What Is Neurosurgery?
THE BRAIN AND BEYOND
When most people hear the word “neurosurgery” they automatically think of brain surgery. However, neurosurgery encompasses far more than the brain. Neurosurgery is the medical specialty concerned with the diagnosis and treatment of the entire nervous system, composed of the brain, spinal cord and spinal column, as well as the nerves that travel through all parts of the body (hands, legs, arms, face.)
That means neurosurgeons treat degenerative and congenital diseases of the spine, pain from pinched nerves in the neck, low back pain, sciatica, carpal tunnel syndrome, epilepsy, stroke, Parkinson’s disease, chronic pain and sports injuries of the head and spine, in addition to brain tumors, hemorrhages and trauma, tumors of the pituitary gland, and disorders of the arteries that carry blood from the heart to the brain. The field of neurosurgery encompasses both adult and pediatric patients.
THE MAKING OF A NEUROSURGEON
Neurosurgery has one of the longest training periods of any medical specialty due to the extreme complexity of the nervous system and the advanced techniques used in neurosurgical operations.
To become a neurosurgeon, a physician must accomplish the following:
- graduate from an accredited medical school (four years);
- complete a six month to one-year surgical internship program, to build fundamental clinical skills;
- complete five to seven years in a neurosurgical residency program accredited by the American Council on Graduate Medical Education (ACGME).
During residency training, neurosurgeons are trained in all aspects of neurosurgery, including cerebrovascular system, the spine and spinal cord, trauma, tumors, pain management and pediatric surgery. Residents must complete a minimal of 60 months of training in the neurological sciences, with at least 36 of those months devoted to clinical neurosurgery and a minimal of three months devoted to clinical neurology.
Some neurosurgeons opt to complete an additional fellowship in a particular specialized area of study after their residency.
BECOMING BOARD CERTIFIED
Following residency training, neurosurgeons may seek certification in the practice of neurosurgery through the American Board of Neurological Surgery (ABNS) This credential signals a special level of commitment to, and expertise in, the neurosurgical specialty. Certification by the ABNS is based upon approval of an applicant’s educational and training qualifications, a review of the physician’s professional practice-including opinions of his or her colleagues, and the passage of written and oral examinations that covers the diagnosis and management of surgical and medical diseases of the nervous system. The certification process includes a thorough assessment of the neurosurgeon’s skill, judgment and depth of knowledge. The successful completion of this process will result in board certification.
Certification by the ABNS-the only board authorized by the American Board of Medical Specialties to certify surgeons in neurosurgery-is considered the “gold standard” in the field. By choosing a neurosurgeon who is board certified by the ABNS or one who is tracking toward ABNS board certification, a patient can be assured that his or her doctor has a high level of commitment to, and expertise in, the neurosurgical specialty.
Once board certified by the ABNS, a neurosurgeon is eligible to become and Active member of the American Association of Neurological Surgeons (AANS). In addition to holding board certification, AANS members are required to keep their skills and knowledge up to date throughout their professional career. The AANS provides meetings, symposia and other educational opportunities to help the neurosurgeon keep pace with rapid changes and developments within the specialty.
WHEN CAN A NEUROSURGEON HELP?
A neurosurgeon is a highly skilled specialist who has received extensive training to provide surgical or non-surgical care for patients with neurological disorders of all types. Because of their expertise in diagnosing all neurological diseases, neurosurgeons are frequently consulted by a variety of physicians including emergency room doctors, neurologists, internists, family practitioners, osteopathic physicians and pediatricians.
Some of the specific disorders of the brain, spine and nerves commonly treated by neurosurgeons include:
Aneurysms – an abnormal increase in diameter (dilation) of a blood vessel. The rupture of intracranial aneurysms resulting in bleeding into space around the brain, can lead to severe disability or death.
Arteriovenous Malformations (AVMs) – AVMs are tangles of abnormal blood vessels that are formed during development and may present with a variety of symptoms. AVMs typically begin to cause problems for patients between 20 and 40 years of age when they may experience headaches, seizures or bleeding in the brain. Current treatments are usually effective and involve a combination of clogging the abnormal vessels with glue or particles (embolization), open skull surgery and radiosurgery.
