neurosurgeon

Neurosurgery
	Intervention
ICD-10-PCS	00-01
ICD-9-CM	01–05
MeSH	D019635
OPS-301 code:	5-01...5-05

Neurosurgery
	Stereotactic guided insertion of DBS electrodes in neurosurgery
Occupation
Activity sectors	Surgery
Description
Education required	Bachelor of Medicine, Bachelor of Surgery (M.B.B.S.) with Fellowship of the Royal College of Surgeons (F.R.C.S.); or Master of Surgery (M.S.); or Doctor of Medicine (M.D.); or Doctor of Osteopathic Medicine (D.O.);

脳神経外科医

WordNet

someone who does surgery on the nervous system (especially the brain) (同)brain surgeon

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/04/05 04:19:16」(JST)

wiki en

[Wiki en表示]

Neurosurgery (or neurological surgery) is the medical specialty concerned with the prevention, diagnosis, treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.^[1]

Education and training

In different countries, there are different requirements for an individual to legally practice neurosurgery, and there are varying methods through which they must be educated. In most countries neurosurgeon training is a minimum period of 7 years after graduating from medical school.

United States

In the United States, a neurosurgeon must generally complete four years of college, four years of medical school, and seven years of residency (PGY-1-7).^[2] Most, but not all, residency programs have some component of basic science or clinical research. Neurosurgeons may pursue an additional training in a fellowship, after residency or in some cases, as a senior resident. These fellowships include pediatric neurosurgery, trauma/neurocritical care, functional and stereotactic surgery, surgical neuro-oncology, radiosurgery, neurovascular surgery, Skull-Base Surgery, peripheral nerve and spine surgery.^[3] In the U.S., neurosurgery is considered a highly competitive specialty composed of 0.6% of all practicing physicians.

United Kingdom

In the United Kingdom, students must gain entry into medical school. MBBS qualification (Bachelor of Medicine, Bachelor of Surgery) takes 4–6 years depending on the student's route. The newly qualified physician must then complete foundation training lasting two years; this is a paid training program in a hospital or clinical setting covering a range of medical specialties including surgery. Junior doctors then apply to enter the neurosurgical pathway. Unlike most other surgical specialties, it currently has its own independent training pathway which takes around eight years (ST1-8); before being able to sit for consultant exams with sufficient amounts of experience and practice behind them. Neurosurgery remains consistently amongst the most competitive medical specialties to obtain entry into.^[4]

Main divisions of neurosurgery

General neurosurgery involves most neurosurgical conditions including neuro-trauma and other neuro-emergencies such as intracranial hemorrhage. Most level 1 hospitals have this kind of practice.

Specialized branches have developed to cater to special and difficult conditions. These specialized branches co-exist with general neurosurgery in more sophisticated hospitals. To practice these higher specialization within neurosurgery, additional higher fellowship training of 1–2 years is expected from the neurosurgeon. Some of these divisions of neurosurgery are:

Vascular and endovascular neurosurgery
Stereotactic,functional and epilepsy neurosurgery
Oncological neurosurgery
Skull-Base Surgery
Spine neurosurgery
Peripheral nerve surgery
Pediatric neurosurgery

Neuropathology

The pathology confronted by neurosurgeons could be either congenital, acquired, traumatic, due to infection, or neoplastic or degenerative conditions. Conditions like congenital hydrocephalus, pediatric tumors and myelomeningocele are encountered in children. Trauma with head or spine injury and bleeds due to arteriovenous malformation are encountered in young adults. Degenerative spine disease, aneurysm bleeds and Parkinson's disease are encountered in much older patients. The science of neuropathology is a well developed branch of pathology.

Neuroanesthesia

Neuroanesthesia is a highly developed science that is linked to neurosurgery. This branch of medicine plays a very important part in day-to-day neurosurgery.

Neurosurgery methods

For a satisfactory neurosurgery outcome a reasonable pre-operative diagnosis is essential. Neuroradiology plays a key role not only in diagnosis but also in the operative phase of neurosurgery.

Neuroradiology methods are used in modern neurosurgery diagnosis and treatment. They include computer assisted imaging computed tomography (CT), magnetic resonance imaging (MRI), positron emission tomography (PET), magnetoencephalography (MEG), and the stereotactic radiosurgery. Some neurosurgery procedures involve the use of intra-operative MRI and functional MRI.

