Neurosurgical procedure

A neurosurgical procedure is a surgical intervention that focuses on the treatment of conditions affecting the nervous system, including the brain, spinal cord, and peripheral nerves.

Neurosurgical procedures may be performed for various purposes, including:

Tumor Resection

Cerebral Aneurysm Repair: Treating weakened blood vessels (aneurysms) in the brain to prevent rupture, which can lead to a stroke.

Treatment of Vascular Malformations: Addressing abnormalities in blood vessels in the brain or spinal cord, such as arteriovenous malformations (AVMs) or cavernous malformations.

Cerebrovascular Surgery: Procedures to restore blood flow in cases of arterial blockages, such as carotid endarterectomy or intracranial bypass surgery.

Epilepsy Surgery: Treating epilepsy that is resistant to medication by removing the area of the brain causing seizures (focus) or by installing responsive neurostimulation devices.

Deep Brain Stimulation (DBS): Implanting electrodes in the brain to modulate brain activity and treat conditions like Parkinson's disease, essential tremor, and dystonia.

Spinal Surgery: Addressing spinal conditions, such as herniated discs, spinal stenosis, and spinal cord tumors, through procedures like discectomy, laminectomy, or spinal fusion.

Peripheral Nerve Surgery: Repairing or decompressing nerves outside the central nervous system, often for conditions like carpal tunnel syndrome or peripheral nerve tumors.

Functional Neurosurgery: Procedures for managing conditions like obsessive-compulsive disorder (OCD) or chronic pain by altering brain function.

Pediatric Neurosurgery: Specialized procedures for children, including the treatment of congenital conditions like spina bifida and craniosynostosis.

Trauma Surgery: Emergency procedures to treat traumatic brain injuries and spinal cord injuries, which may include the removal of blood clots or skull fractures.

The steps involved in a neurosurgical procedure are similar to those in other surgical procedures and include preoperative evaluation, anesthesia, the surgical procedure itself, closure, and postoperative care. Neurosurgical procedures require highly specialized equipment, such as microscopes, endoscopes, and imaging technologies (like MRI and CT scans) to aid in accurate diagnosis and precise surgical techniques.

The choice of neurosurgical procedure depends on the patient's specific condition and the goals of treatment, which may include tumor removal, symptom relief, or the prevention of complications.

Neurosurgery encompasses a variety of procedures, including brain surgery, spinal surgery, and peripheral nerve surgery. Some common neurosurgical procedures include tumor removal, treatment of vascular disorders (aneurysms and arteriovenous malformations), epilepsy surgery, and spinal fusion.

The act of performing surgery may be called a surgical procedure, operation, or simply surgery.

In response to a variety of drivers, surgical curricula are moving away from immersion learning, and the traditional time‐served apprenticeship approach is being replaced by more formal, structured, competency assessment programs. Work schedules are being regulated in many countries by legislation directed at health and safety considerations for both doctors and patients. The consequent reduction in attendance in the operating theatre produces a concomitant reduction in exposure to clinical situations and in the requisite number of operative procedures 1).

True obligatory standards for surgery do not exist. The operation rather depends on other skills like the experience or education of the surgeon or technical and clinical infrastructure.

see Neurosurgery

see Operative neurosurgery

see Microsurgery

see Tumor surgery

see Approaches.

see Approaches.

see Intracranial procedures

see Minimally invasive neurosurgery.

Neurosurgical procedures are associated with unintentional damage to the brain during surgery, known as surgically induced brain injuries (SBI), which have been implicated in orchestrating structural and neurobehavioral deterioration.

Atlas of Neurosurgical Techniques

Schmidek and Sweet Operative Neurosurgical Techniques

Time-critical neurosurgical conditions require urgent operative treatment to prevent death or neurological deficits. In New South Wales/Australian Capital Territory patients' distance from neurosurgical care is often great, presenting a challenge in achieving timely care for patients with acute neurosurgical conditions.

A protocol was developed to facilitate consultant neurosurgery locally. Children with acute, time-critical neurosurgical emergencies underwent operations in hospitals that do not normally offer neurosurgery. The authors describe the developed protocol, the outcome of its use, and the lessons learned in the 9 initial cases where the protocol has been used. Three cases are discussed in detail.

Nine children were treated by a neurosurgeon at 5 rural hospitals, and 2 children were treated at a smaller metropolitan hospital. Road ambulance, fixed wing aircraft, and medical helicopters were used to transport the Newborn and Paediatric Emergency Transport Service (NETS) team, neurosurgeon, and patients. In each case, the time to definitive neurosurgical intervention was significantly reduced. The median interval from triage at the initial hospital to surgical start time was 3:55 hours, (interquartile range [IQR] 03:29-05:20 hours). The median distance traveled to reach a patient was 232 km (range 23-637 km). The median interval from the initial NETS call requesting patient retrieval to surgical start time was 3:15 hours (IQR 00:47-03:37 hours). The estimated median “time saved” was approximately 3:00 hours (IQR 1:44-3:15 hours) compared with the travel time to retrieve the child to the tertiary center: 8:31 hours (IQR 6:56-10:08 hours).

Remote urgent neurosurgical interventions can be performed safely and effectively. This practice is relevant to countries where distance limits urgent access for patients to tertiary pediatric care. This practice is lifesaving for some children with head injuries and other acute neurosurgical conditions 2).

Poulose BK, Ray WA, Arbogast PG, Needleman J, Buerhaus PI, Griffin MR, Abumrad NN, Beauchamp RD, Holzman MD. Resident work hour limits and patient safety. Ann Surg. 2005 Jun;241(6):847-56; discussion 856-60. doi: 10.1097/01.sla.0000164075.18748.38. PMID: 15912034; PMCID: PMC1357165.
Owler BK, Carmo KA, Bladwell W, Fa'asalele TA, Roxburgh J, Kendrick T, Berry A. Mobile pediatric neurosurgery: rapid response neurosurgery for remote or urgent pediatric patients. J Neurosurg Pediatr. 2015 Sep;16(3):340-5. doi: 10.3171/2015.2.PEDS14310. Epub 2015 Jun 19. PubMed PMID: 26090548.
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