View source for Neurosurgery

{{short description|Medical specialty of disorders which affect any portion of the nervous system}}
{{For|the journal|Neurosurgery (journal)}}
{{Infobox occupation
| name= Neurosurgery
| image= [[File:Parkinson surgery.jpg|240px]]
| caption= Stereotactic guided insertion of [[Deep brain stimulation|DBS]] electrodes in neurosurgery
| activity_sector= [[Surgery]]
| competencies=
| formation= *[[Doctor of Medicine]] (M.D.) or [[Doctor of Osteopathic Medicine]] (D.O.) with [[Residency (medicine)#Specialty selection 2|Residency in Neurosurgery]]
or
* [[Bachelor of Medicine, Bachelor of Surgery]] (M.B.B.S.) with  [[Residency (medicine)#Specialty selection 2|Residency in Neurosurgery]] or [[Fellowship of the Royal College of Surgeons]] (F.R.C.S.)
or
* [[Master of Surgery]] (M.S.) / [[Magister Chirurgiae]] (M.Ch.)

| employment_field= [[Hospital]]s, [[clinic]]s
| related_occupation=
| average_salary=
}}

'''Neurosurgery''' or/and '''neurological surgery''', known in [[common parlance]] as '''brain surgery''', is the [[specialty (medicine)|medical specialty]] that focuses on the surgical treatment or rehabilitation of disorders which affect any portion of the [[nervous system]] including the [[Human brain|brain]], [[spinal cord]], [[peripheral nervous system]], and cerebrovascular system.<ref>{{cite web | title = Neurological Surgery Specialty Description | publisher = American Medical Association | url = https://www.ama-assn.org/specialty/neurological-surgery-specialty-description | access-date = 4 October 2020 | archive-date = 12 October 2020 | archive-url = https://web.archive.org/web/20201012081244/https://www.ama-assn.org/specialty/neurological-surgery-specialty-description | url-status = live }}</ref> Neurosurgery as a medical specialty also includes non-surgical management of some neurological conditions.<ref>{{Cite book |last=Greenberg |first=Mark S. |title=Handbook of neurosurgery |date=2020 |publisher=Thieme |isbn=978-1-68420-137-2 |edition=9th |location=New York Stuttgart Delhi}}</ref>

==Education and context==
In different countries, there are different requirements for an individual to legally practice neurosurgery, and there are varying methods through which they must be educated. In most countries, neurosurgeon training requires a minimum period of seven years after graduating from medical school.<ref>{{cite web|title=Brain Surgeon: Job Description, Salary, Duties and Requirements|url=https://study.com/articles/Brain_Surgeon_Job_Description_Salary_Duties_and_Requirements.html|website=Science|access-date=29 December 2019|archive-date=29 December 2019|archive-url=https://web.archive.org/web/20191229150029/https://study.com/articles/Brain_Surgeon_Job_Description_Salary_Duties_and_Requirements.html|url-status=live}}</ref>
=== Canada===
In Canada, neurosurgery residency is overseen by the [[Royal College of Physicians and Surgeons of Canada]] (RCPSC). To qualify, candidates must hold a [[Doctor of Medicine]] (M.D.) degree and be licensed physicians.<ref>{{Cite web |title=Specialty Training Requirements in Neurosurgery |url=https://www.royalcollege.ca/content/dam/documents/ibd/neurosurgery/neurosurgery-str-e.html/ |access-date=2025-10-26 |website=[[Royal College of Physicians and Surgeons of Canada]]}}</ref><ref>{{Cite web |title=Neurosurgery — Department of Neurology and Neurosurgery |url=https://www.mcgill.ca/neurology-neurosurgery/education/residency/neurosurgery |access-date=2025-10-26 |website=[[McGill University]] |language=en}}</ref> The residency program lasts six years, often with one year of mandatory research as in [[University of Calgary]], and it comprises two years of ''Surgical Foundations'' and four years of specialized neurosurgery training. Admission is facilitated through the [[Canadian Resident Matching Service]] (CaRMS), which matches candidates to programs based on academic credentials, interviews, and references.<ref>{{Cite web |title=DCNS {{!}} Residency Neurosurgery Program {{!}} Cumming School of Medicine {{!}} University of Calgary |url=https://cumming.ucalgary.ca/departments/dcns/education/residency/neurosurgery |access-date=2025-10-26 |website=cumming.ucalgary.ca |language=en}}</ref><ref>{{Cite web |title=How to Match to Neurosurgery Residency |url=https://bemoacademicconsulting.com/blog/neurosurgery-residency |access-date=2025-10-26 |website=BeMo® |language=en}}</ref> Training requirements and certification processes differ slightly in [[Quebec]], where the [[Collège des médecins du Québec]] (CMQ) collaborates with RCPSC, but has [[french language]] requirements and different application procedure. Upon completion, residents take the RCPSC examination to earn the Fellowship of the [[Royal College of Physicians and Surgeons of Canada]] (FRCSC) designation.<ref>{{Cite web |title=Neurosurgery in Canada: A Period of Transition toward Competency-by-design (CBD) for the Fellowship of the Royal College of Surgeons of Canada |url=https://newsletters.aans.org/ync/winter-2020/neurosurgery-in-canada-a-period-of-transition-toward-competency-by-design-cbd-for-the-fellowship-of-the-royal-college-of-surgeons-of-canada/ |access-date=2025-10-26 |website=AANS Young Neurosurgeons News |language=en-US}}</ref><ref>{{Cite web |title=Program Descriptions - First Iteration |url=https://www.carms.ca/match/r-1-main-residency-match/program-descriptions/ |access-date=2025-10-26 |website=CaRMS |language=en-US}}</ref>

