Table of Contents
Neurosurgery is the surgical discipline that involves the diagnosis, prevention, management and rehabilitation of conditions that affect the central nervous system, which includes the brain, cranial nerves and spinal cord, the peripheral nervous system, which includes the peripheral nerves, and the autonomic nervous system, which includes the sympathetic and parasympathetic nerve pathways.
In order to specialise in neurosurgery, a doctor has to complete their 4-5 year undergraduate training and receive the degree in bachelor of medicine and surgery (M.B.B.S. or M.B.,Ch.B). Thereafter a 1-2 year internship phase needs to be completed before being able to apply for a specialist post. If a doctor is accepted into the specialty of neurosurgery, they will have to complete a 7-8 year residency programme in this discipline. This is by far the longest residency programme for any medical or surgical discipline if one excludes fellowship training for sub-specialties.
If a neurosurgeon wants to further specialise in sub-disciplines of neurosurgery, then this will entail a further 1-2 years of training. The sub-specialties of neurosurgery include the following:
- Vascular neurosurgery
- Stereotactic neurosurgery
- Epilepsy surgery - this includes performing procedures such as total or partial corpus callosotomy (removing all of or a part of the corpus callosum), total or partial lobectomy (the removal of all of or part of one of the lobes of the brain) or even hemispherectomy (removal of one of the cerebral hemispheres of the brain) to stop or decrease seizure activity and spread. The latter two procedures are also used in oncology neurosurgery (rarely) or to manage severe trauma, such as a gunshot or stab wound to the brain.
- Spinal neurosurgery
- Skull base surgery
- Oncological neurosurgery, that also includes paediatric oncological neurosurgery.
- Peripheral nerve surgery
- Paediatric neurosurgery
Conventional open surgery - the neurosurgeon will open the skull and creates a large opening to gain access to the brain. This technique is traditionally used in trauma or emergency situations.
Microsurgery - this method is used in procedures such as laminectomy, microdiscectomy and artificial disc replacement.
Stereotaxy - this is used to approach a very small target in the brain through a small opening by making used of image guiding systems. The combination of stereotactic and open surgery, used in managing intraventricular haemorrhages, can be very successfully.
Minimally invasive endoscopic surgery - this techniques is used when operating on pathologies such as pituitary tumours and when repairing cerebrospinal fluid leaks.
Stereotactic radiosurgery - together with radiation oncologists, neurosurgeons use this method to manage conditions such as intracranial tumours and arterio-venous malformations (AVMs).
Endovascular neurosurgery - endovascular image guiding is used to manage issues such as AVMs, aneurysms, carotid stenosis, spinal malformations and strokes. Procedures such as stenting, angioplasty and diagnostic angiography are regarded as endovascular procedures.
Ventriculo-Peritoneal Shunt (VP Shunt) - this is performed on children in cases of congenital hydrocephalus, and in adults who are diagnosed with normal pressure hydrocephalus (NPH).
Spinal neurosurgery - pathologies that are managed here include compression of the spinal canal due to spinal disc degeneration or trauma. Subsequently, disc herniations may occur and a procedure known as a discectomy will have to be performed.
Surgery of the peripheral nervous system - procedures such as peripheral nerve transposition and carpal tunnel decompression are performed.
Radiologically assisted spinal surgery - this entails performing minimally-invasive procedures such as kyphoplasty or vertebroplasty to treat spinal fractures.
Surgery for chronic pain - this involves implantation of stimulators deep in the brain, the spinal cord or peripheral areas to offer pain relief.