In Germany, neurosurgery is assigned to a branch of medicine that treats diseases of the central or peripheral nervous system through surgical intervention. Contrary to the technical name, this medical discipline is not assigned to surgery or neurology.
What is neurosurgery?
Neurosurgery is used to detect and surgically treat injuries, malformations, and diseases of the central nervous system and its sheaths, as well as the autonomic and peripheral nervous systems. Neurosurgery is an independent medical discipline and, by definition, includes the detection and surgical treatment of injuries, malformations, and diseases of the central nervous system and its sheaths, as well as the autonomic and peripheral nervous systems. This also includes the necessary preliminary examinations, conservative treatment procedures and the rehabilitation that follows after surgery. In Germany, a neurosurgeon undergoes six years of training to become a specialist. The person entitled to further training spends 48 months in inpatient patient care and six months in intensive care of neurosurgical patients. Up to twelve months of work in surgery, neuropathology, neurology, or neuroradiology or 6 months in anatomy, anesthesiology, otolaryngology, ophthalmology, pediatrics, and adolescent medicine or oral and maxillofacial surgery are creditable toward the residency.
Function, effect, and goals
Brain procedures include surgical removal of tumors in supra- and infratentorial (skin separating cerebellum and cerebrum) intracerebral (internal brain tissue) processes, including area-specific tumor therapy, and treatment of infarcts and hemorrhage. Surgical interventions enable the elimination of craniocerebral traumas as well as deformities of the brain, spinal cord and skull in the form of intra- and extradural hematomas, cerebrospinal fluid fistulas, impression fractures as well as on the nerves. Neurosurgeons perform surgeries for cleft malformations or place cerebrospinal fluid drains. They treat diseases of the vessels, the intervertebral disc and the cervical, thoracic and lumbar spine. Nerve root and spinal cord decompression are particularly suitable for this purpose. Functional disorders such as epilepsy and pain syndromes can be eliminated by destructive implantation procedures. Diagnostic procedures include myelography and ventricular and lumbar CSF drainage with non-pressure measurement and biopsies. Neurosurgeons treat hydrocephalus (cerebrospinal fluid outflow abnormalities) by endoscopic procedures, placement of a temporary drain or permanent drains. In specialty clinics, patients with central movement disorders are treated by navigation-based special simulation procedures. A similarly oriented navigation technique allows physicians to treat tumors by placing radiating elements that target brain tumor therapy. Neurologists ensure proper specimen collection and specimen handling for laboratory tests and place them in the appropriate clinical picture. Neurosurgery is also used in the area of many spinal diseases. Tumors, herniated discs and spinal canal stenosis are surgically treated and removed. Stray tumors of other tumors growing in the body such as bone tumors, connective tissue tumors, tumors of the meninges and nerve tissue tumors are removed. In the case of herniated discs and spinal canal stenosis, the constricting and pain-causing tissue is removed. In peripheral neurosurgery, physicians deal with the treatment of constriction syndromes such as ulnar groove syndrome (nerve constriction of the elbow), tarsal tunnel syndrome (nerve constriction of the foot), supinator tunnel syndrome (paralysis of the long finger and thumb) and carpal tunnel syndrome (nerve constriction of the hand). Other responsibilities include organ donation preparatory procedures, treatment of tumors on the nerves, and restoration of nerve continuity through acute care immediately following transplant surgery and injury. Neurologists must be proficient in the use of infusion, transfusion and blood replacement therapy and enteral and parenteral nutrition for their patients. They know how to properly use catheter and puncture techniques and evaluate the resulting examination material.Simple ventilation techniques and ventilation weaning after surgical interventions are routine clinical practice. Physicians care for palliative patients and ease their final stage of life through medical therapies. Neurosurgeons must not only be able to identify physical causes of their patients’ illnesses, but also address their psychological state. This includes recognizing psychogenic syndromes, somatopsychic reactions (physical symptoms with no apparent medical cause), and psychosocial correlations. They assist their patients with occupational therapy, physical therapy, and speech therapy. By providing basic intensive care as well as recognizing acute emergencies and performing life-saving measures on patients, they guarantee that their vital functions are maintained and that they are resuscitated. Tracheotomy (surgical access to the trachea) ensures that the patient is ventilated. General activities include wound care, sterile draping, and diagnostic preparation and pre- and post-operative care of patients with common neurosurgical conditions. Neurologists also learn seemingly simple activities during their specialty training, such as how to interact appropriately with patients and colleagues, presenting patients during rounds, neurosurgical demonstrations and documentation, and operating room behaviors.
Risks, side effects, and hazards
The risks of neurosurgery are minimal nowadays thanks to modern technology, although with any surgical intervention in the human organism, some risk cannot be completely eliminated. Neurosurgery regularly strives for minimally invasive procedures through endoscopic and stereotactic methodology. The use of innovative diagnostic imaging technology such as computed tomography and magnetic resonance imaging provides the basis for microneurosurgery. The functions of the human body can already be visualized preoperatively by positron emission tomography (PET, nuclear medical procedure for visualizing metabolic processes in the body for early detection of tumor diseases), magnetoencephalography (MEG, brain measurement) as well as in functional magnetic resonance imaging (MRI, visualization of tissues and organs by magnetic fields and radio waves). Powerful computers help physicians to incorporate the information obtained with regard to patients’ mental and physical functions into their surgical planning. Functional computer-assisted microsurgery is now a standard procedure in all well-equipped clinics. This clinical routine is complemented by modern methods such as optical coherence tomography (detection of retinal and choroidal diseases) and multiphoton fluorescence tomography (non-invasive, novel diagnostic system without markers and radiological exposure). Other interoperative imaging techniques include ultrasound and laser fluorescence labeling of tumors, sonographic (ultrasound) and Doppler/duplex studies of extracranial brain-supplying and intracranial vessels. Physicians perform neurophysiological examinations by electroencephalogram (non-invasive method of measuring brain electrical currents) including evoked potentials (specifically triggered electrical phenomena). The electromyogram (measurement of natural electrical muscle tension, “conduction”) and myelography (X-ray imaging by injection of contrast medium into the spinal canal) are other imaging methods. These innovative methods allow microscopic definition of tumors in the patient’s body and gentle minimally invasive yet maximally effective neurosurgery while sparing important nerve and brain functions.
Typical and common nerve disorders
- Nerve pain
- Nerve inflammation
- Polyneuropathy
- Epilepsy