In conventional open surgery the neurosurgeon opens the skull, uses a large opening to access the brain. Technique of using smaller openings and using microscopes and endoscopes were developed later. With this smaller openings and high clarity microscopic visualization of neural tissue excellent results can be obtained. But, the open methods are still used in trauma or emergency situations^[10] ^{Principles of Neurosurgery-Rengachari, Ellenbogen}, ^{[11] Neurotrauma and Critical Care of the Brain-Jallo, Loftus} .'

Microsurgery is utilized in many aspects of neurological surgery. Microvascular techniques are used in EC-IC by-pass surgery and in restoration carotid endarterectomy. The clipping of an aneurysm is performed under microscopic vision. Minimally invasive spine surgery utilizes microscopes or endoscopes. Procedures such as microdiscectomy, laminectomy, and artificial disc replacement rely on microsurgery.^[5]

Using Stereotaxy neurosurgeons can approach a minute target in the brain through a minimal opening. This is used in functional neurosurgery where electrodes are implanted or gene therapy is instituted with high level of accuracy as in the case of Parkinson's disease or Alzheimer's disease. Then in the combination method of open and stereotactic surgery intraventricular hemorrhages could be evacuated successfully.^[6]

Minimally invasive endoscopic surgery is utilized by neurosurgeons. Techniques such as endoscopic endonasal surgery is used in pituitary tumors, craniopharyngiomas, chordomas, and the repair of cerebrospinal fluid leaks. Ventricular endoscopy is used in the treatment of intraventricular bleeds, hydrocephalus, colloid cysts and neurocysticercosis. Endonasal endoscopy at times is carried out with neurosurgeons and ENT surgeons as a team.

Repair of craniofacial disorders and disturbance of cerebrospinal fluid circulation is done by neurosurgeons, and at times teaming up with maxillofacial and plastic surgeons. Cranioplasty for craniosynostosis is performed by pediatric neurosurgeons with or without plastic surgeons.

Neurosurgeons are involved in Stereotactic Radiosurgery along with Radiation Oncologists in tumor and AVM treatment^{[13]Intracranial Stereotactic Radiosurgery-Lunsford, Sheehan, [14]Spine Radiosurgery-Gerszten, Ryu}. Radiosurgical methods such as Gamma knife, Cyberknife and Novalis Shaped Beam Surgery are used.^[7]

Endovascular Neurosurgery utilize endovascular image guided procedures for the treatment of aneurysms, AVMs, carotid stenosis, strokes, and spinal malformations, and vasospasms. Techniques such as angioplasty, stenting, clot retrieval, embolization, and diagnostic angiography are endovascular procedures.^[8]

A common procedure performed in neurosurgery is the placement of Ventriculo-Peritoneal Shunt (VP Shunt). In pediatric practice this is for congenital hydrocephalus. The commonest indication in adults is Normal Pressure Hydrocephalus (NPH).

Neurosurgery of the spine covers cervical, thoracic and lumbar spine. Some indications for spine surgery are spinal cord compression from trauma, arthritis or spondylosis. In cervical cord compression patients may have gait difficulty, balance issues, numbness and tingling in hands or feet. Spondylosis is spinal disc degeneration and arthritis that compresses the spinal canal resulting in bone spurring and disc herniation. Power drills and special instruments are used to correct any compression to the spinal canal. Disk herniations of spinal vertebral disks are removed by Kerrison pitiutary rongeurs. This is called a discectomy. Laminectomy is removing Lamina portion of the vertebra of the spine to make room for the compressed nerve tissue. Minimally invasive, radiology assisted spine surgery include vertebroplasty and kyphoplasty where some kinds of spinal fractures are managed^{[12] Essentials of Spinal Cord Injury-Fehlings, Vaccaro, Boakye et al}.

Pain surgery handled by the neurosurgeons include implantation of deep brain stimulators, spinal cord stimulators and pain pumps ^[9] ^{Functional Neurosurgery-Starr, Barbaro, Larson.} Surgery of the peripheral nervous system include carpal tunnel decompression and peripheral nerve transposition.

