Neurological Surgery

What is a neurosurgeon?

Neurological Surgery constitutes a medical discipline and surgical specialty that provides care for adult and pediatric patients in the treatment of pain or pathological processes that may modify the function or activity of the central nervous system (e.g., brain, hypophysis, and spinal cord), the peripheral nervous system (e.g., cranial, spinal, and peripheral nerves), the autonomic nervous system, the supporting structures of these systems (e.g., meninges, skull and skull base, and vertebral column), and their vascular supply (e.g., intracranial, extracranial, and spinal vasculature).

Treatment encompasses both non-operative management (e.g., prevention, diagnosis—including image interpretation—and treatments such as, but not limited to, neurocritical intensive care and rehabilitation) and operative management with its associated image use and interpretation (e.g., endovascular surgery, functional and restorative surgery, stereotactic radiosurgery, and spinal fusion—including its instrumentation).

What does a neurosurgeon do?

Neurosurgery is a discipline that focuses on the diagnosis and medical/surgical treatment of disorders of the nervous system. Because the nervous system includes the central, peripheral and autonomic systems, a neurosurgeon may operate on the brain, spine or extremities in a given day or week. Neurosurgeons operate on patients of all ages, treating diseases ranging from congenital anomalies of the newborn to degenerative disorders of the brain/spine in the aging. Spine, tumors, vascular lesions and infectious pathologies are other frequently encountered pathologies. A neurosurgeon is an expert in the diagnosis of neurological disease, is capable of interpreting a variety of radiological studies, and is able to offer surgical and nonsurgical treatment options.

Our understanding of the nervous system is rapidly evolving and thus neurosurgery is constantly changing. An important tradition of this field is the development and rapid dissemination of new technologies. Those considering the field should have the intellectual curiosity and ability to embrace the complexity of neuroscience. The intellectual challenge of constant learning must be coupled  with a strong desire to be a surgeon or endovascular specialist and a willingness to make and take responsibility for decisions.

Like all specialties, neurosurgery strives to attract the best and the brightest candidates. Neurosurgeons often must communicate complex concepts to patients and family members about quality of life and the role of surgical procedures on the most delicate organ in the body. Because  of these conversations, the patient and physician relationship often takes on great depth and is long- lasting. Interestingly, though some conversations focus on complicated matters, many more of the conversations that neurosurgeons have with patients are in the outpatient setting about common ailments such as headache or back pain. In these cases, neurosurgeons truly make a difference in the patient’s outcome even when not performing surgery by discussing preventive measures such as tobacco cessation, weight loss and exercise. Because the majority of the disorders seen are degenerative in nature, are long-lasting and/or have sequelae, there is a great deal of continuity of care in this specialty.

Today neurosurgeons practice in a variety of locations from academic centers to community hospitals to major research facilities such as the National Institutes of Health (NIH). Work-life balance for the neurosurgeon as well as most surgical specialists is often dependent on the type of practice you enter. It is not as much a matter of what subspecialty you practice and/or whether you are academic or in private practice, but rather the complexion of the practice itself. In any field, it is essential to select a practice that allows you the amount of time you deem appropriate to be free of clinical responsibilities and to focus on other priorities. This balance is certainly achievable in neurosurgery.

How to become a neurosurgeon?

Specialty training required prior to certification: Seven years.

The community of neurosurgeons is relatively  small. In the United States, there are approximately 3,500 practicing board-certified neurosurgeons. Sub-specialization has become a part of neurosurgery and now there are post-residency graduate fellowships in pediatric neurosurgery, spine surgery, endovascular neurosurgery, vascular surgery, neuro-oncology, pain, trauma and functional neurosurgery. Neurosurgical residency is seven years. Typically fellowship is one year, with the exception of endovascular neurosurgery, which is two years. There may be an opportunity to enfold a portion of fellowship into residency dependent on the program.