What Is a Neurosurgeon?

A neurosurgeon, also known as a neurological surgeon, is a highly skilled medical professional who specializes in surgery of the brain, spinal cord, peripheral nerves, and cerebrovascular system. Neurosurgeons are trained to treat a wide range of congenital brain disorders, traumas, tumors, vascular disorders, infections, stroke, and degenerative spinal diseases.

It can take anywhere from 14 to 16 years of education to become a fully board-certified neurosurgeon. Some will embark on additional fellowships to specialize in a specific area of neurosurgery.

Neurosurgeons are closely associated with neurologists in that both require specialized knowledge of the nervous system.

While neurologists and neurosurgeons both diagnose and treat neurological disorders, only neurosurgeons perform surgery. Orthopedic surgery also frequently overlaps with neurosurgery when it involves the spine.

Concentrations

The nervous system is a complex, sophisticated system that regulates and coordinates body activities. As a field of medicine, neurology focuses on three specific organ systems: the central nervous system (CNS), the peripheral nervous system (PNS), and the intracranial cerebrovascular system (the network of arteries and veins that deliver blood to the brain).

The conditions a neurosurgeon may be called to treat can be broadly described by their underlying cause.

These include:

• Congenital malformations, such as anencephaly, aneurysm, hydrocephalus, or spina bifida
• Traumatic injuries of the spinal cord, peripheral nerves, or brain (including skull fractures and brain hemorrhage)
• Benign or cancerous tumors of the brain or spine
• Vascular disorders, including arteriovenous malformations (AVM) and capillary telangiectasia
• CNS infections, such as meningitis, encephalitis, vertebral osteomyelitis, and epidural abscess
• Degenerative spinal disorders, including spinal stenosis and spinal disc herniation
• Epilepsy and movement disorders, such as Parkinson's disease, essential tremor, and dystonia
• Treatment-resistant psychiatric disorders, including severe obsessive-compulsive disorder (OCD), Tourette's syndrome, and major depressive disorder (MDD)
• Intractable pain associated with cancer, trauma, or other causes

Procedural Expertise

Neurosurgery requires a high degree of technical expertise, as well as exceptional manual dexterity skills. The tools used in the trade are extensive, many of which employ cutting-edge technologies, including microsurgery and brain implants.

Key to the success of neurosurgery is the array of radiology tools used to diagnose and treat neurological disorders.

These include:

• Computed tomography (CT), a computer-assisted X-ray technique that creates three-dimensional images of the brain or spinal cord
• Magnetic resonance imaging (MRI), employing magnetic and radio waves to generate highly detailed images, especially of soft tissues
• Positron emission tomography (PET), which uses a radioactive tracer to evaluate metabolic function in the nervous system
• Magnetoencephalography (MEG), a technique for mapping the brain by recording nerves signals with magnetic receptors

Equipped with these imaging tools, a neurosurgeon can perform both conventional open surgery and minimally invasive surgical procedures.

Conventional Open Surgery

Conventional open surgery requires the neurosurgeon to open the skull. It is often used in emergencies to treat traumatic injuries. The technique, known as a craniotomy, employs specialized tools to remove a section of bone (called the bone flap), which is replaced after the brain surgery has been completed.

Endoscopic Surgery

Endoscopic surgery involves the drilling of the skull to introduce a tube-like instrument, called an endoscope, to transmit video images from deep inside the brain. Guided by the live images, the neurosurgeon can introduce surgical tools through additional holes to treat intracranial bleeds, tumors, hydrocephalus (excess fluid around the brain), and cerebrospinal fluid leaks, among other things.

Microsurgery

Microsurgery is often used to clear plaque from the carotid artery that feeds the brain (carotid endarterectomy), as well as to treat aneurysms, replace herniated spinal discs (microdiscectomy), or decompress the vertebras of the spine (laminectomy).

Neurosurgeons will use either an operating room microscope with images projected on a monitor or high-powered loupe magnification eyewear to aid in the surgery.

Stereostatic Radiosurgery

Stereotactic radiosurgery uses precisely targeted beams of radiation to accurately locate the position of brain tumors and other anomalies. Cameras and electromagnetic fields direct the surgical procedure.

Stereostatic radiosurgery is often used in combination with radiation therapy to treat tumors or AVM. Radiosurgical techniques include gamma knife and cyberknife systems.