Carotid artery disease – a disorder affecting one of the major blood vessels that carry blood to the head and neck. Tissue called plaque can accumulate on the walls of these blood vessels causing a narrowing that interferes with blood flow and can result in a stroke.
Carpal tunnel syndrome – a painful condition that occurs when the tendons in the wrist are inflamed after being aggravated by repetitive movements. It may cause progressive narrowing of the carpal wrist tunnel, resulting in nerve pressure and pain. Treatment for carpal tunnel syndrome includes rest, the use of a wrist splint during sleep or a relatively short operative procedure under local anesthesia relieving pressure on the affected nerve.
Cerebral palsy – a disorder caused by a permanent brain defect or an injury at birth or soon after. Patients may exhibit symptoms of stiffness (spasticity) that require medical or surgical treatment.
Cervical spine disorders – conditions that cause constant pain in the neck or shoulder, tingling or numbness in the arms or weakness when using arms or hands.
Chronic pain – pain that generally persists or reoccurs over a long period of time (more than six months). Patients suffering from chronic pain often have damage to a nerve and that nerve is in constant state of aggravation. Nerves can be damaged by injury, cancer treatment or a circulatory problem.
Craniosynostosis – a birth defect in which the bones of the skull close prematurely, limiting or distorting the skull’s growth. It is characterized in infancy by an abnormal but characteristic head shape.
Epilepsy – a disorder that causes abnormal electrical discharges in the brain. Normally, millions of electrical impulses pass between brain cells, sending messages that control movement, speech and thought. In epilepsy, these electrical impulses are interrupted by sudden bursts of activity that result in seizures. Epilepsy may be treated with drug therapy and/or surgery.
Head injury – commonly referred to as traumatic brain injury, head injury is a major health problem commonly occurring in teens and young adults. The most common effects of a head injury are a hematoma (blood clot in the brain) or contusion (“bruised brain”).
Herniated disc – a break in the cartilage surrounding a disc in the spine, causing pressure on spinal nerves that produce pain down the legs. It is usually preceded by an episode of low back pain or a long history of intermittent episodes of back pain.
Hydrocephalus – a disorder in which too much spinal fluid, usually under high pressure, accumulates in the cavities of the brain. This can be caused by a birth defect, brain tumor, infection, hemorrhage or brain injury. Some elderly patients with dementia can have hydrocephalus, called “normal pressure” hydrocephalus. Most forms of hydrocephalus can be treated with a shunt procedure.
Low back pain – the second most common cause of chronic pain after headaches. Causes include disc herniation, spinal stenosis, tumors, infections and inflammatory diseases.
Lumbar spinal stenosis - a narrowing of the spinal canal that may result in nerve compression, and pain that travels from the lumbar spine into the legs. Treatment can be either conservative or surgical. Conservative treatments include non-steroidal anti-inflammatory medication, physical therapy and epidural steroid injections.
Parkinson’s disease – a slowly progressing disorder caused by damage to brain cells. Symptoms include tremor, or involuntary and rhythmic movements of the hands, arms legs and jaw, stiffness of the limbs loss of spontaneous movement and an unsteady walk. Some symptoms of Parkinson’s disease can be treated with medicine or a neurosurgical procedure.
Pituitary tumors - growths in the pituitary gland, which rests at the base of the brain. Pituitary tumors can vary in size and behavior. Treatment can be conservative with observation, medications or surgical removal of the tumor.
Radiosurgery (Stereotactic Radiosurgery) – Stereotactic radiosurgery (SRS) treats brain disorders with a precise delivery of a single, high dose of radiation, which minimizes radiation exposure to the surrounding brain tissue and nerves. Focused radiation beams are delivered to a specific area of the brain to treat abnormalities such as AVMs, small tumors (benign or malignant), or functional disorders.
Sciatica – inflammation of the sciatic nerve, usually accompanied by pain and soreness of the thigh and the leg.
Spinal bifida - occurs during the third and fourth weeks of pregnancy, when a portion of the fetal spinal cord fails to close properly. As a result, the child is born with a part of the spinal nerve roots protruding from the back. With early treatment, the child can lead an active and productive life.
