Brought to you by The Idaho Neurological Institute at Saint Alphonsus, expert(s) at Neurosurgery.

Neurosurgery, branching beyond the brain

It's easy to categorize neurosurgeons simply as brain doctors. But neurosurgery deals with far more than just the brain.

Neurological surgery, or neurosurgery, is the surgical specialty concerned with the diagnosis and treatment of patients with injury to, and diseases of, the brain, spine or peripheral nerves.

Neurosurgeons may provide either surgical or non-surgical care for a variety of disorders including: head and spine trauma, cerebrovascular disorders such as aneurysms and clogged arteries, chronic back pain, birth defects and pediatric disorders, neurodegenerative disorders such as Parkinson's disease and brain and spine tumors.

It is estimated that in 2005, there were a total of 18,500 new cases of brain and other central nervous system tumors diagnosed, with an estimated 12,760 deaths related to these cases. That same year, a total of 3,410 new cases of childhood primary nonmalignant and malignant brain and central nervous system tumors were diagnosed.

Neurosurgeons also routinely treat conditions including carpal tunnel syndrome, cervical spine disorders, chronic pain, epilepsy, head injuries, herniated disks, spina bifida and spinal cord injuries.

An estimated 11,000 new spinal cord injuries occur in the country every year, and nearly two million people sustain head injuries, which lead to 34 percent of all traumatic deaths.

Strokes are one of the most common disorders neurosurgeons are called to deal with. Stroke is the third leading cause of death in the United States, with more than 700,000 people suffering a stroke each year. Of those, roughly 500,000 are first attacks, and approximately 25 percent of those who survive a first stroke will have another within five years.

Treating these conditions takes special knowledge and training. After four years of medical school and an internship program, the doctor enters a neurosurgical residency program of five to seven years.

While in the program, neurosurgical residents are trained in all aspects of neurosurgery, including cerebrovascular, pediatrics, spine, trauma and tumor. The resident program is long and difficult, due to the extreme complexity of the nervous system and the advanced techniques used in neurosurgical operations. Some neurosurgeons opt to do an additional fellowship in a particular area of study following their residency.

Following residency training and several years in practice, the neurological surgeon may take the American Board of Neurological Surgery examination - a thorough assessment of the neurosurgeon's skill, judgement and depth of knowledge. The successful completion of this examination results in board certification.

While the neurological surgeon has a comprehensive knowledge after medical school and residency training, there are continual changes in this specialty that require ongoing study throughout the neurological surgeon's professional career. Monthly scientific journals, annual meetings, specialized symposia and other educational opportunities help the neurosurgeon keep pace with rapid changes and developments in neurosurgery.

Neurosurgeons have been leaders in the incorporation of new technologies into the diagnosis, evaluation and surgical and non-surgical treatment of patients.

Although neurosurgery is by nature a surgical field, many patients suffering from neurological illnesses are undergoing non-surgical or minimally invasive treatments. To that end, the explosion of less invasive surgical equipment and techniques, such as microscopes, lasers and focused radiation, as well as cutting-edge medical tools such as stents, shunts and radiosurgery, are changing the way some neurological disorders are treated.

These medical advancements have positioned neurosurgeons on the cutting-edge of technology, enhancing the neurosurgeon's ability to care for patients and making surgery easier on the patient.

Neurosurgeons today use sophisticated techniques and tools, especially in treating brain tumors. In attacking a tumor, neurosurgeons rely on computers, MRIs and image-guidance technology to help them navigate through the complex terrain of the brain with greater precision.

Brain tumors have long been difficult to treat. Because they occur at the control center for thought, emotion and physical function, neurosurgeons must be careful not to damage healthy brain tissue. Fortunately, the new sophisticated techniques and tools ensure the safest and most complete removal of tumors. Tumors that were once inoperable, such as those in the brain stem or thalamus, are now often accessible, and many of these tumors can be removed without impairing neurological function.

Although brain tumors may be attacked in a number of ways, surgery is usually the first step for tumors that can be removed without damaging vital neurological functions. A tumor will recur if any tumor cells are left behind, so neurosurgeons attempt to remove the entire tumor if possible. Radiation therapy and chemotherapy may be used as secondary treatments for some tumors.

One of the most common advanced surgical tools used to treat tumors is a high-powered microscope. Microsurgery produces a magnified and illuminated view of the surgical field, making it easier to see and remove tumor tissue without disturbing healthy tissue. Image guidance, or stereotaxis, involves the use of MRI or computerized tomography (CT) scanning. A neurosurgeon in the operating room uses the latest computer technology to reformat data previously obtained from an MRI or CT scan. The result is a workable image of the brain tumor tissue.

An intraoperative MRI further aids a neurosurgeon. Because the brain "shifts" slightly during an operation, the real-time imaging allows for a more precise removal of the brain tumor. Another high-tech tool of today's operating rooms is the laser, which destroys tumor cells with intense heat. Used in addition to or in place of scalpels, lasers can reach a tumor embedded deep within the brain.

Neurosurgeons continue to discover novel ways to identify and attack tumors. Photodynamic therapy involves injecting a photosensitizing drug into a vein or artery prior to surgery. During the operation, the tumor cells appear fluorescent, giving neurosurgeons a relatively easy target at which to aim the laser.

Neurosurgeons also have pioneered the use of stereotactic radiosurgery, which shoots high-dose radiation beams at the tumor. Stereo refers to three-dimensional, and stereotactic radiosurgery involves making an image map of the brain through an MRI or CT scan before delivering the radiation beams.

There are two ways to deliver the radiation beams - through a large helmet or through a modified linear accelerator. In one technique, a sophisticated machine shoots many finely focused beams of radiation at the tumor. The patient wears a large helmet with holes that match the tumor's shape and through which the beams of energy pass. Alternatively, the radiation can be delivered through an adapted linear accelerator that delivers a beam of radiation to the tumor.

Neurosurgeons have made advances over the last decade in refining molecular techniques for treating tumors. These include gene therapy, in which engineered viruses deliver toxic agents into tumor cells or deliver genes that help impede the growth of the tumor cells. Another molecular technique is toxin therapy, which attacks the tumor cells.

The challenge of these therapies is to find effective ways for delivering the agents into the brain. One common method is convection-enhanced delivery, in which small agents are delivered to large regions of the brain. A significant new approach is the use of chemotherapy wafers, implanted directly into the cavity left behind after a tumor is removed.

Advances in the diagnosis and treatment of brain tumors are expected to continue in the next decade. Years ago, a diagnosis of brain tumor meant little hope for treatment and recovery. Today many brain tumors are treated successfully, and in the future, increasingly refined and sophisticated techniques and tools are expected to allow a higher percentage of patients to recover and return to their normal lives.

Information provided by the American Association of Neurological Surgeons