ESSENTIAL NEUROSURGERY FOR MEDICAL STUDENTS

Introduction: What is Neurosurgery?

Daniel L. Barrow, MD∗

A
rchaeological evidence demonstrates that and vertebral column), and their vascular supply
Bernard R. Bendok, MD, humans were performing trephinations (eg, intracranial, extracranial, and spinal vascu-
on other humans since prehistoric times. lature).
MSCI‡ § ¶ || #
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Despite the early genesis of surgery on the human Treatment encompasses both non-operative
∗
Department of Neurosurgery, Emory skull, the specialty of neurosurgery is a relatively management (eg, prevention, diagnosis—
University School of Medicine, Atlanta, recent evolutionary product of the broader field including image interpretation—and treatments
Georgia; ‡ Department of Neurological
Surgery, Neurovascular and Skullbase of general surgery. Neurosurgery as a recognized such as, but not limited to, neurocritical
Program, Mayo Clinic, Phoenix, Arizona; subspecialty is among the youngest and most intensive care and rehabilitation) and operative
§
Precision Neuro-therapeutics Innovation rapidly evolving surgical disciplines. The great management with its associated image use
Laboratory Mayo Clinic Phoenix, Arizona;
pioneers of the specialty in the late 19th and early and interpretation (eg, endovascular surgery,
¶
Neurosurgery Simulation and Innova- functional and restorative surgery, stereotactic
tion Laboratory Mayo Clinic Phoenix, 20th century were well-trained general surgeons
radiosurgery, and spinal fusion—including its
Arizona; || Department of Otolaryngology and creative scientists who used their expertise
Mayo Clinic Phoenix, Arizona; # Depart- instrumentation.”
in neurophysiology to become superb clini-
ment of Radiology Mayo Clinic Phoenix,
Arizona
cians and specialize in the nervous system. Our More simply, neurosurgery is the medical
specialty was limited in the early 20th century specialty that focuses on the diagnosis and
Given constraints of this publication by a poor understanding of pathology, archaic treatment of disorders of the brain, spine,
modality (ie, a book rather than journal imaging of that pathology, primitive anesthesi- spinal cord, and peripheral nerves. Although it
articles), the citations and bibliography
are not to the level of detail of a journal
ology, limited intraoperative visualization, and is fundamentally a surgical discipline, neuro-
article. Readers are directed to the marginal postoperative care. surgery requires knowledge of neurology, critical
suggested reading lists, which contain The past few decades have witnessed dramatic care, trauma care, and radiology. A significant
references to subsequent references and improvements in all of these important facets of number of patients seen by the neurosurgeon
derivatives of the article content.
neurosurgical care: introduction of the operating are managed with nonsurgical options that may
Correspondence: microscope, dramatic advances in neuroimaging, include medical, physical, or minimally invasive
Daniel L. Barrow, MD, development of the subspecialty of neuroanes- interventional therapies. A neurosurgeon can
Emory University, thesiology, introduction of neurocritical care, practice neurology, but a neurologist cannot
Department of Neurosurgery,
School of Medicine,
neuroendovascular therapy, neuromodulation perform surgery.
1365-B Clifton Road NE, Suite 6400, and molecular biology, to name a few. Unique Neuroimaging has evolved in tandem with
Atlanta, GA 30322. aspects of modern neurosurgery are the emphasis neurosurgery. The specialty is highly dependent
Email: [email protected] placed on research, evolving technology, and on diagnostic imaging and the neurosurgeon
rapid dissemination of new ideas and techniques. must become proficient in the interpretation
Received, January 30, 2019.
Accepted, January 31, 2019. The official definition of neurosurgery, or of a variety of imaging studies, including X-
Published Online, May 17, 2019. neurological surgery, provided by the American ray, computed tomography, magnetic resonance
Board of Neurological Surgeons (ABNS) is as imaging, and angiography.
Copyright 
C 2019 by the
follows: Neurosurgeons manage a more diverse group
Congress of Neurological Surgeons
of conditions than many surgical subspecialties
“Neurological surgery constitutes a medical disci-
that focus on a particular organ or organ system.
pline and surgical specialty that provides care for
adult and pediatric patients in the treatment of They treat a wide range of abnormalities that
pain or pathological processes that may modify include congenital anomalies of the newborn,
the function or activity of the central nervous trauma, tumors of the nervous system and its
system (eg, brain, hypophysis, and spinal cord), supporting structures, neurovascular disorders,
the peripheral nervous system (eg, cranial, seizures, infections, and abnormalities of the
spinal, and peripheral nerves), the autonomic aging such as stroke, functional disorders, or
nervous system, the supporting structures of degenerative diseases of the spine.
these systems (eg, meninges, skull and skull base, There are about 3500 practicing neurosur-
geons in the United States and 110 neuro-
ABBREVIATION: ABNS, American Board of Neuro-
surgery residency-training programs accredited
logical Surgeons by the ACGME for 2018 that offered 225
positions. Residents are trained in all aspects of

OPERATIVE NEUROSURGERY WWW.CNS.ORG VOLUME 17 | NUMBER 2 | AUGUST 2019 SUPPLEMENT | S1

neurosurgery, including neurocritical care, and board certification in the peer-reviewed literature. Men and women considering
by the ABNS is one of a very few that certifies diplomates for the a career in neurosurgery should have intellectual curiosity and
entire discipline and not specific subspecialties. However, in the physical stamina to meet the challenges of a demanding residency
past 2 decades, enfolded or postresidency fellowships have become and surgical procedures that often extend for many hours.
increasingly common and most neurosurgeons do subspecialize. Neuroanatomy and disorders of the human nervous system
Neurosurgical subspecialties include pediatric neurosurgery, may be intimidating to students and non-neurological physi-
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spine surgery, neuroendovascular, cerebrovascular/skull base, cians. All practitioners, however, should be familiar with some
neuro-oncology, pain, peripheral nerve, trauma, and functional aspects of the discipline of neurosurgery. This text is designed
neurosurgery. to provide what the editors believe is the basic fund of
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Neurosurgery is one of the most competitive residencies to knowledge all physicians should have, regardless of their chosen
obtain and strives to attract the best and the brightest candidates specialty.
graduating from accredited medical schools. Therefore, most
students granted acceptance to a neurosurgical training program
are exemplary, generally rank at or near the top of their class, Disclosure
and have board scores in the higher percentiles. Most competitive The author has no personal, financial, or institutional interest in any of the
applicants have had some research experience and have published drugs, materials, or devices described in this article.

S2 | VOLUME 17 | NUMBER 2 | AUGUST 2019 SUPPLEMENT WWW.CNS.ORG www.operativeneurosurgery-online.com