Some Questions for Neurosurgeons.

[chemist12]

Hi there,

I was wondering, in terms of peripheral nerve surgery, how knowledge intensive is it?

The peripheral nerves travel all around the body, wouldn't that mean a neurosurgeon is required to have a good grasp of the anatomy of the entire body?

Are neurosurgeons required to stay familiar with emergency medicine? I assume that all doctors are expected to be able to intervene if they witness a care accident and they are the only medical personal available... would you feel comfortable in this situation?

Thnaks in advance.

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[neusu]

Hi there,

I was wondering, in terms of peripheral nerve surgery, how knowledge intensive is it?

The peripheral nerves travel all around the body, wouldn't that mean a neurosurgeon is required to have a good grasp of the anatomy of the entire body?

Are neurosurgeons required to stay familiar with emergency medicine? I assume that all doctors are expected to be able to intervene if they witness a care accident and they are the only medical personal available... would you feel comfortable in this situation?

Thnaks in advance.

Peripheral nerve is certainly part of neurosurgery. Depending on the program, and individual surgeon, it can range from mostly carpal tunnel decompression and sural nerve biopsies to full on brachial plexus repair or tumor resection.

Any physician has to stay familiar with emergency medicine. For the most part, if I see a car accident and am the only medical personal I would put the patient in the rescue position unless spinal cord injury is suspected, evaluate the ABCs in an ongoing basis, and wait for the paramedics to arrive. Not much can be done with out the proper tools.

 

[chemist12]

Is there any peripheral nerve surgery that is part of the core of all neurosurgery programs?

Are you able to give more details about what level of non-nervous system related anatomy backgroud is required for this?

Even carpel tunnel decompression would require a lot of knowledge regarding the anatomy and physiology of the wrist...

I also wounder if neurosurgeons may need to operate when the enteric nervous system is damaged... or is this purely the realm of general surgeons? Or perhaps no surgeons at all?

Thanks.

 

[phenylacetone]

Is there any peripheral nerve surgery that is part of the core of all neurosurgery programs?

Are you able to give more details about what level of non-nervous system related anatomy backgroud is required for this?

Even carpel tunnel decompression would require a lot of knowledge regarding the anatomy and physiology of the wrist...

I also wounder if neurosurgeons may need to operate when the enteric nervous system is damaged... or is this purely the realm of general surgeons? Or perhaps no surgeons at all?

Thanks.

I think most neurosurgery is restricted to the brain and spinal cord for a few reasons. For one, injury to these areas is likely to be catastrophic, whereas the deficit from a peripheral nerve injury is local and easier to cope with through occupational and physical therapy. Important peripheral nerve surgeries are things like tumors (schwannomas and neurofibrosarcomas) and brachial plexus injuries.

All medical students learn the anatomy of the carpal tunnel release in their first year. I'm sure most of them forget a lot of it by the time residency rolls around, but it's pretty easy to pick back up to do a simple carpal tunnel release.

Damage to the enteric nervous system can't be fixed surgically because the nerves are microscopic and buried in the wall of the intestines (Auerbach's and Meissner's plexus). These problems are dealt with using medications. Sometimes, the consequence of an enteric nervous system problem is treated by general surgeons (such as Heller myotomy for achalasia or surgical resection of Hirschsprung's disease).

 

[deleted185747]

At my hospital the spine surgeons team up with general surgeons. First the general surgeon opens the abdomen and dissects down to the spine. Then the neurosurgeon/orthopedic surgeon does the lumbar spine anterior fusion and turns it over to the general surgeon to close.

Regarding nerve damage: There are several different types of nerve injury which can be delineated via EMG/NCS. Neurapraxia, axotmesis, neurotmesis. Severed nerves regrow and the more surrounding structures are present to help guide the sprouting axon the better chance of it reaching its target. If the terminal sprout goes to the wrong area then you get a phenomen known as synkinesis where one motion causes another.