gamma knife Cyberknife and Novalis Radiosurgery are used as well 43 Endovascular surgical neuroradiology utilize endovascular image guided procedures for the treatment of aneurysms AVMs carotid stenosis strokes and spinal malformations and vasospasms Techniques such as angioplasty stenting clot retrieval embolization and diagnostic angiography are endovascular procedures 44 A common procedure performed in neurosurgery is the placement of ventriculo peritoneal shunt VP shunt In pediatric practice this is often implemented in cases of congenital hydrocephalus The most common indication for this procedure in adults is normal pressure hydrocephalus NPH 45 Neurosurgery of the spine covers the cervical thoracic and lumbar spine Some indications for spine surgery include spinal cord compression resulting from trauma arthritis of the spinal discs or spondylosis In cervical cord compression patients may have difficulty with gait balance issues and or numbness and tingling in the hands or feet Spondylosis is the condition of spinal disc degeneration and arthritis that may compress the spinal canal This condition can often result in bone spurring and disc herniation Power drills and special instruments are often used to correct any compression problems of the spinal canal Disc herniations of spinal vertebral discs are removed with special rongeurs This procedure is known as a discectomy Generally once a disc is removed it is replaced by an implant which will create a bony fusion between vertebral bodies above and below Instead a mobile disc could be implanted into the disc space to maintain mobility This is commonly used in cervical disc surgery At times instead of disc removal a Laser discectomy could be used to decompress a nerve root This method is mainly used for lumbar discs Laminectomy is the removal of the lamina of the vertebrae of the spine in order to make room for the compressed nerve tissue 46 Surgery for chronic pain is a sub branch of functional neurosurgery Some of the techniques include implantation of deep brain stimulators spinal cord stimulators peripheral stimulators and pain pumps 47 Surgery of the peripheral nervous system is also possible and includes the very common procedures of carpal tunnel decompression and peripheral nerve transposition Numerous other types of nerve entrapment conditions and other problems with the peripheral nervous system are treated as well 48 Conditions EditConditions treated by neurosurgeons include but are not limited to 49 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 diseaseRecovery EditPostoperative pain Edit Pain following brain surgery can be significant and may lengthen recovery increase the amount of time a person stays in the hospital following surgery and increase the risk of complications following surgery 50 Severe acute pain following brain surgery may also increase the risk of a person developing a chronic post craniotomy headache 50 Approaches to treating pain in adults include treatment with nonsteroidal anti inflammatory drugs NSAIDs which have been shown to reduce pain for up to 24 hours following surgery 50 Low quality evidence supports the use of the medications dexmedetomidine pregabalin or gabapentin to reduce post operative pain 50 Low quality evidence also supports scalp blocks and scalp infiltration to reduce postoperative pain 50 Gabapentin or pregabalin may also decrease vomiting and nausea following surgery based on very low quality medical evidence 50 Notable neurosurgeons EditSaleem Abdulrauf developed awake craniotomy for complex aneurysms and vascular malformations John R Adler Stanford University neurosurgeon who invented the Cyberknife Alim Louis Benabid known as one of the developers of deep brain stimulation surgery for movement disorder Ben Carson