Neurosurgery is the surgical discipline focused on treating those central, peripheral nervous system and spinal column diseases amenable to mechanical intervention. Surgery (from the χειρουργική cheirourgikē, via chirurgiae meaning "hand work" is a medical specialty that uses operative manual and instrumental In Vertebrates the central nervous system ( CNS) is the part of the Nervous system which is enclosed in the Meninges. The peripheral nervous system ( PNS) resides or extends outside the Central nervous system (CNS which consists of the Brain and Spinal cord. "Brain surgery" is commonly used, much like rocket science, to refer to a task requiring significant knowledge and skill.

Contents 1 Definition and scope 2 History 3 Risks 4 Conditions 5 Job field 6 Career 7 See also 8 References 9 External links

Definition and scope

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

“

Neurological Surgery is a discipline of medicine and that specialty of surgery which provides the operative and nonoperative management (i. e. , 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 heat fixation, instrumentation, or endovascular techniques; and disorders of the cranial and spinal nerves throughout their distribution.

”

History

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.

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, osteomylitis, 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). Obsidian is a naturally occurring Glass formed as an extrusive Igneous rock.

Africa showed evidence of brain surgery as early as 3,000 B. C. in papyrus writings found in Egypt. Papyrus (/pəˈpaɪrəs/ (Rhymes -aɪrəs)is a thick paper-like material produced from the Pith of the papyrus plant Cyperus papyrus "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. Hippocrates of Cos II or Hippokrates of Kos ( ca. 460 BC – ca 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 butt 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 despite the Church's own brain surgery. Leonardo di ser Piero da Vinci ( April 15 1452 – May 2 1519 was an Italian Polymath, having been a scientist Mathematician, Engineer

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. The human brain controls the Central nervous system (CNS by way of the Cranial nerves and Spinal cord, the Peripheral nervous system (PNS The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected The peripheral nervous system ( PNS) resides or extends outside the Central nervous system (CNS which consists of the Brain and Spinal cord.

Conditions treated by neurosurgeons include:

• Chiari Malformations
• Spinal disc herniation
• Spinal stenosis
• Hydrocephalus
• Head trauma (brain hemorrhages, skull fractures, etc. Spinal stenosis is a medical condition in which the spinal canal narrows and compresses the spinal cord and nerves Hydrocephalus (pronunciation ˌhaɪˌdɹoʊˈsɛfələs is a term derived from the Greek words "hydro" meaning water and "cephalus" meaning head and this condition Traumatic brain injury. THIS PAGE IS FOR INFORMATION ON HEAD INJURY (NOT SPECIFICALLY THE BRAIN--> Head injury is )
• 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. The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected Treatment of physical trauma is described here and in First aid. Treatment of physical trauma is described here and in First aid. The peripheral nervous system ( PNS) resides or extends outside the Central nervous system (CNS which consists of the Brain and Spinal cord. A brain tumor is any intracranial Tumor created by abnormal and uncontrolled cell division, normally either in the Brain itself ( Neurons See also Cancer A tumor or tumour is the name for a swelling or lesion formed by an abnormal growth of cells (termed neoplastic In Human anatomy, the vertebral column ( backbone or spine) is a column of 34 Vertebrae the Sacrum, Intervertebral The spinal cord is a long thin tubular bundle of Nerves that is an extension of the Central nervous system from the brain and is enclosed in and protected The peripheral nervous system ( PNS) resides or extends outside the Central nervous system (CNS which consists of the Brain and Spinal cord. A cerebral aneurysm or brain aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral Artery or Vein A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain A stroke is the rapidly developing loss of brain functions due to a disturbance in the blood vessels supplying blood to the brain Subarachnoid hemorrhage ( SAH,) or subarachnoid haemorrhage in British English, is Bleeding into the Subarachnoid space —the Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from Epilepsy is a common chronic Neurological disorder that is characterized by recurrent unprovoked seizures. Movement disorders include Akathisia Akinesia ( lack of movement) Athetosis ( contorted torsion Parkinson's disease (also known as Parkinson disease or PD) is a degenerative disorder of the Central nervous system that often impairs the sufferer's Stereotactic surgery or stereotaxy is a Minimally-invasive form of surgical intervention which makes use of a three-dimensional Coordinates system Ablative surgery is the surgical Ablation by burning or freezing of Brain tissue to treat neurological or psychological disorders In Neurotechnology, deep brain stimulation ( DBS) is a surgical treatment involving the implantation of a medical device called a Brain pacemaker Psychiatry is a medical specialty which exists to study, prevent, and treat Mental disorders in Humans Psychiatric A congenital disorder is a disease or disorder that is present at birth The nervous system is a Network of specialized cells that communicate information about an animal's surroundings and itself Carotid stenosis is a narrowing of the lumen of the Carotid artery, usually caused by Atherosclerosis. 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. Cerebral arteriovenous malformation Arteriovenous malformation or AVM in the majority of cases is a Congenital disorder consisting of a connection between Cavernous angioma, also known as cerebral cavernous malformation (CCM cavernous haemangioma, and cavernoma, is a vascular disorder of the Central Carpal tunnel syndrome (CTS or median neuropathy at the wrist is a medical condition in which the Median nerve is compressed at the Wrist, leading Moyamoya disease is an extremely rare disorder in most parts of the world Spina bifida ( Latin: "split spine" is a developmental Birth defect involving the Neural tube: incomplete closure of the Embryonic neural Craniosynostosis, is a medical condition in which some or all of the sutures in the Skull of an Infant or child close too early causing problems with normal 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). ^[2]

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 3 years out of training.

See also

• Anton Eiselsberg – Established Neurosurgery as an independent discipline
• Bio-plate
• Gazi Yasargil – Known as the father of modern neurosurgery
• Harvey Cushing – Known as the father of neurosurgery
• Ben Carson – Famous African American Neurosurgeon

References

External links

• Congress of Neurological Surgeons
• American Association of Neurological Surgeons
• American Board of Neurological Surgery
• Neurosurgical Society of Australasia
• Brain Surgery-Neurosurgery Patient Help Site
• European Association of Neurosurgical Societies
• Surgical Instruments used in Neurosurgery

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