On the other hand, to qualify for residency, [[International medical graduate|International Medical Graduates]] must pass equivalent licensing exams, including the [[Medical Council of Canada Qualifying Examination|Medical Council of Canada Qualifying Examination Part I]] (MCCQE Part I) and the National Assessment Collaboration (NAC) [[Objective structured clinical examination|Objective Structured Clinical Examination]], to be eligible for residency. They apply through CaRMS, where competition is high, and may face additional requirements in Quebec due to french language fluency expectations.<ref>{{Cite web |date=2024-04-17 |title=Eligibility and application {{!}} Medical Council of Canada |url=https://mcc.ca/examinations-assessments/mccqe-part-i/eligibility-and-application/ |access-date=2025-10-26 |website=mcc.ca |language=en-US}}</ref><ref>{{Cite web |date=2023-12-18 |title=CaRMS and MCC exams {{!}} Medical Council of Canada |url=https://mcc.ca/credentials-and-services/pathways-to-licensure/carms-and-mcc-exams/ |access-date=2025-10-26 |website=mcc.ca |language=en-US}}</ref><ref>{{Cite journal |last=MacFarlane |first=Malcolm M. |date=2021 |title=When a Canadian is not a Canadian: marginalization of IMGs in the CaRMS match |journal=Canadian Medical Education Journal |volume=12 |issue=4 |pages=132–140 |doi=10.36834/cmej.71790 |issn=1923-1202 |pmc=8463232 |pmid=34567315}}</ref>
===India===
In India, neurosurgery training is overseen by the [[National Medical Commission]] (NMC) and  the qualifying examinations by [[National Board of Examinations in Medical Sciences]] (NBEMS).<ref>{{Cite web |title=NEET SS NBEMS |url=https://natboard.edu.in/viewnbeexam?exam=neetss |archive-url=http://web.archive.org/web/20251008201924/https://natboard.edu.in/viewnbeexam?exam=neetss |archive-date=2025-10-08 |access-date=2025-10-26 |website=natboard.edu.in |language=en}}</ref><ref>{{Cite web |title=NEET PG NBEMS |url=https://natboard.edu.in/viewnbeexam?exam=neetpg |archive-url=http://web.archive.org/web/20251008202619/https://natboard.edu.in/viewnbeexam?exam=neetpg |archive-date=2025-10-08 |access-date=2025-10-26 |website=natboard.edu.in |language=en}}</ref> To qualify, candidates must hold a [[Bachelor of Medicine, Bachelor of Surgery]] (MBBS) degree with at least 55% aggregate marks from a [[World Health Organization|WHO]] [[List of medical colleges in India|recognized institution]], complete a one-year compulsory rotating internship, and possess a practising medical license.<ref>{{Cite web |date=2013-10-03 |title=MCh Neurosurgery: Colleges, Syllabus, Admission, Scope, Stipend, Salary |url=https://collegedunia.com/courses/master-of-chirurgiae-mch-neuro-surgery |access-date=2025-10-26 |website=collegedunia.com |language=en}}</ref> The pathway spans three to six years post MBBS. A three-year residency cum degree of [[Master of Surgery]] (M.S.) in neurosurgery is the basic qualification of a [[Neurosurgery in India|neurosurgeon]] in India. Physicians can opt for super specialization of three years i.e., Master of Chirurgiae (M.Ch.) after completing Master of Surgery (M.S.) in [[General surgery|General Surgery]] or Neurosurgery. Qualifying exams for specialisation (M.S.) are — [[National Eligibility cum Entrance Test (Postgraduate)|NEET (PG)]] for admission into general medical colleges and INI CET for admission into [[Institutes of National Importance]], such as [[All India Institutes of Medical Sciences|AIIMS]], [[Jawaharlal Institute of Postgraduate Medical Education and Research|JIPMER]], [[National Institute of Mental Health and Neurosciences|NIMHANS]] and [[Postgraduate Institute of Medical Education and Research|PGIMER]]. [[Subspecialty|Super speciality]] selection exams are NEET SS and INI SS similarly. Neurosurgery is the one of the most competitive specialities in India with fewer than 200 seats annually. [[Foreign Medical Graduates]] (FMG) are required to pass [[Foreign Medical Graduate Examination|FMGE]] for registration into postgraduate training.<ref>{{Cite web |last=CBSPD |title=NEET PG Eligibility Criteria 2025, FMGE and Foreign Students |url=https://www.cbspd.com/blog/neet-pg-eligibility-criteria-2025-fmge-and-foreign-students?srsltid=AfmBOopgtS2hmmh6TxjjcBZqlcVGbeI0iyVFC6kyyoYjrakybu6-0Dxt |access-date=2025-10-26 |website=www.cbspd.com |language=en}}</ref><ref>{{Cite web |last1=Diginerve |last2=Chadha |first2=Anuj |date=2025-08-05 |title=FMGE Exam Eligibility : Full Criteria & Rules |url=https://www.diginerve.com/blogs/fmge-exam-eligibility/ |access-date=2025-10-26 |website=Your Guide At Every Step to Become The Top Doctor |language=en}}</ref>

===United Kingdom===
In the [[United Kingdom]], students must gain entry into medical school. The MBBS qualification ([[Bachelor of Medicine, Bachelor of Surgery]]) takes four to six years depending on the student's route. The newly qualified [[physician]] must then complete foundation training lasting two years; this is a paid training program in a hospital or clinical setting covering a range of medical specialties including surgery. Junior doctors then apply to enter the neurosurgical pathway. Unlike most other surgical specialties, it currently has its own independent training pathway which takes around eight years (ST1-8); before being able to sit for [[consultant]] exams with sufficient amounts of experience and practice behind them. Neurosurgery remains consistently amongst the most competitive medical specialties in which to obtain entry.

===United States===
In the [[United States]], a neurosurgeon must generally complete four years of [[undergraduate education]], four years of [[Medical school in the United States|medical school]], and seven years of [[Residency (medicine)|residency]] (PGY-1-7).<ref name=Preul2005>{{cite journal |last1=Preul |first1=Mark C. |title=History of brain tumor surgery |journal=Neurosurgical Focus |volume=18 |issue=4 |year=2005 |page=1 |doi=10.3171/foc.2005.18.4.1 |doi-access=free }}</ref> Most, but not all, residency programs have some component of basic science or clinical research. Neurosurgeons may pursue additional training in the form of a [[Fellowship (medicine)|fellowship]] after residency, or, in some cases, as a senior resident in the form of an enfolded fellowship. These fellowships include [[pediatric neurosurgery]], trauma/neurocritical care, functional and [[stereotactic]] surgery, surgical neuro-[[oncology]], [[radiosurgery]], neurovascular surgery, skull-base surgery, peripheral nerve and complex spinal surgery.<ref name=pmid6387062>{{cite journal |last1=Kirkpatrick |first1=Douglas B.|title=The first primary brain-tumor operation |journal=Journal of Neurosurgery |volume=61 |issue=5 |pages=809–13 |year=1984 |pmid=6387062 |doi=10.3171/jns.1984.61.5.0809 }}</ref> Fellowships typically span one to two years. In the U.S., neurosurgery is a very small, highly competitive specialty, constituting only 0.5 percent of all physicians.<ref>{{cite web |title=Ensuring an Adequate Neurosurgical Workforce for the 21st Century |url=https://www.aans.org/pdf/Legislative/Neurosurgery%20IOM%20GME%20Paper%2012%2019%2012.pdf |website=American Association of Neurological Surgeons |quote=Neurosurgery is a small specialty, constituting only 0.5 percent of all physicians. |access-date=28 May 2021 |archive-date=11 July 2021 |archive-url=https://web.archive.org/web/20210711163633/https://www.aans.org/pdf/Legislative/Neurosurgery%20IOM%20GME%20Paper%2012%2019%2012.pdf |url-status=dead }}</ref>

==History==
{{main|History of neurology and neurosurgery}}
Neurosurgery, or the premeditated incision into the head for pain relief, has been around for thousands of years, but notable advancements in neurosurgery have only come within the last hundred years.<ref>{{Cite book|url=https://books.google.com/books?id=piKcBQAAQBAJ&q=history+of+neurosurgery+incas&pg=PT59|title=A History of the Brain: From Stone Age surgery to modern neuroscience|last=Wickens|first=Andrew P.|date=2014-12-08|publisher=Psychology Press|isbn=978-1-317-74482-5|language=en}}</ref>
[[File:Edinburgh Skull, trepanning showing hole in back of skull Wellcome M0009393.jpg|thumb|Trepanned skull from [[Edinburgh]]]]

