Neurosurgery

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Introduction

Neurosurgery stands at the forefront of medical science, representing precision, innovation, and a deep understanding of the human brain and nervous system. This specialty is not limited to just brain surgery. It includes diagnosing and treating patients with injuries and disorders of the brain, spinal cord, and peripheral nerves across the body and caters to both adults and children. Neurosurgeons are trained to deal with a wide range of neurological conditions using surgical and non-surgical interventions to restore lost function and improve patients’ quality of life.

Sub-Specialities of Neurosurgery 

Neurosurgery includes multiple sub-specialties, each focusing on a specific section of the nervous system and related disorders. 

These sub-specialties include:

1. Neuro-Oncology: Neuro-oncology diagnoses and treats brain and spinal cord tumors, both malignant and benign. 
2. Spine Surgery: Spine surgery deals with the diagnosis and treatment of disorders affecting the spine, including herniated discs, deformities, tumors, and injuries. 
3. Pediatric Neurosurgery: Pediatric neurosurgery focuses on the treatment of neurological diseases in children, ranging from congenital conditions to tumors, epilepsy, and injuries. 
4. Functional Neurosurgery: Functional neurosurgery specializes in the surgical management of movement disorders. 
5. Vascular Neurosurgery: Vascular neurosurgery deals with disorders of the blood vessels in the brain and spinal cord.
6. Skull Surgery: Skull surgery involves the treatment of tumors, lesions, and abnormalities located at the base of the skull.
7. Peripheral Nerve Surgery: Peripheral nerve surgery focuses on disorders affecting the peripheral nerves.
8. Neurotrauma: Neurotrauma specialists treat physical injuries of the brain, spinal cord, and other parts of the nervous system.
9. Techniques and Procedures Used by Neurosurgeons

A neurosurgeon is skilled in and uses several surgical techniques, including:

1. Craniotomy: It involves opening the skull to access the brain for neurological interventions.
2. Deep Brain Stimulation (DBS): It is used to treat movement disorders and tremors by implanting electrodes to regulate abnormal neural activity.
3. Minimally Invasive Procedures: It uses small incisions to insert surgical tools with a camera and perform surgery. For example, endoscopy, endovascular surgery, etc.
4. Open Surgery: It involves cutting skin and tissues so a surgeon can get a full view of the organs.

1. Microsurgery: It includes reconstructing damaged skin, muscles, and tissues through a microscope.
2. Radiosurgery: It involves radiation therapy that produces a similar result as an actual surgical procedure.
3. Chronic Pain Interventional Procedures: It utilizes pain-blocking techniques to help make daily activities easier.
4. Neuroimaging: It uses procedures such as MRI, CT, and functional imaging techniques to visualize complex anatomical structures and plan surgical approaches with precision.

Conditions Treated Via Neurosurgery

Neurosurgery includes diagnosing, treating, and managing various conditions affecting the brain, spinal cord, peripheral nerves, and related structures. 

The conditions commonly treated by neurosurgeons include:

1. Brain Tumors: This specialty gliomas, meningiomas, pituitary tumors, acoustic neuromas, and metastatic brain tumors 
2. Spinal Disorders: Neurosurgery helps treat various spinal conditions, including herniated discs, spinal stenosis, degenerative disc disease, spinal cord compression, spinal deformities (e.g., scoliosis, kyphosis), and spinal cord tumors.
3. Cerebrovascular Disorders: Neurosurgery plays a significant role in the treatment of cerebrovascular disorders, including cerebral aneurysms, arteriovenous malformations (AVMs), cavernous malformations, moyamoya disease, and stroke.
4. Neurotrauma: Neurosurgery is involved in the acute management of traumatic brain injuries (TBIs), spinal cord injuries (SCIs), and peripheral nerve injuries.
5. Functional Disorders: Neurosurgery provides treatments for various functional disorders of the nervous system, including Parkinson’s disease, essential tremor, dystonia, epilepsy, and chronic pain syndromes. 
6. Peripheral Nerve Disorders: Neurosurgery addresses multiple peripheral nerve disorders, including nerve entrapment syndromes (e.g., carpal tunnel syndrome, etc.), traumatic nerve injuries, nerve tumors (e.g., schwannomas, neurofibromas, etc.), and brachial plexus injuries. 
7. Hydrocephalus: Neurosurgery is involved in the management of hydrocephalus, a condition characterized by the accumulation of cerebrospinal fluid (CSF) within the brain, leading to increased intracranial pressure.
8. Skull Base Disorders: Neurosurgery deals with conditions affecting the skull base, including skull base tumors (e.g., pituitary adenomas, acoustic neuromas, meningiomas, etc.), cranial nerve disorders, and vascular abnormalities (e.g., carotid artery aneurysms, etc.). 
9. Possibility of  Complications of Neurosurgery

Neurosurgery, despite its advancements, poses unique risks due to the complexity and delicate nature of the nervous system. 

These risks include:

1. Neurological Abnormality: Surgery involving the brain and spinal cord involves potential risks like sensory, motor, and cognitive damage. Despite precise surgical techniques, there is a risk of impairing critical neural structures, leading to functional issues.
2. Infections: Infections at the surgical site pose a great risk in neurosurgery, as they can lead to severe complications.
3. Hemorrhage: Bleeding during neurosurgical procedures can be challenging to control due to the rich vascular supply of the brain and spinal cord.
4. Cerebrospinal Fluid (CSF) Leakage: CSF leakage is common after neurosurgical procedures involving the brain and spine and can lead to complications. 
5. Brain Edema: Postoperative brain edema and swelling can occur as a result of surgical trauma, tissue manipulation, or underlying pathology. 
6. Postoperative Neurological Complications: Patients undergoing neurosurgical procedures are at risk of developing postoperative complications such as seizures, stroke, cognitive dysfunction, and focal neurological deficits. 
7. Psychosocial and Rehabilitation Challenges: Neurosurgical patients often face significant psychosocial and rehabilitation challenges, especially with traumatic injuries or neurological conditions. 

When to See a Neurosurgeon?

The following symptoms require evaluation by a neurosurgeon:

1. Persistent headaches accompanied by nausea and vomiting
2. Vision and speech changes 
3. Weakness or numbness
4. Back or neck pain with bowel/bladder dysfunction
5. Seizures
6. Loss of coordination
7. Memory loss and behavioral changes
8. Tremors and movement difficulties
9. Suspected or diagnosed brain and spinal tumors, malformations, or aneurysms
10. Gait disturbances

Neurosurgery is a dynamic and indispensable specialty within the field of medicine, offering hope to patients dealing with various neurological conditions. From life-saving interventions to innovative treatments, neurosurgeons at Fortis continue to push the limits of medical science and exhibit their unwavering commitment to the pursuit of excellence in patient care and scientific advancement.