Neurosurgery

Neurosurgery is the medical specialty concerned with the diagnosis and treatment of patients with disorders affecting the nervous system, which includes the brain, spinal cord and peripheral nerves. A neurosurgeon may provide either surgical or non-surgical care depending upon the nature of the injury or illness. Accidents that injure the head, spinal cord or peripheral nerves require neurosurgical treatment. Neurosurgeons also care for patients with tumors of the brain or spinal cord. Also, children may be born with a brain or spinal cord malformation or with abnormal spinal fluid circulation that requires neurological surgery to help them live a more normal life. The most common condition that neurosurgeons treat is pain in the neck or lower back spreading to the arm or leg due to a ruptured disc. Abnormal discs that are pinching a nerve may be treated non-surgically through bed rest, back braces or physical therapy. Sometimes surgery is performed to treat the disability or pain symptoms.

Areas of neurosurgery

In the brain ("brain surgery") some of the conditions commonly seen include:

• Brain aneurysms – weaknesses on blood vessels that can burst, leading to death or stroke.
• Carotid stenosis – narrowing of the arteries supplying the brain, possible leading to stroke or a warning "TIA".
• Vascular malformations – which can bleed. Some are congenital (meaning we are born with them), and some develop later in life.
• Brain tumours – both benign (often curable with surgery) and malignant (sadly often incurable, but sometimes controllable with surgery).
• Acoustic neuromas – a kind of tumour at the base of the brain, related to the hearing nerves.
• Trigeminal neuralgia – terrible "spasms" of facial pain that are often curable with surgery.
• Hemifacial spasm – involuntary twitching on one side of the face – often curable with surgery.
• Hydrocephalus – a build up of fluid in the brain – sometimes treatable with an endoscope (a surgical camera) or with a shunt (to divert the fluid).
• Head injury – blood clots (haematomas) can develop after a head injury and some need to be removed with surgery.

Some of the spinal conditions treated (in both the lower back and neck) include:

• Herniated or "slipped" disc – which presses on a nerve in the spine causing "sciatica" (or pain in the leg).
• Narrowing of the spinal canal – causing leg or arm weakness or pain.
• Compression of the spinal cord – causing arm and leg weakness or difficulty with fine movements.
• Tumours in the spine.
• Blood vessel abnormalities in the spine
• Back pain – sometimes requiring treatment with "spinal fusion".

Peripheral nerve problems treated by a neurosurgeon include:

• Carpal tunnel syndrome – burning and weakness in the hands, often worse at night.
• Ulnar nerve compression – similar to carpal tunnel syndrome, but caused by compression of a nerve at the elbow.
• Leg weakness – caused by compression of nerves in the leg.
• Thoracic Outlet Syndrome.
• Nerve tumours – in various places in the body and extremities.

A neurosurgeon has unique training to be able to treat many of these potentially life altering, or life threatening, problems.

What does a Neurosurgeon do?

The nervous system is a complex network of thread-like nerves and cells that carry messages to and from the brain and spinal cord to various parts of the body including the sensory organs, arms, hands, legs, and feet.

Neurosurgery (or neurological surgery) is the medical specialty that concentrates on the diagnosis and treatment of conditions, illnesses and injuries involving the nervous system and its support structures. This includes conditions involving the brain, the spinal cord, the actual nerves, the skull, the bones of the spine, spinal disks, as well as the blood vessels, ligaments and the protective coverings that offer support to the nervous tissues.

Neurosurgeons, neurologists, and other medical professionals work together to provide comprehensive inpatient care for patients with complex neurological disorders. Neurologists often work closely with neurosurgeons, but do not perform surgery.

Intervention by a neurosurgeon can be surgical but is most often non-surgical and is determined by the condition or injury as well as the general health of the person. Such problems may be the result of abnormal development from birth (congenital), from aging or “wear and tear” (degenerative), traumatic from a definite injury, infectious, neoplastic from a tumour or it may be related to other medical conditions or disease.

Neurosurgeons treat issues such as:

• Tumours involving the brain, spinal cord, nerves, skull or the spine. These may be a primary growth from the local tissues themselves or a metastatic spread from a cancer in another part of the body.
• Spinal problems resulting in neck or back pain, the pinching of nerves with resultant pain, numbness or weakness in the arms or legs. These conditions can result from ruptured or bulging disks, excessive overgrowth of arthritic bone, slippage of the vertebra, infections or fractures.
• Peripheral nerve injuries or compression resulting in pain, numbness, weakness and wasting of the muscles in the face, arm, hand or leg. Conditions such as Carpal Tunnel syndrome are common when the nerve crossing the wrist is compressed or entrapped.
• Neurovascular disorders such as strokes, brain hemorrhages, aneurysms, vascular malformations, traumatic or non-traumatic blood clots affecting the brain or spinal cord and carotid artery disease.
• Brain disorders such as Parkinson’s disease, epilepsy, hydrocephalus or malformations involving the brain from birth.
• Infections involving the brain and spinal cord, the fluid surrounding these structures or the spinal vertebra and disks.
• Traumatic injuries to the brain, spinal cord, bones of the spine, nerves and skull.