===Ancient===

During the [[Roman Empire]], doctors and surgeons performed [[Surgery in Ancient Rome|neurosurgery]] on depressed skull fractures.<ref>{{Cite book |last1=Desai |first1=Tejal |url=https://books.google.com/books?id=Edk-AAAAQBAJ&dq=neurosurgery+surgery+ancient+Rome&pg=PA97 |title=BioMEMS and Biomedical Nanotechnology: Volume III: Therapeutic Micro/Nanotechnology |last2=Bhatia |first2=Sangeeta N. |date=2007-05-26 |publisher=Springer Science & Business Media |isbn=978-0-387-25844-7 |page=97 |language=en}}</ref><ref>{{Cite book |last=Gillard |first=Arthur |url=https://books.google.com/books?id=WIFmDwAAQBAJ&dq=brain+surgery+ancient+Rome&pg=PA142 |title=Traumatic Brain Injury |date=2012-10-19 |publisher=Greenhaven Publishing LLC |isbn=978-0-7377-7312-5 |page=142 |language=es}}</ref> The [[Inca]]s appear to have practiced a procedure known as [[Trepanning|trepanation]] since before European colonization.<ref>{{cite journal|last1=Andrushko|first1=Valerie A.|last2=Verano|first2=John W.|title=Prehistoric trepanation in the Cuzco region of Peru: A view into an ancient Andean practice|journal=American Journal of Physical Anthropology|date=September 2008|volume=137|issue=1|pages=4–13|doi=10.1002/ajpa.20836|pmid=18386793 |bibcode=2008AJPA..137....4A }}</ref> During the [[Middle Ages]] in [[Al-Andalus]] from 936 to 1013 AD, [[Al-Zahrawi]] performed surgical treatments of head injuries, skull fractures, spinal injuries, [[hydrocephalus]], subdural effusions and headache.<ref>{{Cite journal|last1=Al-Rodhan|first1=N. R.|last2=Fox|first2=J. L.|date=1986-07-01|title=Al-Zahrawi and Arabian neurosurgery, 936-1013 AD|journal=Surgical Neurology|volume=26|issue=1|pages=92–95|issn=0090-3019|pmid=3520907|doi=10.1016/0090-3019(86)90070-4}}</ref> Simple forms of neurosurgery were performed on [[King Henri II]] in 1559, after a [[jousting]] accident with [[Gabriel Montgomery]] fatally wounded him. [[Ambroise Paré]] and [[Andreas Vesalius]], both experts in their field at the time, 
attempted their own methods, to no avail, in curing Henri.<ref>{{cite book
 |last=Kean
 |first=Sam
 |date=2014
 |title=The Tale of the Dueling Neurosurgeons: The History of the Human Brain as Revealed by True Stories of Trauma, Madness, and Recovery
|title-link=The Tale of the Dueling Neurosurgeons
 |location=New York
 |publisher=Little, Brown and Company
 |pages=25–40
}}</ref> In China, [[Hua Tuo]] created the first general [[anaesthesia]] called mafeisan, which he used on surgical procedures on the brain.<ref>{{Cite journal|last=Zhang|first=Yuqi|title=HUA Tuo: The First Neurosurgeon in the World|journal=Translational Neuroscience and Clinics|url=https://journals.sagepub.com/doi/pdf/10.18679/CN11-6030_R.2015.008|date=2015-03-18|volume=1|pages=71–72|doi=10.18679/CN11-6030_R.2015.008|s2cid=207942533|access-date=2021-03-31|archive-date=2024-01-04|archive-url=https://web.archive.org/web/20240104002507/https://journals.sagepub.com/doi/pdf/10.18679/CN11-6030_R.2015.008|url-status=live|url-access=subscription}}</ref>

===Modern===
'''History of tumor removal''': In 1879, after locating it via neurological signs alone, Scottish surgeon [[William Macewen]] (1848–1924) performed the first successful brain tumor removal.<ref name=Preul2005/>  On November 25, 1884, after English physician [[Alexander Hughes Bennett]] (1848–1901) used Macewen's technique to locate it, English surgeon [[Rickman Godlee]] (1849–1925) performed the first primary brain tumor removal,<ref name=pmid6387062/><ref>{{Cite journal | doi=10.3322/canjclin.24.3.169|pmid = 4210862|title = Alexander Hughes Bennett (1848-1901): Rickman John Godlee (1849-1925)|journal = CA: A Cancer Journal for Clinicians| volume=24| issue=3| pages=169–170|year = 1974|s2cid = 45097428|doi-access = free}}</ref> which differs from Macewen's operation in that Bennett operated on the exposed brain, whereas Macewen operated outside of the "brain proper" via [[trepanation]].<ref name="uakron gage surgery">{{Cite web|url=https://www.uakron.edu/gage/surgery.dot|title=Surgery|access-date=2016-02-11|archive-date=2021-11-13|archive-url=https://web.archive.org/web/20211113202445/https://www.uakron.edu/gage/surgery.dot|url-status=live}}</ref> On March 16, 1907, Austrian surgeon [[Hermann Schloffer]] became the first to successfully remove a [[Pituitary gland|pituitary]] tumor.<ref name="neurosurgery.org cybermuseum microneurohall jhardy">{{Cite web | url=http://www.neurosurgery.org/cybermuseum/microneurohall/jhardy.html | title=Cyber Museum of Neurosurgery | access-date=2016-02-11 | archive-date=2017-01-06 | archive-url=https://web.archive.org/web/20170106204126/http://www.neurosurgery.org/cybermuseum/microneurohall/jhardy.html | url-status=dead }}</ref>

'''[[Lobotomy]]''': also known as '''leucotomy''', was a form of [[psychosurgery]], a neurosurgical treatment of [[mental disorder]]s that involves severing connections in the brain's [[prefrontal cortex]].<ref>{{Cite news|url=https://www.livescience.com/42199-lobotomy-definition.html|title=Lobotomy: Definition, Procedure & History|work=Live Science|access-date=2018-06-28|archive-date=2023-09-24|archive-url=https://web.archive.org/web/20230924180952/https://www.livescience.com/42199-lobotomy-definition.html|url-status=live}}</ref> The originator of the procedure, [[Portugal|Portuguese]] neurologist [[António Egas Moniz]], shared the [[Nobel Prize for Physiology or Medicine]] of 1949.<ref>{{Cite web|last=Nouri|first=Aria|date=20 October 2011|title="A brief history of lobotomy"|url=https://www.aaas.org/brief-history-lobotomy|website=aaas.org|access-date=3 December 2021|archive-date=3 December 2021|archive-url=https://web.archive.org/web/20211203192115/https://www.aaas.org/brief-history-lobotomy|url-status=live}}</ref><ref>{{Cite journal|last=Miguel A|first=Faria|date=5 April 2013|title="Violence, mental illness, and the brain – A brief history of psychosurgery: Part 1 – From trephination to lobotomy"|journal=Surgical Neurology International|volume=4|page=49|doi=10.4103/2152-7806.110146|pmid=23646259|pmc=3640229 |doi-access=free }}</ref> Some patients improved in some ways after the operation, but complications and impairments{{snd}}sometimes severe{{snd}}were frequent. The procedure was controversial from its initial use, in part due to the balance between benefits and risks. It is mostly rejected as a treatment now and non-compliant with [[patients' rights]].

'''History of electrodes in the brain''': In 1878, [[Richard Caton]] discovered that electrical signals transmitted through an animal's brain.  In 1950 Jose Delgado invented the first electrode that was implanted in an animal's brain (bull), using it to make it run and change direction.<ref>{{Cite journal|last=C.Marzullo|first=Timothy|date=Spring 2017|title="The Missing Manuscript of Dr. Jose Delgado's Radio Controlled Bulls"|journal=Journal of Undergraduate Neuroscience Education|volume=15 |issue=2 |pages=R29–R35 |pmid=28690447 |pmc=5480854 }}</ref> In 1972 the [[cochlear implant]], a neurological [[Prosthesis|prosthetic]] that allowed deaf people to hear was marketed for commercial use. In 1998 researcher Philip Kennedy implanted the first Brain Computer Interface (BCI) into a human subject.<ref name="Brown BI108">https://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/03/hist.htm{{full citation needed|date=February 2016}} {{Webarchive|url=https://web.archive.org/web/20161130084724/http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/03/hist.htm |date=2016-11-30 }} {{Dead link|date=October 2023}}</ref>

A survey done in 2010 on 100 most cited works in neurosurgery shows that the works mainly cover clinical trials evaluating surgical and medical therapies, descriptions of novel techniques in neurosurgery, and descriptions of systems classifying and grading diseases.<ref name="pmid20078192">{{cite journal |vauthors=Ponce FA, Lozano AM |title=Highly cited works in neurosurgery. Part I: the 100 top-cited papers in neurosurgical journals |journal=Journal of Neurosurgery |volume=112 |issue=2 |pages=223–32 |date=February 2010 |pmid=20078192 |doi=10.3171/2009.12.JNS091599 }}</ref>

