Neurosurgery

What is it?

According to AMA FREIDA: neurological surgery is a "medical and surgical specialty" providing care for adults and children in the treatment of pain or pathological processes that may alter the function of the central (the brain, pituitary gland and spinal cord), peripheral (the cranial, spinal and peripheral nerves) and autonomic nervous systems, and their supporting structures (the meninges, skull, skull base and spine) and their blood vessels, and it focuses on the "diagnosis and medical and surgical treatment of disorders of the nervous system". MedlinePlus (neurology) defines a neurosurgeon as "a doctor who has received additional training in brain and spine surgery", and a neurologist as a doctor who has received additional training in treating disorders of the brain and nervous system.

Conditions it covers

According to MedlinePlus (brain surgery), brain surgery may be performed to treat: a brain tumour, bleeding in the brain, blood clots (haematomas) in the brain, weak vessel walls (repair of a cerebral aneurysm), abnormal vessels (such as arteriovenous malformations), damage to the membranes covering the brain (the dura mater), brain abscesses, severe nerve or facial pain (such as trigeminal neuralgia), skull fractures, raised pressure inside the brain after an injury or stroke, epilepsy, some brain diseases (such as Parkinson's disease) that may benefit from an implanted electronic device, and a build-up of excess cerebrospinal fluid (hydrocephalus). AANS classifies neurosurgical conditions into categories: back and neck (such as slipped disc and low back pain), brain conditions (such as hydrocephalus and epilepsy), trauma, movement disorders (such as Parkinson's and spasticity), pain, paediatric conditions, stroke (such as arteriovenous malformations), and tumours (brain and spinal tumours and pituitary conditions).

Related pages on this site: epilepsy, stroke, transient ischaemic attack, neurology, the brain and the peripheral nerves. According to AANS: about 70% of epilepsy patients have their seizures controlled with treatments, whereas 30% do not and are considered drug-resistant, and in these surgery may be the best chance of controlling seizures, but not every patient is a candidate, and neurosurgeons work within a multidisciplinary team in which epileptologists assess patients. AANS states in its stroke guide that 87% of strokes are ischaemic, 10% are intracerebral haemorrhage and 3% are subarachnoid haemorrhage, that early diagnosis, treatment or prevention of stroke may be undertaken by the neurosurgeon, and that a transient ischaemic attack is a warning sign of a possible stroke and is treated as a neurological emergency.

Common tests and procedures

According to MedlinePlus (neurology), tests in this field include: CT scan, lumbar puncture, magnetic resonance imaging and magnetic resonance angiography, angiography, electroencephalography (EEG), electromyography (EMG), evoked potentials, myelography, nerve conduction velocity tests, neuropsychological tests, sleep studies, emission tomography (SPECT and PET), and biopsy. Treatments include: medicines, interventional neuroradiology procedures, conventional neurosurgery, microsurgery, stereotactic radiosurgery, deep brain stimulation, spinal cord stimulation, rehabilitation and physiotherapy, and spine surgery. See magnetic resonance imaging and computed tomography.

According to AANS the non-invasive assessment before epilepsy surgery includes EEG, its video monitoring, MRI, PET, SPECT and neuropsychological assessment, and surgical options include resection, disconnection, stereotactic radiosurgery and neuromodulation (such as vagus nerve stimulation), and it stresses that the benefits of surgery must always be weighed against its risks. For stroke it mentions: removal of a clot by endovascular catheter, clipping an aneurysm via craniotomy or occluding it with endovascular coils, and carotid endarterectomy or stenting for prevention. MedlinePlus (cerebral aneurysm repair) states that rupture of an aneurysm is an emergency requiring hospital treatment, and that the surgeon helps the patient with an unruptured aneurysm balance preventive surgery against monitoring with imaging. Risks of brain surgery according to MedlinePlus include: problems with speech, memory, muscle strength, balance, vision or coordination, a blood clot or bleeding in the brain, seizures, stroke, coma, infection in the brain, the wound or the skull, brain swelling, and the need for further surgery. The decision for surgery and its type is made with the treating team.

When to see one

This page does not cover detailed criteria for referral to a neurosurgeon. Referral to the specialist is usually decided by the primary care provider according to the condition (MedlinePlus). MedlinePlus states that the neuroscience team usually consists of different specialties; AANS states that epilepsy patients are assessed by epileptologists within a team that includes neurosurgeons and other specialists.

Emergency conditions do not wait for a referral: according to AANS, even if the symptoms of a stroke or transient ischaemic attack go away, it is very important to seek help and assessment immediately from a qualified doctor; MedlinePlus counts head or spine injury, and sudden dizziness, weakness or change in vision, among the emergency signs. The American Board of Neurological Surgery (ABNS) states that its aim is to encourage the study of neurosurgery, improve its practice and raise its standards in service of public health, and FREIDA states that specialist training is seven years before certification (US details; certification systems differ between countries).

Common questions