Neurosurgery is the surgical discipline focused on treating those central, peripheral nervous system and spinal column diseases amenable to mechanical intervention. "Brain surgery" is commonly used, much like rocket science, to refer to a task requiring significant knowledge and skill.
History
Para-sagittal MRI of the head in a patient with benign familial macrocephaly. MRI are frequently performed prior to neurosurgery.
Unearthed remains of successful brain operations, as well as surgical implements, were found in France at one of Europe's noted archaeological digs. The success rate was remarkable, even circa 15,000 B.C.citation needed
Pre-historic evidence of brain surgery was not limited to Europe. Pre-Incan civilization used brain surgery as an extensive practice as early as 2,000 B.C. In Paracas, Peru, a desert strip south of Lima, archeologic evidence indicates that brain surgery was used extensively. Here, too, an inordinate success rate was noted as patients were restored to health. The treatment was used for mental illnesses, epilepsy, headaches, organic diseases, osteomyelitis, as well as head injuries.
Brain surgery was also used for both spiritual and magical reasons; often, the practice was limited to kings, priests and the nobility.
Surgical tools in South America were made of both bronze and man-shaped obsidian (a hard, sharp-edged volcanic rock).
Africa showed evidence of brain surgery as early as 3,000 B.C. in papyrus writings found in Egypt. "Brain," the actual word itself, is used here for the first time in any language. Egyptian knowledge of anatomy may have been rudimentary, but the ancient civilization did contribute important notations on the nervous system.
Hippocrates, the father of modern medical ethics, left many texts on brain surgery. Born on the Aegean Island of Cos in 470 B.C., Hippocrates was quite familiar with the clinical signs of head injuries. He also described seizures accurately, as well as spasms and classified head contusions, fractures and depressions. Many concepts found in his texts were still in good stead two thousand years after his death in 360 B.C.
Ancient Rome in the first century A.D. had its brain surgeon star, Aulus Cornelius Celsus. Hippocrates did not operate on depressed skull fractures; Celsus often did. Celsus also described the symptoms of brain injury in great detail.
Asia was home to many talented brain surgeons: Galenus of Pergamon, born in Turkey, and the physicians of Byzance such as Oribasius (4th century) and Paul of Aegina. An Islamic school of brain surgery also flourished from 800 to 1200 A.D., the height of Islamic influence in the world. Abu Bekr Muhammed el Razi, who lived from 852 to 932 in the Common Era, was perhaps the greatest of Islamic brain surgeons. A second Islamic brain surgeon, Abu l'Qluasim Khalaf, lived and practiced in Cordoba, Spain, and was one of the great influences on western brain surgery.
The Christian surgeons of the old Ages were clerics, well educated, knowledgeable in Latin, and familiar with the realm of medical literature. Despite the church's ban on study of anatomy, many churchmen of great renown (advisors and confessors to a succession of Popes) were outstanding physicians and surgeons. Leonardo da Vinci's portfolio containing hundreds of accurate anatomical sketches indicates the intense intellectual interest in the workings of the human body.
Modern Neurosurgery
Modern neurosurgery has benefited greatly from advances in computer assisted imaging (MRI, Computed Tomography, MEG, PET) and the development of stereotactic surgery. Some neurosurgical procedures even involve the use of MRI and fMRI intraoperatively. As one of the most research oriented specialties of medicine, the scope of neurosurgery has expanded as new diagnostic techniques allow surgeons to perform more complicated surgeries. Some of the most recent and innovative advances have been radiosurgery using the Gamma Knife for tumor treatment and Endovascular surgery for the clipping of aneurysms.
Risks
There are many risks to neurosurgery. Any operation dealing with the brain or spinal cord can cause paralysis (systemic), brain damage, infection, psychosis, or even death.
Conditions
Neurosurgical conditions include primarily brain, spinal cord, vertebral column and peripheral nerve disorders.
Conditions treated by neurosurgeons include:
- Chiari Malformations
- 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
- Tumours of the spine, spinal cord and peripheral nerves
- Cerebral aneurysms
- Stroke, including hemorrhagic stroke and ischemic stroke
- Intracerebral hemorrhage, such as subarachnoid hemorrhage, 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) such as ablative surgery and deep brain stimulation surgery
- 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
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 in the 95th percentile 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 emergency room (ER), operating room (OR), and intensive care unit (ICU).
All neurosurgical residency programs have some form of research included in the training. Most programs include one year of research time, which can be clinical, translational, or basic science research. Some programs offer two or more years of research, and may offer the ability to complete a second degree, such as a PhD, MPH, Masters of Science, etc.
On average 50-60% of medical students applying to neurosurgery match into a residency program (about 80% of US senior medical student applicants).[1]
Career
The average compensation for a neurosurgeon ranges from US $250,000-$500,000 annually. MGMA data from 2001 for US neurosurgeons show an average of $410k in private practice, $275k in academics, and $438k for all neurosurgeons at least three years out of training.
See also
References
External links
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