===Modern surgical instruments===
{{Gallery
| title        = Modern neurosurgical instruments
| align        =center
| height       =250
| width        =250
| File:Dr. B. K. Misra performing Stereotactic Gamma Radiosurgery.jpg
 |A doctor performing Stereotactic Gamma Knife Radiosurgery, a non-invasive procedure
| File:Puma Robotic Arm - GPN-2000-001817.jpg
 |Puma Robotic Arm
| File:DORO Aluminum Headrest System.png
 | Aluminum headrest
}}
The main advancements in neurosurgery came about as a result of highly crafted tools. Modern neurosurgical tools, or instruments, include [[chisel]]s, curettes, dissectors, distractors, elevators, forceps, hooks, impactors, probes, suction tubes, power tools, and robots.<ref name=neurosurgery-surgical-power-tool>{{Cite web | url=http://www.medicalexpo.com/medical-manufacturer/neurosurgery-surgical-power-tool-11882.html | title=Neurosurgery surgical power tool - All medical device manufacturers - Videos | access-date=2016-02-11 | archive-date=2022-01-24 | archive-url=https://web.archive.org/web/20220124113211/https://www.medicalexpo.com/medical-manufacturer/neurosurgery-surgical-power-tool-11882.html | url-status=live }}</ref><ref name="stealthsurgical.com department neurosurgical">{{Cite web | url=http://www.stealthsurgical.com/department/neurosurgical-10000.cfm | title=Neurosurgical Instruments,Neurosurgery Instrument, Neurosurgeon, Surgical Tools | access-date=2016-02-11 | archive-date=2007-05-13 | archive-url=https://web.archive.org/web/20070513053121/http://www.stealthsurgical.com/department/neurosurgical-10000.cfm | url-status=live }}</ref> Most of these modern tools have been in medical practice for a relatively long time. The main difference of these tools in neurosurgery, were the precision in which they were crafted. These tools are crafted with edges that are within a millimeter of desired accuracy.<ref name=technology-increases-precision-safety-during-neurosurgery>{{Cite web | url=http://news.psu.edu/story/285212/2013/08/26/impact/technology-increases-precision-safety-during-neurosurgery | title=Technology increases precision, safety during neurosurgery &#124; Penn State University | access-date=2016-02-11 | archive-date=2013-09-04 | archive-url=https://web.archive.org/web/20130904163911/http://news.psu.edu/story/285212/2013/08/26/impact/technology-increases-precision-safety-during-neurosurgery | url-status=live }}</ref> Other tools, such as handheld power saws and robots, have only recently been commonly used inside of a neurological operating room. As an example, the University of Utah developed a device for computer-aided design / computer-aided manufacturing (CAD-CAM) which uses an image-guided system to define a cutting tool path for a robotic [[cranial drill]].<ref>{{cite journal |title=Robotics in Neurosurgery |journal=Neurosurgical Focus |date=1 May 2017 |volume=42 |issue=5 |url=https://thejns.org/focus/view/journals/neurosurg-focus/42/5/article-pE6.xml |access-date=14 November 2018 |archive-date=14 November 2018 |archive-url=https://web.archive.org/web/20181114224744/https://thejns.org/focus/view/journals/neurosurg-focus/42/5/article-pE6.xml |url-status=live }}</ref>

== Organised neurosurgery ==
[[File:Robert Spetzler in a Neurosurgeons Group.jpg|thumb|World Academy of Neurological Surgery's conference]]
The [[World Federation of Neurosurgical Societies]] (WFNS), founded in 1955 in [[Switzerland]], as a [[professional]], [[scientific]], [[non governmental organization]], is composed of 130 member societies: consisting of 5 Continental Associations ([[American Association of Neurological Surgeons|AANS]], [[Asian Australasian Society of Neurological Surgeons|AASNS]], [[Continental Association of African Neurosurgical Societies|CAANS]], [[European Association of Neurosurgical Societies|EANS]] and [[Latin American Federation of Neurosurgical Societies|FLANC]]), 6 Affiliate Societies, and 119 National Neurosurgical Societies, representing some 50,000 [[neurosurgeons]] worldwide.<ref>{{Cite web|url=https://www.wfns.org/all-member-societies|title=About the Foundation &#124; World Federation of Neurosurgical Societies|access-date=2020-07-10|archive-date=2020-08-04|archive-url=https://web.archive.org/web/20200804160229/https://www.wfns.org/all-member-societies}}</ref> It has a consultative status in the [[United Nations]]. The official Journal of the Organization is [[World Neurosurgery]].<ref name=journal>{{cite web|title=Journal: World Neurosurgery|url=http://www.wfns.org/pages/journal/280.php|publisher=WFNS|access-date=29 May 2014|archive-url=https://web.archive.org/web/20140606032854/http://www.wfns.org/pages/journal/280.php|archive-date=6 June 2014|url-status=dead}}</ref><ref name=Elsevier>{{cite web|title=World Neurosurgery, Home page|url=http://www.worldneurosurgery.org/|publisher=Elsevier|access-date=29 May 2014|archive-date=9 April 2016|archive-url=https://web.archive.org/web/20160409103313/http://www.worldneurosurgery.org/|url-status=live}}</ref> The other global organisations being the World Academy of Neurological Surgery (WANS) and the World Federation of Skull Base Societies (WFSBS).

== Main divisions ==
General neurosurgery involves most neurosurgical conditions including neuro-trauma and other neuro-emergencies such as [[intracranial hemorrhage]]. Most level 1 hospitals have this kind of practice.<ref>{{Cite journal|last1=Esposito|first1=Thomas J.|last2=Reed|first2=R. Lawrence|last3=Gamelli|first3=Richard L.|last4=Luchette|first4=Fred A.|date=2005-01-01|title=Neurosurgical Coverage: Essential, Desired, or Irrelevant for Good Patient Care and Trauma Center Status|journal=Transactions of the ... Meeting of the American Surgical Association|language=en|volume=123|issue=3|pages=67–76|doi=10.1097/01.sla.0000179624.50455.db|issn=0066-0833|pmc=1357744|pmid=16135922}}</ref>

Specialized branches have developed to cater to special and difficult conditions. These specialized branches co-exist with general neurosurgery in more sophisticated hospitals. To practice advanced specialization within neurosurgery, additional higher fellowship training of one to two years is expected from the neurosurgeon.
Some of these divisions of neurosurgery are:
# Vascular neurosurgery includes clipping of [[aneurysm]]s and performing carotid endarterectomy (CEA).
# Stereotactic neurosurgery, functional neurosurgery, and [[epilepsy surgery]] (the latter includes partial or total [[corpus callosotomy]] – severing part or all of the [[corpus callosum]] to stop or lessen seizure spread and activity, and the surgical removal of functional, physiological and/or anatomical pieces or divisions of the brain, called epileptic foci, that are operable and that are causing seizures, and also the more radical and rare partial or total [[lobectomy]], or even [[hemispherectomy]] – the removal of part or all of one of the lobes, or one of the cerebral hemispheres of the brain; those two procedures, when possible, are also very, very rarely used in oncological neurosurgery or to treat very severe neurological trauma, such as stab or gunshot wounds to the brain)
# Oncological neurosurgery also called neurosurgical oncology; includes pediatric oncological neurosurgery; treatment of benign and malignant central and peripheral nervous system cancers and pre-cancerous lesions in adults and children (including, among others, [[glioblastoma multiforme]] and other [[gliomas]], brain stem cancer, [[astrocytoma]], [[pontine glioma]], [[medulloblastoma]], [[spinal cancer]], tumors of the meninges and intracranial spaces, secondary metastases to the brain, spine, and nerves, and peripheral nervous system tumors)
# Skull base surgery
# Spinal neurosurgery
# [[Peripheral nerve]] surgery
# [[Pediatric neurosurgery]] (for cancer, seizures, bleeding, stroke, [[cognitive disorder]]s or congenital neurological disorders)

