Modern surgery has developed to such an extent that the body of knowledge and technical skills required have led to surgeons specialising in particular areas, usually an anatomical area of the body or occasionally in a particular technique or type of patient
There are ten surgical specialties and this briefing covers neurosurgery.
What do neurosurgeons do?
Neurosurgery encompasses the diagnosis, assessment and surgical management of disorders of the nervous system.
The specialty developed in the first half of the twentieth century through the treatment of head and brain injuries. Subsequent advances in technology, intensive care and sophisticated non invasive procedures have widened the scope of neurosurgical practice to include oncology services and neurovascular as well as trauma.
The principle sub-specialties of neurosurgery
- Paediatric neurosurgery – treatment of children accounts for 10-15% of neurosurgery and includes facial anomalies and congenital spinal defects as well as tumours and other rarer conditions.
- Neuro-oncology – The management of brain and spinal tumours.
- Functional neurosurgery – The management of a wide range of problems including epilepsy, spasticity and movement disorders.
- Neurovascular surgery – surgeons work closely with interventional colleagues dealing with complex aneurysms and abnormal or narrowed blood vessels.
- Traumatology – Head injury remains a major cause of death and disability in children and young adults. Research shows that prompt neurosurgical intervention and neuro-intensive care leads to substantially better outcomes.
- Skull-base surgery – Advances in microsurgery, surgical approaches and reconstructions have been incorporated into routine practice of surgeons dealing with disorders of the skull-base and skull base tumours.
- Spinal surgery – Due in part to an increased elderly population the sub-specialty account for more than 50% of department workloads.
Neurosurgeons undertake operations for a wide range of conditions affecting the central nervous system spine and peripheral nerves including:
- The removal of brain, spinal and skull based tumours
- Managing trauma to the head and spine
- Prolapsed discs and other degenerative spinal conditions
- Infections and infestations
- Strokes, in particular haemorrhages due to cerebral (brain) aneurysms (a weakness in the wall of a cerebral artery) and other malformations
- Movement disorders including advanced Parkinson’s diseases using deep brain stimulation surgery (DBS) which involves the implanting of a ‘brain pacemaker’ sending electrical impulses to specific parts of the brain
- Some psychiatric disorders
- Congenital malformations of the nervous system including spina bifida.
- Hydrocephalus and other disturbances of cerebro-spinal fluid flow
Advances in neurosurgery, in particular developments in interventional radiology, microsurgical techniques and non invasive techniques have seen surgeons increasingly working alongside professionals from other medical disciplines.
In 2007, neurosurgery modernised its training programme, introducing a three-year initial training phase incorporating the basic clinical neurosciences. The training programme reflects the developments taking place in clinical neurosciences and the requirements of national service delivery. In 2008 neurosurgery piloted the first national selection into a surgical sub-specialty.