Neurosurgery is a specialized medical field focused on the diagnosis and surgical treatment of disorders affecting the nervous system. This intricate discipline addresses conditions impacting the brain, spinal cord, and peripheral nerves. Neurosurgeons employ advanced techniques and precision due to the delicate nature and vital functions of these anatomical structures.
Scope of Neurosurgery
Neurosurgery encompasses a broad range of anatomical areas within the human body. Neurosurgeons operate on the brain, spinal cord, spinal column, and peripheral nerves. The cerebrovascular system, which includes the blood vessels supplying the brain and spinal cord, also falls within their scope. These diverse areas are grouped under neurosurgery due to their interconnectedness and collective role in controlling bodily functions, sensation, and thought.
Brain Procedures
Neurosurgeons perform a variety of procedures to address conditions affecting the brain. Brain tumor surgery, often involving a craniotomy, removes a section of the skull to access and resect the tumor. Endoscopic techniques, or keyhole brain surgery, offer a less invasive approach for certain tumors, especially those in fluid-filled spaces or near the skull base, by inserting a thin tube with a camera through a small incision or the nose. The goal is to remove as much of the tumor as safely possible, or to obtain a tissue sample for diagnosis.
Vascular conditions like aneurysms and arteriovenous malformations (AVMs) are also treated surgically. Aneurysm clipping involves placing a small metal clip at the base of an aneurysm to prevent rupture, while AVM resection is the surgical removal of an abnormal tangle of blood vessels. Carotid endarterectomy removes fatty plaque buildup from the carotid arteries in the neck, which supply blood to the brain, thereby reducing stroke risk.
For brain trauma, neurosurgeons may perform hematoma evacuation to remove blood clots that put pressure on the brain or repair skull fractures. Hydrocephalus, a condition characterized by excess cerebrospinal fluid in the brain, is often managed by shunt placement, which diverts the fluid to another part of the body where it can be absorbed. In cases of epilepsy that do not respond to medication, lesionectomy can be performed to remove a specific brain abnormality causing seizures.
Deep Brain Stimulation (DBS) is another procedure for certain neurological conditions, including some types of epilepsy and movement disorders like Parkinson’s disease and essential tremor. DBS involves implanting electrodes in specific brain areas, which are connected to a device in the chest that delivers electrical impulses to modulate brain activity.
Spinal Procedures
Neurosurgeons frequently perform surgeries on the spine and spinal cord to alleviate pain, restore function, and address structural issues. A common procedure for herniated discs is a discectomy, often a microdiscectomy, which involves removing the damaged portion of a disc that is pressing on a nerve root. This minimally invasive technique uses a microscope and small instruments through a small incision, aiming for faster recovery.
Spinal stenosis, a narrowing of the spinal canal, can be treated with laminectomy, where a part of the vertebral bone (lamina) is removed to relieve pressure on the spinal cord or nerves. Laminoplasty is an alternative that expands the spinal canal without removing the lamina entirely. Tumors located in or around the spinal cord require surgical resection to remove the growth and decompress the neural structures.
Spinal deformities, such as scoliosis, are corrected through fusion procedures. This surgery involves realigning and fusing vertebrae together, often using metal rods and screws, to stabilize the spine and prevent further curvature progression. For spinal trauma, such as fractures, neurosurgeons perform stabilization procedures, sometimes involving fusion, and decompression to relieve pressure on the spinal cord caused by bone fragments or swelling.
Peripheral Nerve and Other Specialized Procedures
Beyond the brain and spine, neurosurgeons also address conditions affecting peripheral nerves. Carpal tunnel release is a common procedure for carpal tunnel syndrome, where pressure on the median nerve in the wrist causes pain and numbness. During this surgery, the carpal ligament is cut to relieve the pressure on the nerve.
Ulnar nerve transposition may be performed when the ulnar nerve at the elbow is compressed, involving moving the nerve to a new position. Nerve repair for trauma aims to restore function to nerves damaged by injury.
Neurosurgery also includes specialized procedures for pain management. Spinal cord stimulators involve implanting a device that delivers mild electrical pulses to the spinal cord, masking pain signals before they reach the brain. Intrathecal pump implants deliver pain medication directly into the fluid surrounding the spinal cord, allowing for lower doses and reduced systemic side effects compared to oral medications.
Functional neurosurgery encompasses procedures for conditions like trigeminal neuralgia, which causes severe facial pain. Microvascular decompression, a surgical technique for trigeminal neuralgia, involves moving a blood vessel that is compressing the trigeminal nerve.