A neurosurgeon is a medical doctor specializing in the diagnosis and treatment of conditions affecting the nervous system, including the brain, spinal cord, and all peripheral nerves. While often associated with brain surgery, their expertise covers a wide range of neurological disorders and injuries, such as those impacting nerves in the face, arms, and legs. Neurosurgeons offer both surgical and non-surgical care, often exploring conservative treatments like medication or physical therapy before considering surgery. Their training allows them to address nerve damage, either directly through procedures on the nerves or indirectly by treating surrounding structures.
Assessing Nerve Damage
Neurosurgeons employ a thorough approach to diagnose and assess the extent of nerve damage, beginning with a detailed medical history and physical examination. They inquire about symptoms such as weakness, pain, twitching, tingling, or numbness, and evaluate a patient’s lifestyle and any exposure to toxins. A neurological exam further assesses nerve function by checking tendon reflexes, muscle strength and tone, and the patient’s ability to perceive sensations, balance, and coordination.
Neurosurgeons often use specialized diagnostic tests. Electromyography (EMG) measures the electrical activity of muscles at rest and during movement, using a thin-needle electrode. Reduced muscle activity during an EMG can indicate nerve injury and help pinpoint its location. Nerve conduction studies (NCS) are often performed with EMG; electrodes placed on the skin measure how quickly electrical signals travel through nerves. This test assesses the speed and strength of nerve signals, helping to determine the presence, location, and severity of nerve damage.
Imaging tests also help diagnose nerve damage by visualizing affected structures. Magnetic Resonance Imaging (MRI) uses magnetic fields and radio waves to produce detailed images of soft tissues, including nerves. MRI can reveal nerve compression, inflammation, or structural abnormalities, and is effective for visualizing the spine and peripheral nerves. X-rays are useful for viewing bones and fractures but not soft tissues like nerves. Computed Tomography (CT) scans provide detailed images of bones and are used when bone abnormalities are suspected of compressing a nerve.
Surgical Interventions for Nerve Damage
When conservative treatments are insufficient, neurosurgeons perform various surgical interventions to address nerve damage, aiming to restore function and alleviate symptoms. Nerve decompression is a common procedure that relieves pressure on a pinched or entrapped nerve. This often involves removing a small portion of bone or disc material pressing on the nerve root. For conditions like carpal tunnel syndrome, the surgeon may cut away part of a ligament to free the median nerve.
Nerve repair is performed when a nerve has been severed or significantly damaged. For a clean cut, the surgeon may directly reconnect the nerve ends using fine sutures. This requires careful alignment of nerve fibers to promote regeneration. If there is severely damaged or scarred tissue, it may be trimmed before rejoining.
When a gap between damaged nerve ends is too large for direct repair, nerve grafting is used. This procedure involves taking a segment of healthy nerve tissue, often from the patient’s own body or a cadaver, to bridge the gap. The grafted nerve provides a pathway for regenerating nerve fibers to grow across the defect. This process can take several months to a year, as nerves regenerate slowly.
Neurolysis is a surgical procedure that frees a nerve from surrounding scar tissue or constricting structures. Scar tissue can form after trauma or previous surgery, tethering the nerve and causing pain or impaired signal transmission. During neurolysis, the surgeon carefully releases these adhesions. This procedure restores the nerve’s ability to glide smoothly, aiming to reduce pain and improve sensory or motor function in the affected area.
Conditions Managed by Neurosurgeons
Neurosurgeons manage a broad spectrum of nerve damage and related conditions, given their expertise in the entire nervous system. Peripheral nerve injuries, resulting from trauma, compression, or illness, are a common focus. These injuries can involve nerves throughout the body, including those in the limbs, face, and trunk, leading to symptoms like pain, weakness, numbness, or impaired motor skills. Surgical intervention for traumatic nerve injuries may be performed immediately or after observation.
Brachial plexus injuries involve damage to the nerve network originating from the spinal cord that controls movement and sensation in the arm and hand. These injuries often result from trauma and can lead to pain, muscle weakness, or loss of sensation in the upper limb. Neurosurgeons treat these injuries with procedures like nerve repair, nerve grafting, and nerve transfers, aiming to restore function.
Nerve entrapment syndromes occur when nerves become compressed or restricted, often at narrow anatomical passages. Common examples include carpal tunnel syndrome, where the median nerve is compressed at the wrist, and cubital tunnel syndrome, involving the ulnar nerve at the elbow. These conditions cause pain, tingling, numbness, or muscle weakness in the affected region. Neurosurgeons address them by decompressing the nerve, often by releasing surrounding ligaments or tissues.
Nerve damage caused by tumors is another area of neurosurgical expertise. Tumors can grow in or near peripheral nerves, or within the spine, causing compression or direct damage to nerve tissue. While many nerve tumors are benign, they can still lead to pain, weakness, numbness, or loss of function. Neurosurgeons aim to remove the tumor while preserving healthy nerve function.
Nerve root compression, often stemming from spinal issues, is frequently managed by neurosurgeons. Conditions such as herniated discs, spinal stenosis (narrowing of the spinal canal), or bone spurs can put pressure on nerve roots as they exit the spinal cord. This compression can cause pain, numbness, or weakness that radiates into the arms or legs. Neurosurgeons perform procedures like laminectomy or discectomy to relieve this pressure, removing portions of bone or disc material to create more space for the affected nerve roots.