Neurosurgery

Old German engraving depicting a trepanation, an ancient and still performed neurosurgical procedure

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

Definition and scope

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

"Neurological Surgery is a discipline of medicine and that specialty of surgery which provides the operative and nonoperative management (ie, prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes that modify the function or activity of the nervous system, including the hypophysis: and the operative and nonoperative management of pain. As such, neurological surgery encompasses the surgical, nonsurgical and stereotactic radiosurgical treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain, meninges, skull base, and their blood supply, including the surgical and endovascular treatment of disorders of the intracranial and extracranial vasculature supplying the brain and spinal cord; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those that may require treatment by fusion, instrumentation,or endovascular techniques; and disorders of the cranial and spinal nerves throughout their distribution."

Training

In the U.S., neurosurgeons undergo a rigorous training program, known as a residency, consisting of 5-7 years of postgraduate study in neurosurgery (following a mandatory one-year surgery internship). After completing their residency training, some neurosurgeons undertake advanced subspecialty training in programs known as fellowships which are typically one or two years in duration. Some examples of subspecialty areas in neurosurgery include cerebrovascular and skull base surgery, epilepsy, functional and stereotactic neurosurgery, neurosurgery trauma, spine surgery, and pediatric neurosurgery. Admission into advanced fellowship training programs is highly competitive.

In the United Kingdom, competition is fierce for the senior house officer and specialist registrar posts leading up to a consultant qualification^[1].

Conditions

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

Conditions treated by neurosurgeons include:

• Lumbar disc herniation
• Cervical disc herniation
• Spinal stenosis
• Hydrocephalus
• Head trauma (brain hemorrhages, skull fractures, etc.)
• Spinal cord trauma
• Traumatic injuries of peripheral nerves
• Brain tumors
• 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 non-responding epilepsy
• Some forms of movement disorders (advanced Parkinson's disease, chorea, hemiballism) - 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

Reference

1. ^  Chelvarajah R. Brain surgery... not rocket science. BMJ Career Focus 2004;328:95. Fulltext.

External links

• Congress of Neurological Surgeons
• American Association of Neurologic Surgeons
• American Board of Neurologic Surgery
• Neurosurgical Society of Australasia
• European Association of Neurosurgical Societies
• Neurology Society of India

The content of this page is retrieved from http://en.wikipedia.org/wiki/Neurosurgery under GFDL