Spinal cord injuries – commonly referred to as a “broken” neck or back, spinal cord injuries can lead to paralysis and loss of motor function in the arms and legs. Following spinal cord injury, surgery to correct spinal compression or instability can improve neurologic function.
Stroke – caused when normal blood supply to the brain is interrupted. This can happen by a blood clot (ischemic stroke) or bleeding in the brain (hemorrhagic stroke). Warning signs include an unusually severe headache, memory loss, numbness or weakness in the arm and/or leg, slurred speech, loss of vision, poor balance or lack of coordination. Early diagnosis is key to successful treatment.
Trigeminal neuralgia – a disorder of the trigeminal nerve which may cause severe pain in the face. There are surgical and non-surgical treatment options.
Tumors of the brain and spinal cord – symptoms and signs occur due to pressure on neural structures, with resultant irritation or destruction. Tumors of the brain and spinal cord can range from benign to aggressive growth patterns. Oftentimes, biopsy or removal of a tumor is needed for appropriate diagnosis and treatment.
NEUROSURGERY – YESTERDAY AND TODAY
Archeological evidence tells us that the practice of neurosurgery has been around for thousands of years. In fact, signs of purposeful “surgery” have been found on a skull that is more than 10,000 years old.
However, neurosurgery was first identified as a medical specialty when, in October of 1919, Harvey Cushing, MD, gave a presentation on his work at a meeting of the American College of Surgeons. A pioneer in the field, Dr. Cushing was one of the most accomplished neurosurgeons of his time, developing innovative new procedures and techniques that made the treatment of brain tumors safer and more effective.
Dr. Cushing was also the first to envision a professional society that would advance the growth of the new specialty and encourage discourse amount professionals in the field. A little more than a decade later, on October 10, 1931, Dr. Cushing’s vision became a reality when the Harvey Cushing Society –later to become the American Association of Neurological Surgeons (AANS) –was formed. Through his efforts and those of his colleagues in the Society, the need for specialized training and qualifications for the practice of neurosurgery was first advocated, and in 1940 neurosurgery was officially recognized as a medical specialty by the Council of Medical Specialty Societies.
Today, the AANS has more than 7,200 members in the United States, Canada, Mexico, Europe and the Pacific Rim. Its mission is to advance the specialty of neurosurgery in order to provide the highest quality care to patients. Its programs include sponsorship of continuing medical education meetings, publication of textbooks and reference manuals, development of patient education materials, and support for scientific investigation through its Neurosurgery Research and Education Foundation. All active members of the AANS are certified by the American Board of Neurological Surgery.
INVESTING IN THE FUTURE OF NEUROSURGERY
As neurosurgery enters the 21st century, support for scientific investigations is crucial to continuing the advancement of neurosurgical science. Founded in 1981, the Neurosurgery Research and Education Foundation of the American Association of Neurological Surgeons provides funding for promising young neurosurgeons. Over the past 20 years, the foundation has awarded more than $2 million to nearly 60 neurosurgeons in training or in practice, to help them establish their labs and complete initial data. The successful funding of these studies has led to some initial advances in the diagnosis and treatment of brain tumors, stroke and spinal disorders. Studies have also been funded to examine which clinical treatments are best to help assure that the best therapies are always being used.
BREAKING NEW GROUND
Neurosurgeons are on the brink of several exciting advances in the treatment of malignant brain tumors, spinal cord injuries, stroke, chronic pain, Parkinson’s disease, epilepsy and severe head trauma. AANS members convene annually to present cutting-edge research in all of these areas that members can take back to their practices or medical institutions. Among medical specialties, neurosurgery is, by far, one of the most technically advanced.
In recent decades, the introduction of equipment—such as the operating microscope, 3-D brain imaging and incision-free sterotactic neurosurgery—has tremendously improved neurosurgeons’ ability to provide their patients with safer, more effective treatments.
Continued innovation has been an important part of this process. The neurosurgeon of the 21st century is well equipped for the challenges ahead and is already developing the solutions to these problems.
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