Neurosurgery

  Neurosurgery is the surgical discipline focused on treating those central, peripheral nervous system and spinal column diseases amenable to mechanical intervention.

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Definition and scope

According to the U.S. Accreditation Council of Graduate Medical Education (ACGME) [1],

Risks

There are many risks to neurosurgery. Any operation dealing with the brain or spinal cord can cause paralysis, brain damage, and even severe blood loss.

Conditions

Neurosurgical conditions include primarily brain, spinal cord, vertebral column and peripheral nerve disorders.

Conditions treated by neurosurgeons include:

• Spinal disc herniation
• Spinal stenosis
• Hydrocephalus
• Head trauma (brain hemorrhages, skull fractures, etc.)
• Spinal cord trauma
• Traumatic injuries of peripheral nerves
• Brain tumors
• Infections and infestations
• Tumors of the spine, spinal cord and peripheral nerves
• Cerebral aneurysms
• Some forms of hemorrhagic stroke, such as subarachnoid hemorrhages, as well as intraparenchymal and intraventricular hemorrhages
• Some forms of pharmacologically 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)
• Intractable pain of cancer or trauma patients and cranial/peripheral nerve pain
• Some forms of intractable psychiatric disorders
• Malformations of the nervous system
• Carotid artery stenosis
• Vascular malformations (i.e., arteriovenous malformations, venous angiomas, cavernous angiomas, capillary telangectasias) of the brain and spinal cord
• Peripheral neuropathies such as Carpal Tunnel Syndrome and ulnar neuropathy
• Moyamoya disease
• Congenital malformations of the nervous system, including spina bifida and craniosynostosis

Job field

Neurosurgeons work in a variety of practice settings. Some neurosurgeons practice general neurosurgery, while others choose to limit their practice to specific subspecialties. Some areas of specialty include pediatric, spine, vascular/endovascular, tumor, peripheral nerve, functional, and skull base. Practices range from solo practices to large group practices with multidisciplinary components. Increasingly, neurosurgeons are working together with psychiatrists, neurologists and therapists to provide comprehensive care for patients with neurologic disorders such as back pain. About 20 percent of neurosurgeons practice under the auspices of a university practice plan, while the majority of neurosurgeons maintain private practices often with academic affiliations. Typical work schedules for a neurosurgeon include call coverage for one or more emergency rooms requiring sometimes frequent emergency surgeries. Most averages found online describing typical salary for a practicing neurosurgeon in the United States are between $300,000 and $500,000 annually, though these should be considered as weak small-survey estimates based on the values given by the AAMC.

In the United States neurosurgical training is very competitive and grueling. It usually requires six to eight years of residency after completing medical school, plus the option of a fellowship for subspecialization (lasting an additional one to three years). Most applicants to neurosurgery training programs have excellent medical school grades and evaluations, have published scientific and/or clinical research, and have obtained board scores of 95 or higher. Resident work hour limits are set at 88 hours per week for many programs, although many neurosurgical programs have had problems meeting these new work hour limits due to the small size of residency programs, the high volume of neurosurgical patients, and the need to provide constant coverage in the ER, OR, and ICU. On average 50-60% of neurosurgery applicants match into a residency program (~85% of US senior medical student applicants). [2]

See also

• Harvey Cushing - known as the father of neurosurgery
• Gazi Yasargil - known as the father of modern neurosurgery
• Vascular neurosurgery
• Pediatric Neurosurgery