=== Commonly performed surgeries ===
According to an analysis by the [[American College of Surgeons]] [[National Surgical Quality Improvement Program]] (NSQIP), the most common surgeries performed by neurosurgeons in between 2006 and 2014 were the following:<ref>{{Cite report |url=https://www.cns.org/meetings/archived-abstracts-detail/congress-of-neurological-surgeons-2016-annual-meeting-19770 |title=Most Common Neurosurgical Procedures & Complications |last1=M Giantini Larsen BS |first1=Alexandra |last2=Vishwas Karhade BE |first2=Aditya |date=2016 |publisher=Cushing Neurosurgery Outcomes Center |last3=J Cote BS |first3=David |last4=R. Smith MD |first4=Timothy |access-date=2022-05-17 |archive-date=2022-07-03 |archive-url=https://web.archive.org/web/20220703233033/https://www.cns.org/meetings/archived-abstracts-detail/congress-of-neurological-surgeons-2016-annual-meeting-19770 |url-status=live }}</ref>
* [[Anterior cervical discectomy and fusion]] (ACDF)
* [[Craniotomy]] for [[brain tumor]] (CBT)
* [[Discectomy]]
* [[Laminectomy]]
* Posterolateral [[lumbar fusion]] (PLF)

==Neuropathology==
[[File:Neuropathology case V 03.jpg|thumb|[[Histopathology]] specimen of [[Angiocentric glioma]], higher magnification, HE stain]]
[[Neuropathology]] is a specialty within the study of [[pathology]] focused on the disease of the brain, spinal cord, and neural tissue.<ref>{{Cite web | url=http://www.mc.vanderbilt.edu/root/vumc.php?site=vmcpathology&doc=12892 | title=Department of Pathology, Microbiology and Immunology | access-date=2016-02-12 | archive-date=2021-01-25 | archive-url=https://web.archive.org/web/20210125150458/https://www.mc.vanderbilt.edu/root/vumc.php?site=vmcpathology  }}</ref> This includes the central nervous system and the peripheral nervous system. Tissue analysis comes from either surgical [[Biopsy|biopsies]] or post mortem [[Autopsy|autopsies]]. Common tissue samples include muscle fibers and nervous tissue.<ref>{{Cite journal |last=Love |first=S. |date=April 2004 |title=Post mortem sampling of the brain and other tissues in neurodegenerative disease |journal=Histopathology |volume=44 |issue=4 |pages=309–317 |doi=10.1111/j.1365-2559.2004.01794.x |issn=0309-0167 |pmid=15049895 }}</ref> Common applications of neuropathology include studying samples of tissue in patients who have [[Parkinson's disease]], [[Alzheimer's disease]], [[dementia]], [[Huntington's disease]], [[amyotrophic lateral sclerosis]], [[Mitochondrial disease|mitochondria disease]], and any disorder that has neural deterioration in the brain or spinal cord.<ref>{{Cite web |title=Dementia |url=http://neuropathology-web.org/chapter9/chapter9aDementia.html |website=neuropathology-web.org |access-date=2016-02-12 |archive-date=2021-04-13 |archive-url=https://web.archive.org/web/20210413035737/http://neuropathology-web.org/chapter9/chapter9aDementia.html |url-status=live }}</ref><ref>{{cite journal |last1=Filosto |first1=Massimiliano |last2=Tomelleri |first2=Giuliano |last3=Tonin |first3=Paola |last4=Scarpelli |first4=Mauro |last5=Vattemi |first5=Gaetano |last6=Rizzuto |first6=Nicolò |last7=Padovani |first7=Alessandro |last8=Simonati |first8=Alessandro |title=Neuropathology of mitochondrial diseases |journal=Bioscience Reports |volume=27 |issue=1–3 |pages=23–30 |year=2007 |pmid=17541738 |doi=10.1007/s10540-007-9034-3 |s2cid=36830289 }}</ref>

===History===
While pathology has been studied for millennia only within the last few hundred years has medicine focused on a tissue- and organ-based approach to tissue disease. In 1810, [[Thomas Hodgkin]] started to look at the damaged tissue for the cause. This was conjoined with the emergence of microscopy and started the current understanding of how the tissue of the human body is studied.<ref>{{cite journal |last1=van den Tweel |first1=Jan G. |last2=Taylor |first2=Clive R. |title=A brief history of pathology |journal=Virchows Archiv |volume=457 |issue=1 |pages=3–10 |year=2010 |pmid=20499087 |pmc=2895866 |doi=10.1007/s00428-010-0934-4 }}</ref>

==Neuroanesthesia==
Neuroanesthesia is a field of [[anesthesiology]] which focuses on neurosurgery. Anesthesia is not used during the middle of an "awake" brain surgery. Awake brain surgery is where the patient is conscious for the middle of the procedure and sedated for the beginning and end. This procedure is used when the tumor does not have clear boundaries and the surgeon wants to know if they are invading on critical regions of the brain which involve functions like talking, [[cognition]], vision, and hearing. It will also be conducted for procedures which the surgeon is trying to combat [[Epileptic seizure|epileptic]] seizures.<ref>{{Cite web | url=http://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/ionm/types/intraoperative-brain-mapping.html | title=Awake Brain Surgery (Intraoperative Brain Mapping) &#124; Imaging Services &#124; Johns Hopkins Intraoperative Neurophysiological Monitoring Unit (IONM) | date=26 April 2022 | access-date=12 February 2016 | archive-date=28 April 2021 | archive-url=https://web.archive.org/web/20210428074903/https://www.hopkinsmedicine.org/neurology_neurosurgery/centers_clinics/ionm/types/intraoperative-brain-mapping.html | url-status=live | last1=Kieffer | first1=Sara }}</ref>

===History===
The physician [[Hippocrates]] (460–370 BCE) made accounts of using different wines to [[Sedation|sedate]] patients while trepanning. In 60 CE, [[Pedanius Dioscorides|Dioscorides]], a physician, pharmacologist, and botanist, detailed how [[mandrake]], [[Hyoscyamus niger|henbane]], [[opium]], and alcohol were used to put patients to sleep during trepanning. In 972 CE, two brother surgeons in [[Paramara dynasty|Paramara]], now India, used "samohine" to sedate a patient while removing a small tumor, and awoke the patient by pouring onion and vinegar in the patient's mouth. The combination of carbon dioxide, hydrogen, and nitrogen, was a form of neuroanesthesia adopted in the 18th century and introduced by [[Humphry Davy]].<ref>{{cite journal |last1=Chivukula |first1=Srinivas |last2=Grandhi |first2=Ramesh |last3=Friedlander |first3=Robert M. |title=A brief history of early neuroanesthesia |journal=Neurosurgical Focus |volume=36 |issue=4 |pages=E2 |year=2014 |pmid=24684332 |doi=10.3171/2014.2.FOCUS13578 |doi-access=free }}</ref>

==Neurosurgery methods==
{{Infobox medical intervention
| Name        = Neurosurgery
| Image       =
| Caption     =
| ICD10       = {{ICD10PCS|00|0/0}}-{{ICD10PCS|01|0/1}}
| ICD9        = {{ICD9proc|01}}–{{ICD9proc|05}}
| MeshID      = D019635
| OPS301      = {{OPS301|5-01...5-05}}
| OtherCodes  =
| HCPCSlevel2 =
}}

Various Imaging methods are used in modern neurosurgery diagnosis and treatment. They include [[X-ray computed tomography|computer assisted imaging computed tomography (CT)]], [[magnetic resonance imaging]] (MRI), [[positron emission tomography]] (PET), [[magnetoencephalography]] (MEG), and [[stereotactic radiosurgery]]. Some neurosurgery procedures involve the use of intra-operative MRI and functional MRI.<ref>{{Cite book|title=Neuroradiology Companion: Methods, Guidelines, and Imaging Fundamentals |edition=3rd |last=Castillo |first=Mauricio |publisher=Lippincott Williams & Wilkins |year=2005 |location=Philadelphia |pages=1–428}}</ref>

