Neurosurgery

We tend to think of a neurosurgeon as a surgical specialist who operates on the brain and spinal cord. However, neurosurgery focuses on the entire body with respect to the central, peripheral, and autonomic nervous system. A neurosurgery team operates on hands and arms, legs and feet, the spinal area or the brain, and sometimes, all in one day.

A neurosurgeon must undergo one of the longest medical training programs (up to 12 years), due to the extreme complexity of the discipline. In addition, some neurosurgeons choose to specialize, which requires an additional fellowship. Subspecialties include spine surgery, pediatric neurosurgery, neuro-oncology, and interventional neuroradiology. Additional post-residency graduate training specializes in trauma, pain, functional neurosurgery or stereotactic neurosurgery.

For the neurosurgeon who operates on the brain, he or she most commonly sees teenagers and young adults who have been injured in motor vehicle accidents. The next most common cause of traumatic brain injury occurs among young children and the elderly. Their injuries are usually caused by a fall, sometimes occurring during abuse. Elder abuse is not as widely recognized in society as child abuse, but it is widespread and results in many injuries caused by hitting and shoving.

Neurosurgery May Be Delayed

Patients with moderate or severe head injuries must usually be taken directly to surgery from the emergency room. A hematoma or contusion may be increasing pressure in the brain or compressing the brain and must be removed immediately. Some small hematomas that show on the CT-scan take several days to enlarge. If they increase in size while the patient is in the ICU, the patient's condition may worsen. A second CT-scan should show the latest development, and then surgery may be performed several days after admittance. MRIs are generally not useful for a severely injured patient, where time is of critical importance. An MRI may be performed later on a stabilized patient, when prognosis is being determined.