neurosurgery neurosurgery neurosurgery or neurological surgery, known in common parlance as brain surgery, is the medical specialty concerned with the surgical treatment of disorders which affect any portion of the nervous system including the brain, spinal cord and peripheral nervous system. neurosurgerystereotactic guided insertion of dbs electrodes in neurosurgeryoccupationactivity sectorssurgerydescriptioneducation required doctor of medicine (m.d.) or doctor of osteopathic medicine (d.o.) with residency in neurosurgery or bachelor of medicine, bachelor of surgery (m.b.b.s.) with residency in neurosurgery or fellowship of the royal college of surgeons (f.r.c.s.) or master of surgery (m.s.) / magister chirurgiae (m.ch.) fields ofemploymenthospitals, clinics education and context in different countries, there are different requirements for an individual to legally practice neurosurgery, and there are varying methods through which they must be educated. in most countries, neurosurgeon training requires a minimum period of seven years after graduating from medical school. united states in the united states, a neurosurgeon must generally complete four years of undergraduate education, four years of medical school, and seven years of residency (pgy-1-7). most, but not all, residency programs have some component of basic science or clinical research. neurosurgeons may pursue additional training in the form of a fellowship after residency, or, in some cases, as a senior resident in the form of an enfolded fellowship. these fellowships include pediatric neurosurgery, trauma/neurocritical care, functional and stereotactic surgery, surgical neuro-oncology, radiosurgery, neurovascular surgery, skull-base surgery, peripheral nerve and complex spinal surgery. fellowships typically span one to two years. in the u.s., neurosurgery is a very small, highly competitive specialty, constituting only 0.5 percent of all physicians. united kingdom in the united kingdom, students must gain entry into medical school. mbbs qualification (bachelor of medicine, bachelor of surgery) takes four to six years depending on the student's route. the newly qualified physician must then complete foundation training lasting two years; this is a paid training program in a hospital or clinical setting covering a range of medical specialties including surgery. junior doctors then apply to enter the neurosurgical pathway. unlike most other surgical specialties, it currently has its own independent training pathway which takes around eight years (st1-8); before being able to sit for consultant exams with sufficient amounts of experience and practice behind them. neurosurgery remains consistently amongst the most competitive medical specialties in which to obtain entry. history main article: history of neurology and neurosurgery neurosurgery, or the premeditated incision into the head for pain relief, has been around for thousands of years, but notable advancements in neurosurgery have only come within the last hundred years. trepanned skull from edinburgh ancient the incas appear to have practiced a procedure known as trepanation since before european colonization. during the middle ages in al-andalus from 936 to 1013 ad, al-zahrawi performed surgical treatments of head injuries, skull fractures, spinal injuries, hydrocephalus, subdural effusions and headache. during the roman empire, doctors and surgeons performed neurosurgery on depressed skull fractures. simple forms of neurosurgery were performed on king henri ii in 1559, after a jousting accident with gabriel montgomery fatally wounded him. ambroise paré and andreas vesalius, both experts in their field at the time, attempted their own methods, to no avail, in curing henri. in china, hua tuo created the first general anaesthesia called mafeisan, which he used on surgical procedures on the brain. modern history of tumor removal: in 1879, after locating it via neurological signs alone, scottish surgeon william macewen (1848–1924) performed the first successful brain tumor removal. on november 25, 1884, after english physician alexander hughes bennett (1848–1901) used macewen's technique to locate it, english surgeon rickman godlee (1849–1925) performed the first primary brain tumor removal, which differs from macewen's operation in that bennett operated on the exposed brain, whereas macewen operated outside of the "brain proper" via trepanation. on march 16, 1907, austrian surgeon hermann schloffer became the first to successfully remove a pituitary tumor. lobotomy: also known as leucotomy, was a form of psychosurgery, a neurosurgical treatment of mental disorders that involves severing connections in the brain's prefrontal cortex. the originator of the procedure, portuguese neurologist antónio egas moniz, shared the nobel