NEUROSURGERY CENTRAL NERVOUS SYSTEM SPINE
Category: Neurosurgery
Abstract :
Neurosurgery Definition : Neurosurgery is a specialized field of surgery for the treatment of diseases or conditions of the central nervous system (CNS) and spine. Description Neurosurgery is the specialized field of surgery that treats diseases that affect the CNS - the brain and the spine. A neurosurgeon is a medical doctor who has received extensive training in the surgical and
Neurosurgery
Definition : Neurosurgery is a specialized field of surgery for the treatment of diseases or conditions of the central nervous system (CNS) and spine.
Description
Neurosurgery is the specialized field of surgery that treats diseases that affect the CNS - the brain and the spine. A neurosurgeon is a medical doctor who has received extensive training in the surgical and medical management of neurological diseases.
The field of neurosurgery is one of the most sophisticated surgical specialties and encompasses advanced surgical and imaging technology and new research in molecular neurosurgery and gene therapy. There are five general categories of neurosurgical diseases that are commonly managed by neurosurgeons: cerebrovascular (hemorrhage and aneurysms); traumatic head injury (THI)(traumatic injury caused by accident); degeneration diseases of the spine; tumors in the CNS; functional neurosurgery; surgery for congenital abnormalities; and neurosurgical management of the CNS.
Cerebrovascular diseases that usually require surgery include spontaneous intracranial hemorrhage, spontaneous subarachnoid hemorrhage, spontaneous intracerebral hemorrhage, cerebral aneurysms, hypertensive intracerebral hemorrhage, and angiomatous malformations.
Degenerative disorders of the spine
Degenerative disorders of the spine are a common problem. Between 50% and 90% of the population will experience back pain at some point in their lifetime. However, most of these back pain symptoms subside on their own within a few weeks; the cost, however, results in decreased productivity and lost wages - a public health problem. Lower back pain (in the lumbar spine) is most common reason adults seek medical attention. In a normal person, the lumbar spine comprises five lumbar vertebra. The lumbar spine supports the weight of the entire column and, therefore, withstands a great load. Lower back disorders are among the most frequent reasons for referral to a neurosurgeon.
Lumbar discs are very prone to herniation and desiccation (drying out) as a result of the heavy load they bear and the motion to which they are subject. Nerves that run from the vertebrae extend out to distant structures. Degeneration of the discs may change bony structures in such a manner that can cause nerve compression. Typically, persons with degenerative disorders of the spine may have pain, numbness, paresthesia (tingling), and restriction of neck movement (if the affected vertebrae is in the cervical spine, which is located in the back of the neck).
Surgery for congenital abnormalities
Congenital abnormalities occur during embryonic development. During development of the human embryo, important changes in growth and chemistry occur during the second week of gestation; these changes contribute to the development of the nervous system. Several different types of cells proliferate as they move together or separate into other structures according to an orchestrated, natural time clock. Defects can occur at different stages of development. The defects with which infants can be born include myelomeningoceles, encephaloceles, hydrocephalus, and craniosynostosis.
Central nervous system infections
Solitary or multiple brain abscesses can occur as a result of infection in the brain. Patients present with clinical symptoms such as focal (a specific area is affected) neurologic signs, seizures, altered mental status, and increased intracranial pressure. CT scans and magnetic resonance imaging (MRI) are helpful for identification of brain abscesses. Surgery is usually indicated if the abscess fails to resolve or worsens following antibiotic treatment, or if there are signs of mass effect and brain herniation. Although rare, a spinal epidural abscess can occur. Typically, bacteria can spread in patients who have acute bacterial meningitis (infection of the subarachnoid spaces and meninges). The specific type of bacteria varies according to the patient’s age.
Functional neurosurgery
Functional neurosurgery is a special type of surgical procedure used to manage movement disorder, epilepsy, and pain. Stereotactic neurosurgery makes use of a coordinate system that provides accurate navigation to a specific point or region in the brain. This is usually done by placing and fixing into position a frame on the scalp (using four threaded pins that penetrate the outer skull to stabilize the frame in position) under local anesthesia. A special box and sterotactic arc are placed to precisely determine X,Y, and Z coordinates of any point within the frame.
Epilepsy surgery
Approximately 70 per 100,000 population in the United States take antiepileptic medications for seizure disorders. The risk of developing epilepsy over a lifetime is 3%, and there are 100,000 new cases per year. The majority of cases (approximately 60,000) are temporal lobe (the brain lobes located on the sides of the head) epilepsy. Approximately 25% of persons prescribed antiepileptic drugs for temporal lobe seizures are not controlled or the side effects of the drug are far too great and outweigh the therapeutic benefits. Approximately 5,000 new cases per year require epilepsy surgery (partial anterior temporal lobectomy). The patient and neurosurgeon should consider surgery if continual seizures cause injuries due to repeated falls; driving restrictions; limitation of social interactions; problems related to education and learning; and employment limitations.
The future of neurosurgery
Neurosurgery as a field is faced with many new opportunities and challenges, based on advanced technological approaches and molecular approaches to neurosurgical problems. Advances in technology have allowed the neurosurgeon to precisely locate abnormal tissue in the brain and spinal cord, thereby preserving normal tissues from surgical trauma. In addition to cardiovascular neurosurgery, functional neurosurgery, neuro-oncologic neurosurgery (surgical removal of brain tumors), and spinal surgery, the future holds many new research innovations. In the new millennium, the field of molecular neurosurgery can make it possible to introduce genetic material into nerve cells and to redirect protein synthesis—to work toward reversing the disease process, in general.
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