Neurosurgery is the specialized medical discipline dedicated to the diagnosis and surgical treatment of disorders affecting the nervous system. This system includes the central components—the brain and spinal cord—as well as the network of peripheral nerves throughout the body. Neurosurgeons manage complex conditions affecting these delicate tissues and their supporting structures. The scope of the specialty is broader than just “brain surgery,” encompassing procedures from emergency trauma intervention to the long-term management of chronic neurological disease.
Cranial Procedures
Neurosurgeons frequently perform operations within the skull, addressing oncological, vascular, and traumatic conditions. Oncological surgery focuses on the precise removal of brain tumors, such as gliomas and meningiomas, while preserving neurological function. Advanced tools, including intraoperative magnetic resonance imaging (iMRI) and neuronavigation systems, are used to achieve the maximum safe tumor resection. Sometimes, an awake craniotomy is performed, allowing the surgical team to monitor the patient’s speech and motor function in real-time as the tumor is removed from sensitive areas of the brain.
Vascular procedures target abnormalities in the brain’s blood supply, primarily treating cerebral aneurysms using microsurgical clipping or endovascular coiling. Microsurgical clipping involves opening the skull and placing a titanium clip across the aneurysm’s neck to block blood flow. Endovascular coiling is a less invasive technique where a catheter is threaded through the vascular system to fill the aneurysm with platinum coils from the inside, often resulting in a shorter recovery time. The choice between these methods depends on the aneurysm’s size, location, and the patient’s overall health.
Emergency neurosurgery addresses traumatic brain injuries, focusing on the evacuation of intracranial hematomas that cause pressure on the brain. Acute epidural hematomas (EDHs) and subdural hematomas (SDHs) require rapid surgical intervention. A craniotomy is performed to create an opening in the skull, allowing the surgeon to remove the blood clot and control the source of bleeding, thereby decompressing the brain. Specific criteria, such as a hematoma volume greater than 30 cubic centimeters or a significant shift in brain structure, mandate immediate evacuation to prevent irreversible damage.
Spinal and Vertebral Column Surgeries
Operations on the spinal column constitute a large portion of a neurosurgeon’s practice, addressing issues from degenerative compression to structural instability. Degenerative conditions often cause nerve root or spinal cord compression, treated with procedures like laminectomy and discectomy. A laminectomy involves removing the lamina (the bony roof of the spinal canal) to create more space for compressed nerves. A discectomy removes the portion of a herniated intervertebral disc that is pressing on a nerve root, often performed using minimally invasive techniques.
When spinal instability is a concern, such as from advanced degeneration or trauma, a spinal fusion is often necessary. This procedure permanently connects two or more vertebrae using a bone graft to eliminate motion and provide stability. To enhance fusion and maintain alignment while the bone heals, the surgeon uses spinal instrumentation, including metallic components like titanium rods, plates, and screws. These devices stabilize the segment until the fusion solidifies, which is common following a vertebral fracture or the removal of a spinal tumor.
Neurosurgical intervention is also used for tumors affecting the spine and spinal cord, which can grow within the bone or the neural tissue. The goal of surgery is to remove the tumor while preserving neurological function, achieved through careful microsurgical dissection. If tumors have compromised the vertebral column’s structural integrity, removal is followed by spinal stabilization using rods and screws to prevent collapse and restore alignment.
Surgical Treatment for Functional and Movement Disorders
A specialized subfield of neurosurgery focuses on modulating or disrupting specific neural circuits to control chronic conditions, rather than removing mass lesions. Deep Brain Stimulation (DBS) is primarily used for movement disorders like Parkinson’s disease and essential tremor. The surgery involves implanting electrodes into precise, deep brain targets, such as the subthalamic nucleus. These electrodes connect to a neurostimulator placed under the skin in the chest, which delivers continuous electrical impulses to block the abnormal signals causing symptoms like tremor and rigidity.
For patients with drug-resistant epilepsy, surgery can offer relief by identifying and removing the specific epileptic focus where seizures originate. Procedures like a corpus callosotomy are sometimes performed, involving cutting the nerve fibers connecting the two cerebral hemispheres to prevent seizures from spreading. For chronic pain syndromes, neurosurgeons may implant spinal cord stimulators (SCS), which send low-voltage electricity to the spinal cord to interrupt pain signals. These procedures aim to restore quality of life and improve control over symptoms that do not respond sufficiently to medication.
Peripheral Nerve Interventions
Neurosurgeons also treat disorders of the peripheral nervous system (nerves outside the brain and spinal cord). These interventions commonly address nerve entrapment syndromes, where a nerve is compressed by surrounding tissue. A frequent example is carpal tunnel release, a minimally invasive procedure to cut the ligament roof of the carpal tunnel, relieving pressure on the median nerve.
Another common procedure is ulnar nerve transposition, performed to alleviate symptoms of cubital tunnel syndrome, where the ulnar nerve is compressed at the elbow. The surgeon moves the nerve from behind the bony prominence of the elbow to a new position in front of it, reducing tension and irritation. Repair of damaged peripheral nerves following trauma, such as a brachial plexus injury, also falls under the neurosurgeon’s purview. Neurosurgeons are equipped to manage the repair and reconstruction of these nerves due to their detailed anatomical knowledge.