Neurosurgery is the medical specialty dedicated to the surgical treatment of disorders affecting the nervous system, which includes the brain, the spinal cord, and the network of peripheral nerves extending throughout the body. While the general public often associates neurosurgeons primarily with complex brain operations, the scope of their work covers a vast array of conditions. This surgical discipline requires intense focus and highly specialized training to manage diseases, trauma, and congenital malformations. This overview identifies and examines the specific types of procedures that neurosurgeons perform most frequently in current practice.
Identifying the Most Frequent Procedures
Procedures involving the spine—the bony column, spinal cord, and associated nerve roots—represent the largest volume of surgery for most neurosurgeons. The high frequency of spinal procedures is largely driven by the sheer prevalence of degenerative conditions that occur as people age, such as arthritis and disc wear. In many neurosurgical practices, spinal operations can constitute 60% to 70% of the total case volume, significantly outweighing cranial procedures.
The most common spinal procedures generally fall into two broad categories: decompression and stabilization. Decompression procedures aim to relieve pressure on the spinal cord or nerves, while stabilization procedures work to limit painful or excessive motion between vertebrae. Specific procedures like anterior cervical discectomy and fusion (ACDF), laminectomy, and discectomy consistently rank among the most frequently reported operations performed by neurosurgeons.
Common Conditions Treated with Spinal Surgery
The primary drivers of surgical volume are conditions where a structural issue in the spine impinges upon the sensitive nervous tissue. Lumbar spinal stenosis, a narrowing of the spinal canal in the lower back, is a common age-related condition that causes back and leg pain by compressing the spinal nerves. To treat this, a neurosurgeon often performs a laminectomy, which involves surgically removing the lamina, the back part of the vertebra, to create more space for the nerves and spinal cord. This removal of bone is a classic example of a decompression procedure intended to alleviate nerve root compression.
Herniated discs are another major source of neurosurgical cases, occurring when the soft interior of a disc pushes through its tough outer layer and irritates a nearby nerve. When a disc in the neck is herniated, a neurosurgeon may perform an ACDF, removing the damaged disc and fusing the two adjacent vertebrae to stabilize the segment. For a herniated disc in the lower back, a microdiscectomy is a common procedure where only the protruding disc material is removed through a small incision, relieving pressure on the nerve root without requiring a fusion.
Spondylolisthesis, the slippage of one vertebra over the one beneath it, often requires a more complex solution involving stabilization. If non-surgical methods fail to manage the pain and instability, a spinal fusion may be performed. Fusion procedures involve permanently connecting two or more vertebrae using bone grafts and metal hardware like rods and screws. This stops the abnormal movement that causes nerve irritation and pain, providing rigid support and stabilizing the spine after decompression has been performed.
Cranial and Vascular Interventions
While spinal procedures are more numerous, operations on the brain and its blood vessels are often highly complex and require distinct expertise. Brain tumors necessitate procedures ranging from biopsies to full tumor resection, often requiring a craniotomy, which temporarily removes a section of the skull to access the brain tissue. These operations are performed with the goal of removing as much of the abnormal growth as possible while preserving surrounding functional brain areas, sometimes guided by advanced intraoperative imaging.
Traumatic brain injuries, such as those resulting from falls or accidents, also require prompt neurosurgical intervention, particularly to manage bleeding or swelling. Procedures like the evacuation of a subdural or epidural hematoma—a collection of blood pressing on the brain—are time-sensitive, life-saving surgeries. The neurosurgeon must rapidly relieve the pressure before permanent brain damage occurs, which contrasts with the often more elective nature of degenerative spinal surgery.
Neurovascular interventions focus on conditions affecting the blood supply to the brain, such as aneurysms and arteriovenous malformations (AVMs). An aneurysm, a balloon-like bulge in an artery wall, can be treated by surgically clipping the neck of the sac to prevent rupture, or by using endovascular techniques such as coiling. Treating an AVM, an abnormal tangle of blood vessels that bypasses the capillaries, involves complex surgical planning to safely remove the malformation and reduce the risk of hemorrhage.
Specialized and Functional Neurosurgery
Beyond the common spine and cranial procedures, neurosurgeons also specialize in a variety of lower-volume, highly focused areas. Functional neurosurgery focuses on treating neurological disorders by altering the activity of the nervous system, often involving the precise placement of stimulating devices. Deep Brain Stimulation (DBS) is one such procedure, where electrodes are implanted into specific brain areas to deliver electrical impulses that help manage symptoms of Parkinson’s disease, essential tremor, and certain movement disorders.
Peripheral nerve surgery addresses damage or compression of nerves outside of the brain and spinal cord, such as those causing complex regional pain syndromes or severe nerve entrapment. While common nerve decompression like carpal tunnel release is often performed by other specialists, neurosurgeons handle more intricate cases involving nerve repair following trauma or nerve transfers to restore function. Pediatric neurosurgery is another unique subspecialty, focusing on conditions like hydrocephalus, the buildup of fluid in the brain, often requiring the placement of a shunt to drain the excess fluid.