Conditions

Other conditions treated by neurosurgeons include:

Meningitis and other central nervous system infections including abscesses
Spinal disc herniation
Cervical spinal stenosis and Lumbar spinal stenosis
Hydrocephalus
Head trauma (brain hemorrhages, skull fractures, etc.)
Spinal cord trauma
Traumatic injuries of peripheral nerves
Tumors of the spine, spinal cord and peripheral nerves
Intracerebral hemorrhage, such as subarachnoid hemorrhage, interdepartmental, and intracellular hemorrhages
Some forms of drug-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
Vascular malformations (i.e., arteriovenous malformations, venous angiomas, cavernous angiomas, capillary telangectasias) of the brain and spinal cord
Moyamoya disease

References

^ AANS – Patient Information
^ ABNS.org
^ http://www.aans.org/medical_students/questions.asp
^ "The society of British neurological surgeons". Retrieved 2011-03-11. ^{[dead link]}
^ Cyber Museum of Neurosurgery
^ http://www.world-sci.com/read.aspx?id=135
^ Stereotactic Radiosurgery Program | UCLA Neurosurgery
^ Neuroradiology – Information for Patients & Referring Physicians

External links

The Brain that Changed Everything by Luke Dittrich – Esquire, November 2010

UpToDate Contents

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English Journal

Everyday memory in microsurgically treated patients after subarachnoid hemorrhage.

Koso M1, Dizdarevic K2, Sose-Selimotic J3.
Journal of clinical medicine research.J Clin Med Res.2015 Apr;7(4):225-31. doi: 10.14740/jocmr2073w. Epub 2015 Feb 9.
BACKGROUND: Memory declines measured by traditional tests in patients after subarachnoid hemorrhage (SAH) are well documented. Classic examinations of memory problems sometimes do not significantly correlate with memory functions in everyday life. The objective of the study was to assess the specifi
PMID 25699118

British Association of Spine Surgeons standards of care for cauda equina syndrome.

Germon T1, Ahuja S2, Casey AT3, Todd NV4, Rai A5.
The spine journal : official journal of the North American Spine Society.Spine J.2015 Mar 2;15(3 Suppl):S2-4. doi: 10.1016/j.spinee.2015.01.006.
PMID 25708139

Charles Harrison Frazier (1870-1936) and his legacy to neurosurgery.

Kaya Y1, Sarikcioglu L.
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery.Childs Nerv Syst.2015 Mar;31(3):355-8. doi: 10.1007/s00381-014-2543-z. Epub 2014 Sep 7.
Charles Harrison Frazier (1870-1936) was a visionary neurosurgeon of his time. He devoted himself almost exclusively to neurosurgery based on his training in Germany on neurology, surgery, and surgical pathology and his accomplishments as a military physician during war years. The authors reviewed h
PMID 25194856

Japanese Journal

脳神経外科医の基礎研究と臨床研究のバランス(<特集>脳神経外科医のresearch mindとacademism)

黒田敏
脳神経外科ジャーナル 21(6), 458-463, 2012-06-20
わが国の脳神経外科医にとっての基礎研究,臨床研究の目的,意義,手法について,筆者の経験に基づいて概説した.われわれ脳神経外科医にとっての基礎研究,臨床研究は,新たな「知」の創造を通して未来の医療を向上させる以外に,科学的思考能力を身につけて絶え間なく自らの診療行為を発展させ,ひいては患者さん一人ひとりの健康を向上させるための手段である.基礎研究と臨床研究との間には優劣の差はない.ただし,それぞれ異 …
NAID 110009457754

海外留学の実態調査および海外での基礎研究の意義(<特集>脳神経外科医のresearch mindとacademism)

野崎和彦
脳神経外科ジャーナル 21(6), 452-457, 2012-06-20
日本から海外へ留学する学生の数は年々減少傾向にあり,第31回日本脳神経外科コングレス総会会長の小笠原邦昭先生の御配慮のもと,2011年に全国の80大学の脳神経外科学教室へ向けて行った,日本の脳神経外科学教室における2000年〜2010年の海外留学実態調査においても,特に研究目的の留学者数の減少傾向がみられ,海外留学自体の目的意識の変化,海外での経験への意義の変化などが関係していると思われる.ヒトの …
NAID 110009457753

脳神経外科医の基礎研究と臨床研究のバランス

黒田敏
脳神経外科ジャーナル = Japanese journal of neurosurgery 21(6), 458-463, 2012-06-20
NAID 10030863989

Related Pictures

[1] AANS – Patient Information

[2] ABNS.org

[3] ttp://www.aans.org/medical_students/questions.asp

[4] "The society of British neurological surgeons". Retrieved 2011-03-11. ^{[dead link]}

[5] Cyber Museum of Neurosurgery

[6] ttp://www.world-sci.com/read.aspx?id=135

[7] Stereotactic Radiosurgery Program | UCLA Neurosurgery

[8] Neuroradiology – Information for Patients & Referring Physicians

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