Endovascular Surgery

Endovascular surgery involves the introduction of surgical tools through an opening in the femoral artery of the leg. It is used to treat brain disorders from inside a blood vessel, including stroke, AVM, aneurysm, and brain tumors.

The route of blood circulation may be surveyed beforehand with CT, MRI, or a high-resolution angiogram. The surgery itself guided by real-time X-ray images.

Spinal Neurosurgery

Spinal neurosurgery covers the cervical (neck), thoracic (middle), and lumbar (low) spine. It may be used to treat spinal cord compression resulting from trauma, arthritis of the spinal discs, or spondylosis (characterized by bone spurs and disc degeneration).

Power drills and special instruments may be used to correct compression problems, while spinal rongeurs (scissorlike devices used to gouge out bone) can help remove herniated discs. Spinal fusions may be performed as an open or laparoscopic ("keyhole") surgery.

Psychiatric Neurosurgery

Neurosurgery may be used to treat psychiatric disorders that fail to respond to standard medications, psychotherapy, or electroconvulsive therapy (ECT). Also known as psychosurgery, it remains a controversial practice with inconsistent outcomes. Modern psychiatric neurosurgery does not employ many of the older techniques commonly used in the past, such as lobotomy.

Today, much of the focus of psychiatric neurosurgery is placed on deep brain stimulation (DBS) to treat OCD and major depression. This involves the implantation of an electrical device to stimulate parts of the brain associated with mood or anxiety disorders.

Other Surgical Techniques

Surgery for chronic pain is a sub-branch of neurosurgery. Some of the techniques used include DBS, spinal cord stimulation, peripheral nerve stimulation, and pain pumps (implanted devices that deliver pain medication over time).

Surgery of the peripheral nervous system is also possible. It may be used to decompress nerves associated with carpal tunnel syndrome (CTS) or to reposition pinched nerves that cause referred pain.

Subspecialties

Because the function of the brain and nervous system is so vast and diverse, it is not uncommon for neurosurgeons to limit the scope of their practice to specific population groups or areas of the nervous system.

Neurosurgical subspecialties include:

• Endoscopic cranial surgery
• Functional neurosurgery (used to treat movement disorders)
• Neuro-oncology (involving brain tumors and cancer)
• Neurovascular surgery
• Pediatric neurosurgery
• Peripheral nerve surgery
• Skull base neurosurgery (used to treat benign or cancerous growths on the underside of the skull and upper vertebra)
• Spinal neurosurgery
• Stereostatic neurosurgery

Training and Certification

The education needed to become a neurosurgeon is rigorous and extensive, requiring a four-year undergraduate degree, four years of medical school, and five to seven years of residency training.

After receiving their state medical license, neurosurgeons need to practice for several years before they are even eligible to obtain board certification through the American Board of Neurological Surgery (ABNS).

Appointment Tips

People are generally referred to a neurosurgeon in an emergency or when non-surgical treatments fail to provide relief.

In a non-emergency situation, you can get the most of your appointment by documenting your symptoms in advance of your meeting. This includes noting the time, severity, duration, and location of symptoms, as well as what you were doing at the time of each event. The more accurately you can describe your symptoms, the sooner the neurosurgeon can order the correct tests and evaluations.

On the day of your appointment, bring your insurance ID card and lab or imaging test results you may have. You should also ask your primary care physician to forward all relevant electronic medical records (EMR) in advance of your appointment.

Be prepared to ask any and all questions you need to fully understand your condition and what to expect moving forward. Write them down so that you don't forget.

Questions may include:

• Why do I need this surgery?
• How exactly will it help?
• What are the chances of success?
• What are the risks?
• Have all other surgical options been exhausted?
• How long will the procedure take?
• How long will recovery be?
• What might happen if I choose not to have the surgery?
• When will I know if the surgery was successful?

Fees

The cost of neurosurgery is often extremely high. Before your appointment, it is important to check if the office accepts your insurance. If not, speak with the hospital billing department before your surgery to discuss whether no-interest payment plans or uninsured patient discounts are available. There may also be financial assistance programs for conditions like Parkinson's or brain cancer.

Even with copay or coinsurance benefits, you may find yourself paying a lot out of pocket. To help plan for your medical expenses, check the out-of-pocket maximum on your insurance policy. This is the most you have to pay for covered services in a plan year. After you meet this maximum amount, all covered services for the remainder of the year will free.

If possible, schedule your surgery strategically so that the bulk of rehabilitation costs fall within the coverage year rather than being applied to next year's deductible.