retired pediatric neurosurgeon from Johns Hopkins Hospital pioneer in hemispherectomy and pioneer in the separation of craniopagus twins joined at the head former 2016 Republican Party presidential candidate and former United States Secretary of Housing and Urban Development under the Trump Administration Harvey Cushing known as one of the fathers of modern Neurosurgery Walter Dandy known as one of the founding fathers of modern Neurosurgery Christopher Duntsch Former neurosurgeon who killed or maimed nearly every patient he operated on before being incarcerated Victor Horsley known as the first neurosurgeon Lars Leksell Swedish neurosurgeon who developed the Gamma Knife Wirginia Maixner pediatric neurosurgeon at Melbourne s Royal Children s Hospital Primarily known for separating conjoined Bangladeshi twins Trishna and Krishna Henry Marsh leading English neurosurgeon and pioneer of neurosurgical advancements in Ukraine Frank Henderson Mayfield invented the Mayfield skull clamp B K Misra First neurosurgeon in the world to perform image guided surgery for aneurysms first in South Asia to perform stereotactic radiosurgery first in India to perform awake craniotomy and laparoscopic spine surgery 51 Karin Muraszko first woman to occupy a chair of neurosurgery at an American medical school University of Michigan Hirotaro Narabayashi a pioneer of stereotactic Neurosurgery Ayub K Ommaya invented the Ommaya reservoir Wilder Penfield known as one of the founding fathers of modern neurosurgery and pioneer of epilepsy Neurosurgery Ludvig Puusepp known as one of the founding fathers of modern neurosurgery world s first professor of Neurosurgery Joseph Ransohoff known for his pioneering use of medical imaging and catheterization in neurosurgery and for founding the first neurosurgery intensive care unit Majid Samii pioneer of cerebello pontine angle tumor surgery World Federation of Neurosurgical Societies coined a medal of honor bearing Samii s name which would be given to outstanding neurosurgeons every two years citation needed Juliet Sekabunga Nalwanga Uganda s first female neurosurgeon Hermann Schloffer invented transsphenoidal surgery in 1907 Robert Wheeler Rand along with Theodore Kurze MD was among the first to introduce the surgical microscope into neurosurgical procedures in 1957 and published first textbook on Microneurosurgery in 1969 Robert J White Established the Vatican s Commission on Biomedical Ethics in 1981 after his appointment to the Pontifical Academy of Sciences and was famous for his head transplants on living monkeys 52 53 Gazi Yasargil known as the father of microneurosurgery See also Edit Medicine portalAmerican Association of Neurological Surgeons Scientific and educational association Congress of Neurological Surgeons Professional organization Cranial auscultation Medical neurological procedure to check for intracranial bruits Global neurosurgery Global health subspecialty List of neurologists and neurosurgeons Polyaxial screw Orthopedic screwReferences Edit Neurological Surgery Specialty Description American Medical Association Retrieved 4 October 2020 Brain Surgeon Job Description Salary Duties and Requirements Science Retrieved 29 December 2019 a b Preul Mark C 2005 History of brain tumor surgery Neurosurgical Focus 18 4 1 doi 10 3171 foc 2005 18 4 1 a b Kirkpatrick Douglas B 1984 The first primary brain tumor operation Journal of Neurosurgery 61 5 809 13 doi 10 3171 jns 1984 61 5 0809 PMID 6387062 Ensuring an Adequate Neurosurgical Workforce for the 21st Century PDF American Association of Neurological Surgeons Archived from the original PDF on 11 July 2021 Retrieved 28 May 2021 Neurosurgery is a small specialty constituting only 0 5 percent of all physicians Wickens Andrew P 2014 12 08 A History of the Brain