脳外科、脳神経外科

WordNet

any surgery that involves the nervous system (brain or spinal cord or peripheral nerves)

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2014/10/16 10:17:14」(JST)

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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.

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, Interventional neuroradiology, peripheral nerve, spine surgery and skull base surgery.^[3] In the U.S., neurosurgery is considered an extremely competitive specialty composed of only 0.6% of all practicing physicians and attracts only the top students of medical schools per year (with a <60% match rate and highest average USMLE scores).

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 Doctor 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 neurological pathway. Unlike other surgical specialties, it currently has its own independent training pathway which takes around eight years (ST1-8); before being able to sit consultant exams with great amounts of experience and practice behind them.^[4]

Main divisions of neurosurgery

General Neurosurgery is the practice where a neurosurgeon handles most of the neurosurgery 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 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
Spine neurosurgery
Peripheral nerve surgery
Pediatric neurosurgery

Neuropathology

The pathology confronted by neurosurgeons could be either congenital, acquired, traumatic, infection, neoplastic or degenerative. Conditions like congenital hydrocephalus, pediatric tumors and myelomeningocele are encountered in pediatric age group. Trauma with head or spine injury and AVM bleeds are encountered in young adults. Degenerative spine disease, aneurysm bleeds and Parkinson's disease are encountered in much older population.

The science of Neuropathology is a well developed branch of pathology which immensely help the modern day neurosurgeon.

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.

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 peadiatric neurosurgeons with or without plastic surgeons.

Neurosurgeons are involved in Stereotactic Radiosurgery along with Radiation Oncologists in tumor and AVM treatment. 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]

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 ronguers. 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.

Pain surgery handled by the neurosurgeons include implantation of deep brain stimulators, spinal cord stimulators and pain pumps.

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

[1]

UpToDate Contents

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1. 成人における手術部位感染症予防のための予防的抗菌薬投与 antimicrobial prophylaxis for prevention of surgical site infection in adults
2. 動脈瘤性くも膜下出血の治療 treatment of aneurysmal subarachnoid hemorrhage
3. 中枢性尿崩症の臨床症状および原因 clinical manifestations and causes of central diabetes insipidus
4. 術後発熱 postoperative fever
5. 頭蓋に対する定位手術的照射 stereotactic cranial radiosurgery

English Journal

LncRNAs: New Players in Gliomas, With Special Emphasis on the Interaction of lncRNAs With EZH2.

Bian EB1, Li J, Xie YS, Zong G, Li J, Zhao B.
Journal of cellular physiology.J Cell Physiol.2015 Mar;230(3):496-503. doi: 10.1002/jcp.24549.
Gliomas are the most common primary malignancy in the brain, accounting for 50-60%. Despite all the efforts of cytoreductive surgery in combination with intense chemoradiotherapy, glioma remains an incurable disease. Recent studies have shown that long noncoding RNAs (lncRNAs) are involved in the pa
PMID 24403021

A capacitive DNA sensor-based test for simple and sensitive analysis of antibiotic resistance in field setting.

Liu Y1, Hedström M2, Chen D3, Fan X3, Mattiasson B2.
Biosensors & bioelectronics.Biosens Bioelectron.2015 Feb 15;64:255-9. doi: 10.1016/j.bios.2014.08.084. Epub 2014 Sep 6.
To meet urgent needs for solving serious worldwide drug-resistance problems, a sensitive label-free capacitive sensor developed in our group was investigated as a tool to be applied in the field of antibiotic resistance genotyping, for instance the detection of ampicillin resistance gene (ampR). Pro
PMID 25238540

Management of Extracranial Carotid Artery Disease.

Ooi YC1, Gonzalez NR2.
Cardiology clinics.Cardiol Clin.2015 Feb;33(1):1-35. doi: 10.1016/j.ccl.2014.09.001.
Stroke is the third leading cause of death in developed nations. Up to 88% of strokes are ischemic in nature. Extracranial carotid artery atherosclerotic disease is the third leading cause of ischemic stroke in the general population and the second most common nontraumatic cause among adults younger
PMID 25439328

Japanese Journal

くも膜下出血後の脳血管平滑筋収縮性亢進の分子機構

吉川雄一郎,佐々木富男,平野真弓,平野勝也,Kikkawa Yuichiro,Sasaki Tomio,Hirano Mayumi,Hirano Katsuya,キッカワユウイチロウ,ササキトミオ,ヒラノマユミ,ヒラノカツヤ
福岡医学雑誌 102, 325-332, 2011-12-25
脳血管攣縮は，くも膜下出血発症後４日目から14 日目頃にかけて遅発性に生じる脳動脈の可逆的狭窄である．脳血管攣縮は，血管造影上約70％の患者に認められ，脳虚血症状の出現頻度は20?30％と言われている．血管攣縮は，重篤な神経障害や死をもたらす場合があり，急性期を脱したくも膜下出血患者の機能予後および生命予後を決定する重要な合併症といえる．脳血管攣縮は，くも膜下出血発症後一定の時期を経て，遅発性に生 …
NAID 120003678722

側頭骨骨折に対する手術治療 : 脳神経外科の立場から

酒井圭一,本郷一博
Facial nerve research 30, 22-24, 2011-12-20
NAID 10027667679

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★リンクテーブル★

リンク元	「神経外科学」「脳外科」「脳神経外科」
拡張検索	「functional neurosurgery」「endovascular neurosurgery」「microneurosurgery」「pediatric neurosurgery」

「神経外科学」

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.);