In ''conventional neurosurgery'' the neurosurgeon opens the skull, creating a large opening to access the brain. Techniques involving smaller openings with the aid of microscopes and endoscopes are now being used as well. Methods that utilize small [[Craniotomy|craniotomies]] in conjunction with high-clarity microscopic visualization of neural tissue offer excellent results. However, the open methods are still traditionally used in trauma or emergency situations.<ref name="neurosurgery.org cybermuseum microneurohall jhardy"/><ref name=neurosurgery-surgical-power-tool/>

''Microsurgery'' is utilized in many aspects of neurological surgery. Microvascular techniques are used in EC-IC bypass surgery and in restoration [[carotid endarterectomy]]. The clipping of an aneurysm is performed under microscopic vision. [[Minimally-invasive procedures|Minimally-invasive]] spine surgery utilizes microscopes or endoscopes. Procedures such as microdiscectomy, [[laminectomy]], and artificial disc replacement rely on microsurgery.<ref name="stealthsurgical.com department neurosurgical"/>

Using ''stereotaxy'' neurosurgeons can approach a minute target in the brain through a minimal opening. This is used in functional neurosurgery where electrodes are implanted or [[gene therapy]] is instituted with high level of accuracy as in the case of Parkinson's disease or Alzheimer's disease. Using the combination method of open and stereotactic surgery, intraventricular hemorrhages can potentially be evacuated successfully.<ref name=technology-increases-precision-safety-during-neurosurgery/> Conventional surgery using image guidance technologies is also becoming common and is referred to as surgical navigation, computer-assisted surgery, navigated surgery, stereotactic navigation. Similar to a car or mobile Global Positioning System (GPS), image-guided surgery systems, like Curve Image Guided Surgery and StealthStation, use cameras or electromagnetic fields to capture and relay the patient's anatomy and the surgeon's precise movements in relation to the patient, to computer monitors in the operating room. These sophisticated computerized systems are used before and during surgery to help orient the surgeon with three-dimensional images of the patient's anatomy including the tumor.<ref>{{cite journal|author1=Duan, Zhaoliang |author2=Yuan, Zhi-Yong |author3=Liao, Xiangyun |author4=Si, Weixin |author5=Zhao, Jianhui |title=3D Tracking and Positioning of Surgical Instruments in Virtual Surgery Simulation |volume=6 |issue=6 |pages=502–509 |date=2011 |journal=Journal of Multimedia |doi=10.4304/jmm.6.6.502-509}}</ref> Real-time functional brain mapping has been employed to identify specific functional regions using [[electrocorticography]] (ECoG)<ref>{{cite journal|author1=Swift, James |author2=Coon, William |author3=Guger, Christoph |author4=Brunner, Peter |author5=Bunch, M |author6=Lynch, T |author7=Frawley, T |author8=Ritaccio, Anthony |author9=Schalk, Gerwin |title=Passive functional mapping of receptive language areas using electrocorticographic signals |volume=6 |issue=12 |pages=2517–2524 |date=2018 |journal=Clinical Neurophysiology |doi=10.1016/j.clinph.2018.09.007|pmid=30342252 |pmc=6414063}}</ref>

Minimally invasive ''endoscopic surgery'' is commonly utilized by neurosurgeons when appropriate. Techniques such as [[endoscopic endonasal surgery]] are used in pituitary tumors, [[craniopharyngioma]]s, chordomas, and the repair of cerebrospinal fluid leaks. Ventricular endoscopy is used in the treatment of intraventricular bleeds, hydrocephalus, [[colloid cyst]] and [[neurocysticercosis]]. Endonasal endoscopy is at times carried out with neurosurgeons and ENT surgeons working together as a team.<ref>{{Cite web |title=Endoscopic Endonasal Approach (EEA) {{!}} Neurological Surgery {{!}} University of Pittsburgh |url=https://www.neurosurgery.pitt.edu/centers/cranial-base/eea |access-date=2025-11-10 |website=www.neurosurgery.pitt.edu}}</ref><ref>{{Cite web |title=Minimally Invasive Surgery Program - Pituitary & Skull Base Tumor {{!}} UCLA Health |url=https://www.uclahealth.org/medical-services/neurosurgery/pituitary-skull-base-tumor/treatment-options/minimally-invasive-surgery-program |access-date=2025-11-10 |website=www.uclahealth.org |language=en}}</ref>

Repair of craniofacial disorders and disturbance of cerebrospinal fluid circulation is done by neurosurgeons who also occasionally team up with maxillofacial and plastic surgeons. Cranioplasty for [[craniosynostosis]] is performed by pediatric neurosurgeons with or without plastic surgeons.<ref>{{Citation|author=Albright, L. |author2=Pollack, I. |author3=Adelson, D. |year=2015 |title=Principles and practice of pediatric neurosurgery |edition=3rd |publisher=Thieme Medical Publishers, Inc.}}</ref>

Neurosurgeons are involved in ''stereotactic radiosurgery'' along with radiation oncologists in [[tumor]] and [[arteriovenous malformation|AVM]] treatment. Radiosurgical methods such as [[Gamma knife]], [[Cyberknife (device)|Cyberknife]] and [[Novalis radiosurgery|Novalis Radiosurgery]] are used as well.<ref name="brown BI108 neurology">{{Cite web |title=Neurosurgery |url=https://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/neurology.html |archive-url=https://web.archive.org/web/20130605215617/http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/neurology.html |archive-date=June 5, 2013 |website=Division of Biology and Medicine, [[Brown University]] |access-date=February 11, 2016 |url-status=dead }}</ref>

''[[Interventional neuroradiology|Endovascular neurosurgery]]'' utilize endovascular image guided procedures for the treatment of [[aneurysm]]s, AVMs, [[Carotid artery stenosis|carotid stenosis]], strokes, and spinal malformations, and vasospasms. Techniques such as [[angioplasty]], stenting, clot retrieval, embolization, and diagnostic angiography are endovascular procedures.<ref>{{Cite web | url=http://www.mir.wustl.edu/neurorad/internal.asp?NavID=74 | title=Neuroradiology Patients & Families: Washington University Radiologist | access-date=2010-06-20 | archive-date=2010-06-02 | archive-url=https://web.archive.org/web/20100602213247/http://www.mir.wustl.edu/neurorad/internal.asp?NavID=74 | url-status=dead }}</ref>

A common procedure performed in neurosurgery is the placement of ventriculo-peritoneal shunt (VP shunt). In pediatric practice this is often implemented in cases of congenital [[hydrocephalus]]. The most common indication for this procedure in adults is normal pressure hydrocephalus (NPH).<ref>{{Citation|last=Kombogiorgas|first=D.|title=The cerebrospinal fluid shunts}} New York: Nova Medical. 2016</ref>

''Neurosurgery of the spine'' covers the cervical, thoracic and lumbar spine. Some indications for spine surgery include spinal cord compression resulting from trauma, arthritis of the spinal discs, or spondylosis. In cervical cord compression, patients may have difficulty with gait, balance issues, and/or numbness and tingling in the hands or feet. [[Spondylosis]] is the condition of spinal disc degeneration and arthritis that may compress the spinal canal. This condition can often result in bone-spurring and [[Spinal disc herniation|disc herniation]]. Power drills and special instruments are often used to correct any compression problems of the spinal canal. Disc herniations of spinal vertebral discs are removed with special [[rongeur]]s.  This procedure is known as a ''discectomy''. Generally once a disc is removed it is replaced by an implant which will create a bony fusion between vertebral bodies above and below. Instead, a mobile disc could be implanted into the disc space to maintain mobility. This is commonly used in cervical disc surgery. At times instead of disc removal a Laser discectomy could be used to decompress a nerve root. This method is mainly used for lumbar discs. ''Laminectomy'' is the removal of the [[Lamina of the vertebral arch|lamina]] of the vertebrae of the spine in order to make room for the compressed nerve tissue.<ref>{{Cite web|title=Laminectomy - Health Encyclopedia - University of Rochester Medical Center|url=https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=92&contentid=P07681|access-date=2021-05-06|website=www.urmc.rochester.edu}}</ref>