From Stone Age surgery to modern neuroscience Psychology Press ISBN 9781317744825 Andrushko Valerie A Verano John W September 2008 Prehistoric trepanation in the Cuzco region of Peru A view into an ancient Andean practice American Journal of Physical Anthropology 137 1 4 13 doi 10 1002 ajpa 20836 PMID 18386793 Al Rodhan N R Fox J L 1986 07 01 Al Zahrawi and Arabian neurosurgery 936 1013 AD Surgical Neurology 26 1 92 95 doi 10 1016 0090 3019 86 90070 4 ISSN 0090 3019 PMID 3520907 Desai Tejal Bhatia Sangeeta N 2007 05 26 BioMEMS and Biomedical Nanotechnology Volume III Therapeutic Micro Nanotechnology Springer Science amp Business Media p 97 ISBN 978 0 387 25844 7 Gillard Arthur 2012 10 19 Traumatic Brain Injury in Spanish Greenhaven Publishing LLC p 142 ISBN 978 0 7377 7312 5 Kean Sam 2014 The Tale of the Dueling Neurosurgeons The History of the Human Brain as Revealed by True Stories of Trauma Madness and Recovery New York Little Brown and Company p 25 40 Zhang Yuqi 2015 03 18 HUA Tuo The First Neurosurgeon in the World Translational Neuroscience and Clinics 1 71 72 doi 10 18679 CN11 6030 R 2015 008 S2CID 207942533 Alexander Hughes Bennett 1848 1901 Rickman John Godlee 1849 1925 CA A Cancer Journal for Clinicians 24 3 169 170 1974 doi 10 3322 canjclin 24 3 169 PMID 4210862 S2CID 45097428 Surgery a b Cyber Museum of Neurosurgery Archived from the original on 2017 01 06 Retrieved 2016 02 11 Lobotomy Definition Procedure amp History Live Science Retrieved 2018 06 28 Nouri Aria 20 October 2011 A brief history of lobotomy aaas org Miguel A Faria 5 April 2013 Violence mental illness and the brain A brief history of psychosurgery Part 1 From trephination to lobotomy Surgical Neurology International 4 49 doi 10 4103 2152 7806 110146 PMC 3640229 PMID 23646259 C Marzullo Timothy Spring 2017 The Missing Manuscript of Dr Jose Delgado s Radio Controlled Bulls Journal of Undergraduate Neuroscience Education 15 2 R29 R35 PMC 5480854 PMID 28690447 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint url status link http biomed brown edu Courses BI108 BI108 2005 Groups 03 hist htm full citation needed permanent dead link Ponce FA Lozano AM February 2010 Highly cited works in neurosurgery Part I the 100 top cited papers in neurosurgical journals Journal of Neurosurgery 112 2 223 32 doi 10 3171 2009 12 JNS091599 PMID 20078192 a b Neurosurgery surgical power tool All medical device manufacturers Videos a b Neurosurgical Instruments Neurosurgery Instrument Neurosurgeon Surgical Tools a b Technology increases precision safety during neurosurgery Penn State University Robotics in Neurosurgery Neurosurgical Focus 42 5 1 May 2017 Retrieved 14 November 2018 About the Foundation World Federation of Neurosurgical Societies Archived from the original on 2020 08 04 Retrieved 2020 07 10 Journal World Neurosurgery WFNS Archived from the original on 6 June 2014 Retrieved 29 May 2014 World Neurosurgery Home page Elsevier Retrieved 29 May 2014 Esposito Thomas J Reed R Lawrence Gamelli Richard L Luchette Fred A 2005 01 01 Neurosurgical Coverage Essential Desired or Irrelevant for Good Patient Care and Trauma Center Status Transactions of the Meeting of the American Surgical Association 123 3 67 76 doi 10 1097 01 sla 0000179624 50455 db ISSN 0066 0833 PMC 1357744 PMID 16135922 M Giantini Larsen BS Alexandra Vishwas Karhade BE Aditya J Cote BS David R Smith MD Timothy 2016 Most Common Neurosurgical Procedures amp Complications Report Cushing Neurosurgery Outcomes Center Department of Pathology Microbiology and Immunology Archived from the original on 2021 01 25 Retrieved 2016 02 12 http neuropathology stanford edu full citation needed permanent dead link Dementia Filosto Massimiliano Tomelleri Giuliano Tonin Paola Scarpelli Mauro Vattemi Gaetano Rizzuto Nicolo