prize for physiology or medicine of 1949. some patients improved in some ways after the operation, but complications and impairments – sometimes severe – were frequent. the procedure was controversial from its initial use, in part due to the balance between benefits and risks. it is mostly rejected as a treatment now and non-compliant with patients' rights. history of electrodes in the brain: in 1878, richard caton discovered that electrical signals transmitted through an animal's brain. in 1950 dr. jose delgado invented the first electrode that was implanted in an animal's brain (bull), using it to make it run and change direction. in 1972 the cochlear implant, a neurological prosthetic that allowed deaf people to hear was marketed for commercial use. in 1998 researcher philip kennedy implanted the first brain computer interface (bci) into a human subject. a survey done in 2010 on 100 most cited works in neurosurgery shows that the works mainly cover clinical trials evaluating surgical and medical therapies, descriptions of novel techniques in neurosurgery, and descriptions of systems classifying and grading diseases. modern surgical instruments modern neurosurgical instruments a doctor performing stereotactic gamma knife radiosurgery, a non-invasive procedure puma robotic arm aluminum headrest the main advancements in neurosurgery came about as a result of highly crafted tools. modern neurosurgical tools, or instruments, include chisels, curettes, dissectors, distractors, elevators, forceps, hooks, impactors, probes, suction tubes, power tools, and robots. most of these modern tools have been in medical practice for a relatively long time. the main difference of these tools in neurosurgery, were the precision in which they were crafted. these tools are crafted with edges that are within a millimeter of desired accuracy. other tools, such as hand held power saws and robots have only recently been commonly used inside of a neurological operating room. as an example, the university of utah developed a device for computer-aided design / computer-aided manufacturing (cad-cam) which uses an image-guided system to define a cutting tool path for a robotic cranial drill. organised neurosurgery world academy of neurological surgery's conference the world federation of neurosurgical societies (wfns), founded in 1955, in switzerland, as a professional, scientific, non governmental organization, is composed of 130 member societies: consisting of 5 continental associations (aans, aasns, caans, eans and flanc), 6 affiliate societies, and 119 national neurosurgical societies, representing some 50,000 neurosurgeons worldwide. it has a consultative status in the united nations. the official journal of the organization is world neurosurgery. the other global organisations being the world academy of neurological surgery (wans) and the world federation of skull base societies (wfsbs). main divisions general neurosurgery involves most neurosurgical conditions including neuro-trauma and other neuro-emergencies such as intracranial hemorrhage. most level 1 hospitals have this kind of practice. specialized branches have developed to cater to special and difficult conditions. these specialized branches co-exist with general neurosurgery in more sophisticated hospitals. to practice advanced specialization within neurosurgery, additional higher fellowship training of one to two years is expected from the neurosurgeon. some of these divisions of neurosurgery are: vascular neurosurgery includes clipping of aneurysms and performing carotid endarterectomy (cea). stereotactic neurosurgery, functional neurosurgery, and epilepsy surgery (the latter includes partial or total corpus callosotomy – severing part or all of the corpus callosum to stop or lessen seizure spread and activity, and the surgical removal of functional, physiological and/or anatomical pieces or divisions of the brain, called epileptic foci, that are operable and that are causing seizures, and also the more radical and rare partial or total lobectomy, or even hemispherectomy – the removal of part or all of one of the lobes, or one of the cerebral hemispheres of the brain; those two procedures, when possible, are also very, very rarely used in oncological neurosurgery or to treat very severe neurological trauma, such as stab or gunshot wounds to the brain) oncological neurosurgery also called neurosurgical oncology; includes pediatric oncological neurosurgery; treatment of benign and malignant central and peripheral nervous system cancers and pre-cancerous lesions in adults and children (including, among others, glioblastoma multiforme and other gliomas, brain stem cancer, astrocytoma, pontine glioma, medulloblastoma, spinal cancer, tumors of the meninges and intracranial spaces, secondary metastases