Neurosurgeons are usually best known for their expertise when it comes to the brain. They treat tumors, tissue damage, and neurological injuries caused by blood clots, strokes, and accidents. In many cases, patients and general physicians aren’t sure whether there is a brain problem when the patient is first referred to a neurological expert, or if they are, they aren’t sure of the specifics. A patient may be having persistent headaches, for instance, or may be developing speech problems; trouble with memory or motor skills are sometimes also signs that something is wrong. The neurosurgeon’s job is to make an informed diagnosis and, if possible, come up with a treatment plan.
He or she will usually begin by ascertaining the extent of the patient’s problems, which often involves ordering scans and diagnostic tests. If the surgeon can identify the root cause, he or she will then explore different treatment options, which may or may not involve an operation. It is usually the healthcare professional's job to discuss the pros and cons of any treatment plan with the patient, explaining the risks, rewards, and likely outcomes.
Brain surgery is a very complicated undertaking, and requires a tremendous amount of skill and precision. Most procedures are very lengthy, often taking several hours. Surgeons in these settings must usually have a great degree of confidence in their own talents, but must also surround themselves with support staff — other physicians and nurses — that they trust. Brain surgery is rarely ever a solo affair, and while the surgeon is usually the star of the show, he or she depends a lot on the assistance of a whole team of medical professionals.
In most cases, surgeons who are trained to operate on the brain are also specialists in the spinal column. People with back injuries, from simple slipped discs to more complicated paralysis issues, typically visit neurosurgeons for diagnosis and repair. Most who work with the spine do not also work on the brain, as the intricacies associated with each are such that it is usually easier to specialize in just one area. Their training is almost always broad enough to cover both, though, which means that they can cross over in certain circumstances. Much depends on setting and individual interest.
Many “basic” spinal surgeries are performed by orthopedic surgeons, but this is sometimes dictated by the extent of the injuries at issue. If the procedure will require opening the dura or lining of the canal inside the spine, the job is usually referred to someone with a neurology background because of how sensitive these areas are. One misstep, and the patient could suffer lasting damage. People with neurosurgery backgrounds have the training to execute these sorts of procedures, but most orthopedists do not.
Peripheral Nervous System Repair
Surgeons with neurological training can also repair certain kinds of nerve damage. An extensive series of nerves relays signals related to pain and other sensations from the spine and brain to all other parts of the body. Not all nerve damage can be repaired, but when it can, a neurosurgeon is almost always the one to do the job. This type of surgery can involve almost any part of the body, but on a very precise, highly detailed level. Procedures can be quite lengthy, often taking up the better part of a day even if only a hand or single finger is being operated on.
Types of Work and Settings
Most neurosurgeons work in hospitals, but this is by no means the only place they can be found. A surgeon does not necessarily need to be employed by a hospital in order to use its surgical suites, and many specialists work in private practice, taking patients on a case-by-case basis, usually by referral. They typically have admitting privileges at local hospitals, but need not actually be on staff there.
Private practice specialists have more control over their schedules and patient loads, but they may also have a bit more uncertainty when it comes to work availability. There is not always a high demand for brain, spinal, and nervous system injuries, so a surgeon in the private sector may not always have something to do. A professional on staff with a hospital, in contrast, may be much busier, but at the same time, he or she doesn’t usually have the ability to decline patients or procedures.
In rural or more remote settings, there is not usually enough demand to keep a neurological expert on staff full-time. Major hospitals may have one or two of these experts who will share responsibility for handling cases at outlying clinics or satellite hospitals as they arise. Work in these settings usually requires a bit of travel and the ability to deal with the unexpected — often on very short notice.
Importance of Research and Publication
In addition to caring for individual patients, most surgeons also spend a great deal of time researching conditions and treatments more generally. Many conduct research trials, often as a way of looking for new approaches to things like tumors and aneurysm, or different ways to treat degenerative conditions like Alzheimer’s disease or multiple sclerosis. The results are often published in scholarly journals or medical periodicals.
Surgeons may also use publications to build their prestige. A specialist who has authored or been a part of a very well-known or well-respected study often has a great deal of power when it comes to choosing hospitals and demanding higher pay. Hospitals and surgical centers often fight to woo the most talented or reputable surgeons, as having these experts on staff increases their own ratings — which in turn affects things like funding, grant allocations, and quality of clientele.
Education and Training
The path to becoming a neurosurgeon varies from place to place, but it generally always requires a tremendous amount of schooling. A four-year bachelor’s degree is usually the starting place, often in a field like biology, chemistry, or mathematics. Medical school or dedicated medical training comes next, which typically adds an additional four years. Specializing in neurosurgery usually requires additional training through internships and residency programs; when all is said and done, a person should expect at least ten years of training past high school, though the number is often closer to 14.
Physicians must also usually pass a series of exams in order to earn neurosurgical qualifications. Most of the time, these include both written and physical portions — that is, candidates must not only be able to answer questions on paper, but also must be able to demonstrate procedures on demand, usually in front of a board of examiners. The high-pressure nature of these exams in many ways mirrors the pressures surgeons will face when operating on real patients.
In most places, neurosurgeons’ training does not stop once they earn their licenses or formal credentials. The field is a rapidly changing one, which means that staying current is of critical importance. Many places mandate continuing education and sometimes even continual re-licensing, usually every few years, in order to ensure that all specialists remain at the very top of their game.