Padovani Alessandro Simonati Alessandro 2007 Neuropathology of mitochondrial diseases Bioscience Reports 27 1 3 23 30 doi 10 1007 s10540 007 9034 3 PMID 17541738 S2CID 36830289 van den Tweel Jan G Taylor Clive R 2010 A brief history of pathology Virchows Archiv 457 1 3 10 doi 10 1007 s00428 010 0934 4 PMC 2895866 PMID 20499087 Awake Brain Surgery Intraoperative Brain Mapping Imaging Services Johns Hopkins Intraoperative Neurophysiological Monitoring Unit IONM 26 April 2022 Chivukula Srinivas Grandhi Ramesh Friedlander Robert M 2014 A brief history of early neuroanesthesia Neurosurgical Focus 36 4 E2 doi 10 3171 2014 2 FOCUS13578 PMID 24684332 Castillo Mauricio 2005 Neuroradiology Companion Methods Guidelines and Imaging Fundamentals 3rd ed Philadelphia Lippincott Williams amp Wilkins pp 1 428 Duan Zhaoliang amp Yuan Zhi Yong amp Liao Xiangyun amp Si Weixin amp Zhao Jianhui 2011 3D Tracking and Positioning of Surgical Instruments in Virtual Surgery Simulation Journal of Multimedia 6 6 502 509 doi 10 4304 jmm 6 6 502 509 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint uses authors parameter link Swift James amp Coon William amp Guger Christoph amp Brunner Peter amp Bunch M amp Lynch T amp Frawley T amp Ritaccio Anthony amp Schalk Gerwin 2018 Passive functional mapping of receptive language areas using electrocorticographic signals Clinical Neurophysiology 6 12 2517 2524 doi 10 1016 j clinph 2018 09 007 PMC 6414063 PMID 30342252 a href Template Cite journal html title Template Cite journal cite journal a CS1 maint uses authors parameter link Ismail M Abdelaziz AA Darwish M April 2019 A comparison between collaborative and single surgeon approach in endoscopic endonasal surgery to sphenoid sinus European Archives of Oto Rhino Laryngology European Archives of Oto Rhino Laryngology volume 276 4 1095 1100 doi 10 1007 s00405 019 05305 y PMID 30680441 S2CID 59223432 Albright L Pollack I amp Adelson D 2015 Principles and practice of pediatric neurosurgery 3rd ed Thieme Medical Publishers Inc a href Template Citation html title Template Citation citation a CS1 maint uses authors parameter link http biomed brown edu Courses BI108 BI108 2005 Groups 04 neurology html Archived 2013 06 05 at the Wayback Machine full citation needed Neuroradiology Patients amp Families Washington University Radiologist Archived from the original on 2010 06 02 Retrieved 2010 06 20 Kombogiorgas D The cerebrospinal fluid shunts New York Nova Medical 2016 Laminectomy Health Encyclopedia University of Rochester Medical Center www urmc rochester edu Retrieved 2021 05 06 How Neurosurgeons Treat Chronic Pain www aans org Retrieved 2021 05 06 Cutts Steven January 2007 Cubital tunnel syndrome Postgraduate Medical Journal 83 975 28 31 doi 10 1136 pgmj 2006 047456 ISSN 0032 5473 PMC 2599973 PMID 17267675 Greenberg Mark S 2010 01 01 Handbook of neurosurgery Greenberg Graphics ISBN 9781604063264 OCLC 892183792 a b c d e f Galvin Imelda M Levy Ron Day Andrew G Gilron Ian November 21 2019 Pharmacological interventions for the prevention of acute postoperative pain in adults following brain surgery The Cochrane Database of Systematic Reviews 2019 11 doi 10 1002 14651858 CD011931 pub2 ISSN 1469 493X PMC 6867906 PMID 31747720 http www neurosocietyindia org site Past president Basant 20Kumar 20Misra 20President 20NSI 202008 pdf bare URL PDF Segall Grant Dealer The Plain 2010 09 16 Dr Robert J White famous neurosurgeron sic and ethicist dies at 84 cleveland Retrieved 2021 05 24 Mims Christopher July 2013 First ever human head transplant is now possible says neuroscientist Quartz Retrieved 2021 05 24 Retrieved from https en wikipedia org w index php title Neurosurgery amp oldid 1144567087, wikipedia, wiki, book, books, library,

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