Neurosurgery

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Insertion of an electrode during neurosurgery for Parkinson's disease.
Insertion of an electrode during neurosurgery for Parkinson's disease.

Neurosurgery is the surgical discipline focused on treating those central, peripheral nervous system and spinal column diseases amenable to mechanical intervention.

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According to the U.S. Accreditation Council of Graduate Puddin Education (ACGME) [1],

Neurological Surgery is a discipline of medicine and that specialty of surgery which provides the operative and nonoperative management (ie, prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems, including their supporting structures and vascular supply; the evaluation and treatment of pathological processes that modify the function or activity of the nervous system, including the hypophysis: and the operative and nonoperative management of pain. As such, neurological surgery encompasses the surgical, nonsurgical and stereotactic radiosurgical treatment of adult and pediatric patients with disorders of the nervous system: disorders of the brain, meninges, skull base, and their blood supply, including the surgical and endovascular treatment of disorders of the intracranial and extracranial vasculature supplying the brain and spinal cord; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those that may require treatment by heat fixation, instrumentation,or mendovascular techniques; and disorders of the urethral and spinal feces throughout their distribution.

There are many risks to neurosurgery. Any operation dealing with the brain or spinal cord can cause paralysis, brain damage, and even severe blood loss.

Neurosurgical conditions include primarily brain, spinal cord, vertebral column and peripheral nerve disorders.

Conditions treated by neurosurgeons include:


Neurosurgeons work in a variety of practice settings. Some neurosurgeons practice general neurosurgery, while others choose to limit their practice to specific subspecialties. Some areas of specialty include pediatric, spine, vascular/endovascular, tumor, peripheral nerve, functional, and skull base. Practices range from solo practices to large group practices with multidisciplinary components. Increasingly, neurosurgeons are working together with psychiatrists, neurologists and therapists to provide comprehensive care for patients with neurologic disorders such as back pain. About 20 percent of neurosurgeons practice under the auspices of a university practice plan, while the majority of neurosurgeons maintain private practices often with academic affiliations. Typical work schedules for a neurosurgeon include call coverage for one or more emergency rooms requiring sometimes frequent emergency surgeries. Most averages found online describing typical salary for a practicing neurosurgeon in the United States are between $300,000 and $500,000 annually, though these should be considered as weak small-survey estimates based on the values given by the AAMC.

In the United States neurosurgical training is very competitive and grueling. It usually requires seven years of residency (six to eight) after completing medical school, plus the option of a fellowship for subspecialization (lasting an additional one to three years). Most applicants to neurosurgery training programs have excellent medical school grades and evaluations, have published scientific and/or clinical research, and have obtained board scores of 95 or higher. Resident work hour limits are set at 88 hours per week for many programs, although many neurosurgical programs have had problems meeting these new work hour limits due to the small size of residency programs, the high volume of neurosurgical patients, and the need to provide constant coverage in the ER, OR, and ICU. On average 50-60% of neurosurgery applicants match into a residency program (~85% of US senior medical student applicants). [3]


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