Neurological Surgery is a discipline of medicine and that specialty of surgery which provides the operative and nonoperative management (i.e., 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 endovascular techniques; and disorders of the cranial and spinal nerves throughout their distribution.
Unearthed remains of successful brain operations, as well as surgical implements, were found in France at one of Europe's noted archaeological digs. The success rate was remarkable, even circa 7,000 B.C.
Pre-historic evidence of brain surgery was not limited to Europe. Pre-Incan civilization used brain surgery as an extensive practice as early as 2,000 B.C. In Paracas, Peru, a desert strip south of Lima, archeologic evidence indicates that brain surgery was used extensively. Here, too, an inordinate success rate was noted as patients were restored to health. The treatment was used for mental illnesses, epilepsy, headaches, organic diseases, osteomylitis, as well as head injuries.
Brain surgery was also used for both spiritual and magical reasons; often, the practice was limited to kings, priests and the nobility.
Surgical tools in South America were made of both bronze and man-shaped obsidian (a hard, sharp-edged volcanic rock).
Africa showed evidence of brain surgery as early as 3,000 B.C. in papyrus writings found in Egypt. "Brain," the actual word itself, is used here for the first time in any language. Egyptian knowledge of anatomy may have been rudimentary, but the ancient civilization did contribute important notations on the nervous system.
Hippocrates, the father of modern medical ethics, left many texts on brain surgery. Born on the Aegean Island of Cos in 470 B.C., Hippocrates was quite familiar with the clinical signs of head injuries. He also described seizures accurately, as well as spasms and classified head contusions, fractures and depressions. Many concepts found in his texts were still in good stead two thousand years after his death in 360 B.C.
Ancient Rome in the first century A.D. had its brain surgeon star, Aulus Cornelius Celsus. Hippocrates did not operate on depressed skull fractures; Celsus often did. Celsus also described the symptoms of brain injury in great detail.
Asia was home to many talented brain surgeons: Galenus of Pergamon, born in Turkey, and the physicians of Byzance such as Oribasius (4th century) and Paul of Aegina. An Islamic school of brain surgery also flourished from 800 to 1200 A.D., the height of Islamic influence in the world. Abu Bekr Muhammed el Razi, who lived from 852 to 932 in the Common Era, was perhaps the greatest of Islamic brain surgeons. A second Islamic brain surgeon, Abu l'Qluasim Khalaf, lived and practiced in Cordoba, Spain, and was one of the great influences on western brain surgery.
The Christian surgeons of the Middle Ages were clerics, well educated, knowledgeable in Latin, and familiar with the realm of medical literature. Despite the church's ban on study of anatomy, many churchmen of great renown (advisors and confessors to a succession of Popes) were outstanding physicians and surgeons. Leonardo da Vinci's portfolio containing hundreds of accurate anatomical sketches indicates the intense intellectual interest in the workings of the human body despite the Church's ban.
Neurosurgical conditions include primarily brain, spinal cord, vertebral column and peripheral nerve disorders.
Conditions treated by neurosurgeons include:
- Chiari Malformations
- Spinal disc herniation
- Spinal stenosis
- Head trauma (brain hemorrhages, skull fractures, etc.)
- Spinal cord trauma
- Traumatic injuries of peripheral nerves
- Brain tumors
- Infections and infestations
- Tumors of the spine, spinal cord and peripheral nerves
- Cerebral aneurysms
- Some forms of hemorrhagic stroke, such as subarachnoid hemorrhages, as well as intraparenchymal and intraventricular hemorrhages
- Some forms of pharmacologically resistant epilepsy
- Some forms of movement disorders (advanced Parkinson's disease, chorea) - this involves the use of specially developed minimally invasive stereotactic techniques (functional, stereotactic neurosurgery)
- Intractable pain of cancer or trauma patients and cranial/peripheral nerve pain
- Some forms of intractable psychiatric disorders
- Malformations of the nervous system
- Carotid artery stenosis
- Vascular malformations (i.e., arteriovenous malformations, venous angiomas ,cavernous angiomas ,capillary telangectasias) of the brain and spinal cord
- Peripheral neuropathies such as Carpal Tunnel Syndrome and ulnar neuropathy
- Moyamoya disease
- Congenital malformations of the nervous system, including spina bifida and craniosynostosis .
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle.Physicians who specialize in neurology are called neurologists, and are trained to investigate, or diagnose and treat, neurological disorders. Pediatric neurologists treat neurological disease in children. Neurologists may also be involved in clinical research, clinical trials, as well as basic research and translational research. In the United Kingdom, contributions to the field of Neurology stem from various professions; saliently, several biomedical research scientists are choosing to specialize in the technical/laboratory aspects of one of neurology's subdisciplines.
Field of work
Neurological disorders are disorders that affect the central nervous system (brain and spinal cord), the peripheral nervous system, or the autonomic nervous system.
Major conditions include:
- behavioral/cognitive syndromes .
- headache disorders such as migraine, cluster headache and tension headache
- seizure disorders .
- neurodegenerative disorders, including Alzheimer's disease, Parkinson's disease, Huntington's disease, and Amyotrophic lateral sclerosis (Lou Gehrig's disease) .
- cerebrovascular disease, such as transient ischemic attack and stroke .
- sleep disorders .
- cerebral palsy .
- infections of the brain (encephalitis), brain meninges (meningitis), spinal cord (myelitis) .
- infections of the peripheral nervous system .
- neoplasms - tumors of the brain and its meninges (brain tumors), spinal cord tumors, tumors of the peripheral nerves (neuroma) .
- movement disorders such as Parkinson's disease, Huntington's disease, hemiballismus, tic disorder, and Gilles de la Tourette syndrome .
- demyelinating diseases of the central nervous system, such as multiple sclerosis, and of the peripheral nervous system, such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP) .
- spinal cord disorders - tumors, infections, trauma, malformations (e.g., myelocele, meningomyelocele, tethered cord) .
- disorders of peripheral nerves, muscle (myopathy) and neuromuscular junctions .
- traumatic injuries to the brain, spinal cord and peripheral nerves .
- altered mental status, encephalopathy, stupor and coma .
- speech and language disorders .
Neurologists are responsible for the diagnosis, treatment, and management of all the above conditions. When surgical intervention is required, the neurologist may refer the patient to a neurosurgeon, an interventional neuroradiologist, or a neurointerventionalist. In some countries, additional legal responsibilities of a neurologist may include making a finding of brain death when it is suspected that a patient is deceased. Neurologists frequently care for people with hereditary (genetic) diseases when the major manifestations are neurological, as is frequently the case. Lumbar punctures are frequently performed by neurologists. Some neurologists may develop an interest in particular subfields, such as dementia, movement disorders, headaches, epilepsy, sleep disorders, chronic pain management, multiple sclerosis or neuromuscular diseases.