Surgery for chronic pain is a sub-branch of functional neurosurgery. Some of the techniques include implantation of deep brain stimulators, spinal cord stimulators, peripheral stimulators and pain pumps.<ref>{{Cite web|title=How Neurosurgeons Treat Chronic Pain|url=https://www.aans.org/|access-date=2021-05-06|website=www.aans.org|language=en|archive-date=2021-04-22|archive-url=https://web.archive.org/web/20210422023706/https://www.aans.org/|url-status=live}}</ref>

Surgery of the peripheral nervous system is also possible, and includes the very common procedures of carpal tunnel decompression and peripheral nerve transposition. Numerous other types of nerve entrapment conditions and other problems with the peripheral nervous system are treated as well.<ref>{{Cite journal|last=Cutts|first=Steven|date=January 2007|title=Cubital tunnel syndrome|journal=Postgraduate Medical Journal|volume=83|issue=975|pages=28–31|doi=10.1136/pgmj.2006.047456|issn=0032-5473|pmc=2599973|pmid=17267675}}</ref>

==Conditions==
Conditions treated by neurosurgeons include, but are not limited to:<ref>{{Cite book|title=Handbook of neurosurgery|last=Greenberg.|first=Mark S.|date=2010-01-01|publisher=Greenberg Graphics|isbn=978-1-60406-326-4|oclc=892183792}}</ref>
* [[Meningitis]] and other central nervous system infections including [[abscess]]es
* [[Spinal disc herniation]]
* [[Cervical spinal stenosis]] and [[Lumbar spinal stenosis]]
* [[Hydrocephalus]]
* [[Head trauma]] (brain hemorrhages, skull fractures, etc.)
* [[Spinal cord trauma]]
* [[Physical trauma|Traumatic injuries]] of [[peripheral nervous system|peripheral nerves]]
* [[Tumor]]s of the spine, [[spinal cord]] and [[peripheral nervous system|peripheral nerves]]
* Intracerebral hemorrhage, such as [[subarachnoid hemorrhage]], interdepartmental, and intracellular [[hemorrhage]]s
* Some forms of [[drug-resistant epilepsy]]
* Some forms of [[movement disorder]]s (advanced [[Parkinson's disease]], [[chorea]]){{spaced ndash}}this involves the use of specially developed minimally invasive [[stereotaxy|stereotactic]] techniques (functional, stereotactic neurosurgery) such as [[ablative surgery]] and [[deep brain stimulation]] surgery
* Intractable pain of [[cancer]] or [[Physical trauma|trauma]] patients and cranial/peripheral nerve pain
* Some forms of intractable [[psychiatric]] disorders
* Vascular malformations (i.e., [[arteriovenous malformation]]s, venous angiomas, [[cavernous angioma]]s, capillary telangectasias) of the brain and spinal cord
* [[Moyamoya disease]]

== Recovery ==

=== Postoperative pain ===
Pain following brain surgery can be significant and may lengthen recovery, increase the amount of time a person stays in the hospital following surgery, and increase the risk of complications following surgery.<ref name=":0">{{Cite journal|last1=Galvin|first1=Imelda M.|last2=Levy|first2=Ron|last3=Day|first3=Andrew G.|last4=Gilron|first4=Ian|date=November 21, 2019|title=Pharmacological interventions for the prevention of acute postoperative pain in adults following brain surgery|journal=The Cochrane Database of Systematic Reviews|volume=2019|issue=11|doi=10.1002/14651858.CD011931.pub2|issn=1469-493X|pmc=6867906|pmid=31747720}}</ref> Severe acute pain following brain surgery may also increase the risk of a person developing a chronic post-[[craniotomy]] headache.<ref name=":0" /> Approaches to treating pain in adults include treatment with nonsteroidal anti‐inflammatory drugs ([[Nonsteroidal anti-inflammatory drug|NSAIDs]]), which have been shown to reduce pain for up to 24 hours following surgery.<ref name=":0" /> Low-quality evidence supports the use of the medications [[dexmedetomidine]], [[pregabalin]] or [[gabapentin]] to reduce post-operative pain.<ref name=":0" /> Low-quality evidence also supports scalp blocks and scalp infiltration to reduce postoperative pain.<ref name=":0" /> [[Gabapentin]] or [[pregabalin]] may also decrease [[vomiting]] and [[nausea]] following surgery, based on very low-quality medical evidence.<ref name=":0" />

==Notable neurosurgeons==

* [[Harvey Cushing]]{{spaced ndash}}known as one of the founders of modern neurosurgery.
* [[Walter Dandy]]{{spaced ndash}}known as one of the founders of modern neurosurgery.
* [[Victor Horsley]]{{spaced ndash}}known as the first neurosurgeon.
* [[Sofia Ionescu|Sofia Ionescu-Ogrezeanu]]{{spaced ndash}}known as the first woman neurosurgeon.<ref>{{Cite web |title=The Professionals, by Eugenia Voda, Interview with Sofia Ionescu-Ogrezeanu | website=[[YouTube]] | date=September 2021 |url=https://www.youtube.com/watch?v=cIVxhsa3lko}}</ref> As a medical student at the University of Bucharest, she performed her first neurosurgical procedure in 1944, under the supervision of Dumitru Bagdasar, and saved the life of an 8-year old comatose boy with an epidural hematoma (during the WWII bombardment of Bucharest).<ref>{{Cite web |title=Sofia Ionescu-Ogrezeanu - Bio |url=https://www.eans.org/page/SofiaIonescu-Ogrezeanu-Bio |website=www.eans.org}}</ref>
* [[Hermann Schloffer]] invented [[transsphenoidal surgery]] in 1907.
* [[Wilder Penfield]]{{spaced ndash}}known as one of the founding fathers of modern neurosurgery, and pioneer of [[epilepsy]] Neurosurgery.
* [[Lars Leksell]]{{spaced ndash}}Swedish neurosurgeon who developed the [[Gamma Knife]].  
* [[Wirginia Maixner]]{{spaced ndash}}pediatric neurosurgeon at Melbourne's [[Royal Children's Hospital]]. Primarily known for separating conjoined [[Bangladesh]]i twins, Trishna and Krishna.
* [[Saleem Abdulrauf]] – developed "awake" craniotomy for complex aneurysms and vascular malformations.
* [[John R. Adler]]{{spaced ndash}}[[Stanford University]] neurosurgeon who invented the [[Cyberknife (device)|Cyberknife]].
* [[Alim-Louis Benabid]]{{spaced ndash}}known as one of the developers of [[deep brain stimulation]] surgery for movement disorder.
* [[Ben Carson]]{{spaced ndash}}retired pediatric neurosurgeon from [[Johns Hopkins Hospital]], pioneer in [[hemispherectomy]], and pioneer in the separation of [[craniopagus twins]] (joined at the head); former [[2016 Republican Party presidential candidates|2016 Republican Party presidential candidate]], and former [[United States Secretary of Housing and Urban Development]] under the [[First presidency of Donald Trump|Presidency of Donald Trump]].
* [[Henry Marsh (neurosurgeon)|Henry Marsh]] – leading English neurosurgeon and pioneer of neurosurgical advancements in Ukraine
* [[Frank Henderson Mayfield]]{{spaced ndash}}invented the Mayfield skull clamp.
* [[B. K. Misra]] –  First neurosurgeon in the world to perform [[image-guided surgery]] for [[Intracranial aneurysm|aneurysm]]s, first in South Asia to perform [[stereotactic radiosurgery]], first in India to perform [[awake craniotomy]] and [[laparoscopic]] spine surgery.<ref>{{Cite web |title=Past Presidents.pmd |url=http://www.neurosocietyindia.org/site/Past-president/Basant%20Kumar%20Misra,%20President%20NSI%202008.pdf |url-status=usurped |archive-url=https://web.archive.org/web/20230718013300/https://www.neurosocietyindia.org/site/Past-president/Basant%20Kumar%20Misra,%20President%20NSI%202008.pdf |archive-date=18 July 2023 |website=[[Neurological Society of India]]}}</ref>
* [[Karin Muraszko]]{{spaced ndash}}first woman to occupy a chair of neurosurgery at an American medical school ([[University of Michigan]]).
* [[Hirotaro Narabayashi]]{{spaced ndash}}a pioneer of stereotactic Neurosurgery.
* [[Ayub K. Ommaya]]{{spaced ndash}}invented the Ommaya reservoir.
* [[Christopher Duntsch]] – Former neurosurgeon who killed or maimed nearly every patient he operated on before being incarcerated.

