What is Neurosurgery?

Neurosurgery is a medical specialty that focuses on the diagnosis, treatment, and surgical management of disorders and diseases affecting the brain, spinal cord, peripheral nerves, and their associated blood vessels. 

Neurosurgeons are highly trained medical professionals who use surgical techniques to treat conditions such as brain tumors, spinal cord injuries, vascular malformations, and other neurological disorders. In addition to performing surgery, neurosurgeons often work in conjunction with other specialists, such as neurologists, radiologists, and critical care physicians, to provide comprehensive care for their patients. (1)

Overview and Definition 

Neurosurgery is a medical specialty that deals with diagnosing and treating disorders affecting the brain, spinal cord, peripheral nerves, and their surrounding blood vessels. While primarily a surgical field, it requires extensive knowledge in areas such as neurology, critical care, trauma care, and radiology. Unlike other medical specialties that focus on specific regions of the body, neurosurgery is concerned with the entire nervous system. This means that a neurosurgeon may perform operations on the brain, spine, or other parts of the body. 

Patients of all ages can benefit from the expertise of a neurosurgeon, who can treat a wide range of conditions, from congenital anomalies in newborns to stroke, tumors, infections, and degenerative diseases associated with aging. Ultimately, the primary objective of a neurosurgeon is to determine the best surgical approach for treating their patients. (2)

Education and Training 

Neurosurgery is a highly specialized field of medicine that requires extensive training and education. Neurosurgeons must first complete four years of undergraduate education followed by four years of medical school to earn their Doctor of Medicine or Doctor of Osteopathic Medicine degree. After completing a one-year internship in general surgery, they must then undergo five to seven years of residency in a neurosurgery program to gain the necessary skills and expertise to perform complex surgical procedures involving the nervous system. 

Some neurosurgeons also choose to complete a fellowship after residency to specialize in a particular area of neurosurgery. In addition to this initial training, neurosurgeons must also engage in ongoing continuing education throughout their careers to stay up-to-date with advances and technology in their field. 

The path to becoming a neurosurgeon is a long and challenging one that can take up to 14-16 years to complete. This includes four years of undergraduate education, four years of medical school, one year of internship, and five to seven years of residency in a neurosurgery program. Additionally, some neurosurgeons may opt to complete a fellowship in a specialized area, which can add another 1-2 years of training. Due to the complexity of the field, neurosurgeons undergo one of the longest training periods of any medical specialty. (3)

Practicing as a Neurosurgeon

A neurosurgeon is a medical doctor who specializes in the diagnosis and treatment of conditions that affect the nervous system, which includes the brain, spinal cord, and nerves. In addition to performing surgical procedures on the nervous system, neurosurgeons also offer non-surgical treatment options, such as medication, steroid injections, and physical therapy. Before recommending surgery, neurosurgeons generally exhaust all non-operative treatment methods.

A neurosurgeon is responsible for evaluating, diagnosing, and treating health issues related to the nervous system, which encompasses the brain, spinal cord, spinal column, and nerves. Although neurosurgeons have the expertise to perform intricate surgical procedures on the spine and brain, they typically advise non-surgical or conservative treatment methods initially. For instance, if a patient is experiencing persistent back pain, the neurosurgeon may first suggest anti-inflammatory medication and/or physical therapy. If the pain persists despite these interventions, surgery may be suggested by the neurosurgeon.

Neurosurgeons receive comprehensive training in all areas of neurosurgery throughout this residency program, including the cerebrovascular system, the spine and spinal cord, trauma, tumors, pain control, and pediatric surgery. A minimum of 60 months must be spent teaching residents in the neurological sciences, of which at least 36 months must be spent in clinical neurosurgery and at least 3 months in clinical neurology. (4,5)

Procedures Performed

A neurosurgeon may advise a variety of procedures. The anterior cervical discectomy, epilepsy neurosurgery, Chiari decompression, craniotomy, lumbar puncture, and laminectomy are a few of the most typical procedures. The procedures performed in neurosurgery include:

• Anterior cervical discectomy

Anterior cervical discectomy is a prevalent neurosurgical procedure that primarily addresses herniated discs in the neck. Its primary objective is to eliminate the herniated disc to alleviate pain. Neurosurgeons usually advise this procedure when non-surgical remedies are insufficient in managing pain.

• Epilepsy neurosurgery

Neurosurgery for epilepsy is intended for people who suffer from epilepsy, particularly those who experience intense epileptic seizures that remain unaddressed by non-surgical methods. Typically, neurologists prescribe medications to manage epilepsy and its associated seizures. However, if medication proves ineffective, epilepsy neurosurgery may become necessary, entailing the removal or alteration of the brain region responsible for severe and potentially lethal seizures.

• Chiari decompression

Chiari decompression is a medical procedure that aims to address Arnold-Chiari malformation, which causes difficulty in maintaining proper balance. The procedure involves the elimination of a skull bone located at the back to expand the foramen magnum. This action usually leads to better coordination and balance for most patients.

• Craniotomy

A craniotomy is a frequently performed neurosurgical technique that entails the extraction of a section of the skull bone, providing direct access to the brain. It is utilized to address diverse neurological problems such as brain strokes and can be lifesaving in certain circumstances. The removed part of the skull is ultimately restored to minimize any permanent visible effects of the procedure.

• Lumbar puncture

The spinal tap, commonly known as a lumbar puncture, is one of the less difficult but still rather challenging neurosurgical procedures. It is a diagnostic process used to ascertain whether the patient exhibits any symptoms of any illnesses affecting the central nervous system. When carried out by a qualified neurologist, the surgery is generally risk-free and poses very little danger.

• Additional neurosurgery procedures

In addition to the treatments mentioned above, neurosurgeons are also capable of performing a ventriculostomy, microdiscectomy, spinal fusion, laminectomy, and ventriculoperitoneal shunt. It is crucial to make sure the neurosurgeon you select offers the precise surgery you require because the specific treatments differ depending on the neurosurgeon.(6)