to the brain, spine, and nerves, and peripheral nervous system tumors) skull base surgery spinal neurosurgery peripheral nerve surgery pediatric neurosurgery (for cancer, seizures, bleeding, stroke, cognitive disorders or congenital neurological disorders) commonly performed surgeries according to an analysis by the american college of surgeons national surgical quality improvement program (nsqip), the most common surgeries performed by neurosurgeons in between 2006 and 2014 were the following: anterior cervical discectomy and fusion (acdf) craniotomy for brain tumor (cbt) discectomy laminectomy posterolateral lumbar fusion (plf) neuropathology histopathology specimen of angiocentric glioma, higher magnification, he stain neuropathology is a specialty within the study of pathology focused on the disease of the brain, spinal cord, and neural tissue. this includes the central nervous system and the peripheral nervous system. tissue analysis comes from either surgical biopsies or post mortem autopsies. common tissue samples include muscle fibers and nervous tissue. common applications of neuropathology include studying samples of tissue in patients who have parkinson's disease, alzheimer's disease, dementia, huntington's disease, amyotrophic lateral sclerosis, mitochondria disease, and any disorder that has neural deterioration in the brain or spinal cord. history while pathology has been studied for millennia only within the last few hundred years has medicine focused on a tissue- and organ-based approach to tissue disease. in 1810, thomas hodgkin started to look at the damaged tissue for the cause. this was conjoined with the emergence of microscopy and started the current understanding of how the tissue of the human body is studied. neuroanesthesia neuroanesthesia is a field of anesthesiology which focuses on neurosurgery. anesthesia is not used during the middle of an "awake" brain surgery. awake brain surgery is where the patient is conscious for the middle of the procedure and sedated for the beginning and end. this procedure is used when the tumor does not have clear boundaries and the surgeon wants to know if they are invading on critical regions of the brain which involve functions like talking, cognition, vision, and hearing. it will also be conducted for procedures which the surgeon is trying to combat epileptic seizures. history the physician hippocrates (460–370 bce) made accounts of using different wines to sedate patients while trepanning. in 60 ce, dioscorides, a physician, pharmacologist, and botanist, detailed how mandrake, henbane, opium, and alcohol were used to put patients to sleep during trepanning. in 972 ce, two brother surgeons in paramara, now india, used "samohine" to sedate a patient while removing a small tumor, and awoke the patient by pouring onion and vinegar in the patient's mouth. the combination of carbon dioxide, hydrogen, and nitrogen, was a form of neuroanesthesia adopted in the 18th century, and introduced by humphry davy. neurosurgery methods neurosurgeryicd-10-pcs00-01icd-9-cm01–05meshd019635ops-301 code5-01...5-05 neuroradiology methods are used in modern neurosurgery diagnosis and treatment. they include computer assisted imaging computed tomography (ct), magnetic resonance imaging (mri), positron emission tomography (pet), magnetoencephalography (meg), and stereotactic radiosurgery. some neurosurgery procedures involve the use of intra-operative mri and functional mri. in conventional open surgery the neurosurgeon opens the skull, creating a large opening to access the brain. techniques involving smaller openings with the aid of microscopes and endoscopes are now being used as well. methods that utilize small craniotomies in conjunction with high-clarity microscopic visualization of neural tissue offer excellent results. however, the open methods are still traditionally used in trauma or emergency situations. microsurgery is utilized in many aspects of neurological surgery. microvascular techniques are used in ec-ic bypass surgery and in restoration carotid endarterectomy. the clipping of an aneurysm is performed under microscopic vision. minimally-invasive spine surgery utilizes microscopes or endoscopes. procedures such as microdiscectomy, laminectomy, and artificial disc replacement rely on microsurgery. using stereotaxy neurosurgeons can approach a minute target in the brain through a minimal opening. this is used in functional neurosurgery where electrodes are implanted or gene therapy is instituted with high level of accuracy as in the case of parkinson's disease or alzheimer's disease. using the combination method of open and stereotactic surgery, intraventricular hemorrhages can potentially be evacuated successfully. conventional surgery using image guidance technologies is also becoming