* [[Ludvig Puusepp]]{{spaced ndash}}known as one of the founding fathers of modern neurosurgery, world's first professor of neurosurgery.
* [[Joseph Ransohoff]]{{spaced ndash}}known for his pioneering use of [[medical imaging]] and [[catheterization]] in neurosurgery, and for founding the first neurosurgery intensive care unit.
* [[Majid Samii]]{{spaced ndash}}pioneer of cerebello-pontine angle tumor surgery. World Federation of Neurosurgical Societies coined a medal of honor bearing Samii's name which would be given to outstanding neurosurgeons every two years.<ref>{{Cite web |title=Madjid Samii Medal of Honor |url=https://www.bbraun.co.za/en/products-and-therapies/neurosurgery1/madjid-samii-medal-of-honor.html |access-date=2025-03-09 |website=www.bbraun.co.za |language=en}}</ref>
* [[Juliet Sekabunga Nalwanga]] – Uganda's first woman neurosurgeon.
* [[Robert Wheeler Rand]]{{spaced ndash}} among the first to introduce the surgical microscope into neurosurgical procedures in 1957 and published first textbook on Microneurosurgery in 1969.
* [[Robert J. White]] – Established the Vatican's Commission on Biomedical Ethics in 1981 after his appointment to the [[Pontifical Academy of Sciences]] and was famous for his head transplants on living monkeys.<ref>{{Cite web|last1=Segall|first1=Grant|last2=Dealer|first2=The Plain|date=2010-09-16|title=Dr. Robert J. White, famous {{sic|nolink=y|reason=error in source|neurosurgeron}} and ethicist, dies at 84|url=https://www.cleveland.com/obituaries/2010/09/dr_robert_j_white_was_a_world-.html|access-date=2021-05-24|website=cleveland|language=en|archive-date=2021-02-28|archive-url=https://web.archive.org/web/20210228133518/https://www.cleveland.com/obituaries/2010/09/dr_robert_j_white_was_a_world-.html|url-status=live}}</ref><ref>{{Cite web|last=Mims|first=Christopher|title=First-ever human head transplant is now possible, says neuroscientist|url=https://qz.com/99413/first-ever-human-head-transplant-is-now-possible-says-neuroscientist/|access-date=2021-05-24|website=Quartz|date=July 2013|language=en|archive-date=2013-07-01|archive-url=https://web.archive.org/web/20130701165530/https://qz.com/99413/first-ever-human-head-transplant-is-now-possible-says-neuroscientist/|url-status=live}}</ref>
* [[Gazi Yaşargil]]{{spaced ndash}}known as the father of microneurosurgery.
* [[Mohana Rao Patibandla]] is known for performing India's first [[Minimally invasive surgery|invasive brain surgery]] using the BrainPath system.<ref>{{Cite news |title=Guntur doctors perform minimally invasive surgery using BrainPath technology |url=https://www.thehindu.com/news/national/andhra-pradesh/guntur-doctors-perform-minimally-invasive-surgery-using-brainpath-technology/article67991176.ece |work=The Hindu |date=15 July 2024 |access-date=29 July 2025 |language=en}}</ref><ref>{{Cite news |title=Dr. Mohana Rao Patibandla leads Dr Rao's Hospital in pioneering minimally invasive brain surgery with BrainPath system, a first in Guntur and India |url=https://health.economictimes.indiatimes.com/news/hospitals/dr-mohana-rao-patibandla-leads-dr-raos-hospital-in-pioneering-minimally-invasive-brain-surgery-with-brainpath-system-a-first-in-guntur-and-india/108948375 |work=ET HealthWorld |publisher=The Economic Times |date=6 April 2024 |access-date=29 July 2025 |language=en}}</ref>

== Bioethics in neurosurgery ==
Neurosurgery is a part of practical [[medicine]] and the only specialty that involves invasive intervention in the activity of the living brain. The brain ensures the structural and functional integrity of the body and the implementation of all the main life processes of the body. Therefore, neurosurgery faces a wide range of bioethical issues and a significant selection of the latest [[Medical treatment|treatment]] technologies.<ref name="ModernProblems2009">{{Cite book |last=Moroz |first=V.A. |title=Suchasni problemy bioetyky |publisher=Akademperiodyka |year=2009 |isbn=978-966-615-333-6 |language=uk |trans-title=Modern problems of bioethics}}</ref>

Neurosurgery has the following applied scientific and ethical problems:

* Ethical and legal aspects of [[clinical research]];
* Αxiological deficit due to [[professional deformation]] and [[professional burnout]];
* Limited access to expensive medical services;
* The industry-specific problem of "[[medical error]]" due to the complexity of neurosurgical [[pathologies]] and the huge number of possible technologies and tools for their [[Medical treatment|treatment]];
* Controversial bioethical and legal issues of surgery for the treatment of [[psychiatric diseases]];
* Bioethical discussions regarding the instrumentation of [[reconstructive surgery]], through the use of experimental technologies;
* Debatable bioethical issues of improving human brain activity with the help of artificial [[Implant (medicine)|implants]], for instance neurocomponents (artificial impulse quasi-[[neuron]]s);
* [[Cyborgization]] in [[transhumanism]] meaning;<ref>{{Cite journal |last1=Jiménez-Ponce |first1=F. |last2=García-Muñoz |first2=L. |last3=Carrillo-Ruiz |first3=J. D. |date=2015-01-01 |title=The role of bioethics in the neurosurgical treatment of psychiatric disorders |url=http://www.elsevier.es/en-revista-revista-medica-del-hospital-general-325-articulo-the-role-bioethics-in-neurosurgical-S0185106315000190 |journal=Revista Médica del Hospital General de México |language=en |volume=78 |issue=1 |pages=47–54 |doi=10.1016/j.hgmx.2015.04.001 |issn=0185-1063 |access-date=2024-06-02 |archive-date=2024-06-02 |archive-url=https://web.archive.org/web/20240602172819/https://www.elsevier.es/en-revista-revista-medica-del-hospital-general-325-articulo-the-role-bioethics-in-neurosurgical-S0185106315000190 |url-status=live |doi-access=free }}</ref>
* Ethical issue of [[standardization]] of research protocols for testing [[neuroengineering]] means of nerve tissue [[Regeneration (biology)|regeneration]] in order to improve the [[implementation]] of experimental research results in [[clinical practice]].<ref name="ModernProblems2009" />

==See also==
{{Portal|Medicine}}
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* {{Annotated link |American Association of Neurological Surgeons}}
* {{Annotated link |Congress of Neurological Surgeons}}
* {{Annotated link |Cranial auscultation}}
* {{Annotated link |Global neurosurgery}}
* {{Annotated link |List of neurologists and neurosurgeons}}
* {{Annotated link |Polyaxial screw}}
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==References==
{{Reflist}}

{{Medicine}}
{{Central nervous system tests and procedures}}
{{Neuroscience}}
{{Authority control}}

[[Category:Neurosurgery| ]]
[[Category:Surgical specialties]]