What does a neurosurgeon do??

[cooldreams]

what exactly does a neurosurgeon do versus neurology??

thanks

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[aphistis]

what exactly does a neurosurgeon do versus neurology??

thanks

Not to be too obvious here, but the "surgeon" part is a good starting point.

 

[cooldreams]

Not to be too obvious here, but the "surgeon" part is a good starting point.

but like, what is "bread and butter neurosurgery" ??? ... remove 5 brains a day or what ?? hehe

 

[VentdependenT]

6 brains a day.

 

[SoulRFlare]

but like, what is "bread and butter neurosurgery" ??? ... remove 5 brains a day or what ?? hehe

A lot of trauma I imagine--removing clots, clipping aneurysms, etc. also, removing tumors, and maybe even microvascular decompression of the trigeminal nerve, although I'm not sure of how many ppl are trained to do this. from what I understand, most practicing neurosurgeons do spine rather than cranial.

Incidently, anyone read this article from medical economics? Insane!

 

[cooldreams]

wow.. that was a cool article... man.... tough but... pretty real....

 

[Mirror Form]

One part of the neurosurgeon's job that they seem to take very seriously is to basically walk around the hospital being asses to interns.

 

[Pir8DeacDoc]

well-known to be one of the last truly malignant medical fields.



Not to say that crap doesn't exist from place to place but apparently it's in every training program for neurosurgery. My surgical advisor suggested I not think about this unless I really knew what the training entailed.

 

[Apollyon]

When I did my neuro block my resident was actually an NSx guy doing HIS neuro time, and, I have to tell you, they are (mostly) chilled out people here, which is a FAR cry from the nasty/spazzy/uptight people I knew in NYC (I befriended several, but saw how they didn't suffer fools too much AT ALL). However, several of the NSx attendings are so aloof, it's like they're idiot savants or autistic. They live on working 100 hours per week, and (apparently) like it, since they don't show much emotion at all.

 

[Idiopathic]

Lots of spine stuff, I imagine...plenty of research and hours upon hours of microscope time...

 

[Carbon Klein]

There are a few areas of overlap between neurosurgery and neurology, such as stroke care, but for the most part, the fields are very different.

The neurosurgeon handles a lot of spine cases (50%+ even in academic practices). These include spinal stenosis, herniated disc, congenital malformation, traumatic injuries, infections and oncology, plus a few more I'm sure I missed. In regards to spine work, the neurosurgeon may manage the patient medically (ie. with pain meds, steroid injections, physical therapy) or surgically via laminectomies, fusions, foraminotomies.

Neuro-oncology is another big neurosurgical area, basically, this is the scooping out the brain tumor arena. But with the advent of gamma knife (focussed radiation) and genetic identification and treatment (via Cleveland Clinic and UCSF research), one day this field will shrink down as we will no longer have to open up your head to kill the tumor. One cool recent innovation for neurooncology (and other subset of neurosurgery as well, but I've seen this used almost exclusively in oncology cases) is the "stealth MRI". Imagine taking a series of MRIs of a patients head and then uploading it into a million dollar computer that you wheel into the operating room. Then with the patient on the OR table, you take a magnetic wand and touch it to a spot on the patient's head and the computer shows you on the MRI image of the brain where the wand is! The wand is kept sterile so that when you open up the skull and stick the wand into the brain, it'll show you where the tip of the wand is located (very approxiamate since the brain shifted with surgery, but the accuracy is good enough for brain surgery).

Neurovascular is a cool neurosurgery field with two main components: Traditional neurovascular work and endovascular work. Traditional neurovascular surgery is raunchy stuff like clipping aneurysms and extra-cranial/intra-cranial anastamosis for things like carotid stenosis and moya-moya etc. Endovascular work is new to neurosurgery, although interventional radiologist have been doing it for a long time. The main neurosurgical practice of endovascular work involves visualization of cerebral vasculature and usually placement of thrombogenic coils into the lumen of aneurysms to create a thrombus and thus sealing it off from the main vasculature (known as "coiling an aneurysm"). This is a big deal in the SUNY Buffalo program as they are known for this procedure.

Neurotrauma is a favorite area of mine in neurosurgery. It involves mainly two surgical procedures, placement of an extraventricular drain (EVD) and evacuation of blood clot (subdural, epidural etc). These are very junior resident level procedures, taking no more than 45 mins each. The rest of neurotrauma is basically critical care: intracranial pressure management and keeping the brain swelling from herniating the brain. Research is very intense in this field but little result has been fruitful.

Pediatric neurosurgery is another subfield of neurosurgery that I just don't know much about. I think they manage a lot of ventriculo-peritoneal shunts for hydrocephalus kids. They probably also do a lot of meningocoele work too, but I really don't know much about the field.

Functional neurosurgery is the newest area of neurosurgery. It is the deep-brain stimulation (DBS) field, where parkinson patients receive a "brain-pace-maker" to stimulate a ganglion in their basal ganglia to control their parkinsonian symptoms. As you can see, I know very little about this field too.

Neurology is a completely different beast. Firstly, they don't operate. Secondly, they handle cases like headaches, epilepsy, parkinsons, alzhiemers, uh...hmm...I'm sure they do more than that, but jeez, it's been almost 2 years since I've been on a neurology service! Either case, they use medicine rather than medicine/surgery on their patients. Of course, I feel that neurosurgery is more fun, but I'm very biased.

For more info on neurosurgery and neurosurgery residencies, check out www.nsmatch.com. It was started by an applicant of the 2004 match and has grown a bit.

 

[cooldreams]

wow.. thanks a lot!

 

[logos]

Lots of spine stuff, I imagine...plenty of research and hours upon hours of microscope time...

Yep...from what i've seen its mostly spinal surgery. Which has to the most aweful boring type of surgery ever...involving staring into a 2in hole for 6 hours straight using the rough equivalent of dental instruments to accomplish some rediculusly simple sounding task. Or worse yet...staring into a surgical microscope for the same period of time....with breaks for flouroscopy every 2min.....Shudder.....but then again... some people seem to really like it...

 

[Energon]

That has got to be one of the best written essays. I especially love the comment:
"when you graduate from medical school, only two people think you're a doctor: you and your mom." "The title 'intern' dictates that you know jack squat."

 

[SoulRFlare]

what exactly does a neurosurgeon do versus neurology??

thanks

Forgot to mention--neurosurgeons pay through the nose (pushing $300,000 in Illinois) for malpractice insurance while neurologists don't.

 

[ItalianScrubs]

A lot of trauma I imagine--removing clots, clipping aneurysms, etc. also, removing tumors, and maybe even microvascular decompression of the trigeminal nerve, although I'm not sure of how many ppl are trained to do this. from what I understand, most practicing neurosurgeons do spine rather than cranial.

Incidently, anyone read this article from medical economics? Insane!

Ummmm.... I don't know what everyone else thought about the article --- I thought it was entertaining --- but honestly it sounded to me like the guy that got hit in the bar was manifesting signs of an epidural hematoma. Brain trauma --> regain consciousness --> lose consciousness again shortly thereafter = = = = Lucent interval. Also rapid bleeding. The article said it was a subdural hematoma??? Must have been some punch though to fracture the guys skull for an epidural bleed -- but I suppose it's possible!
Should have described the CT better in the article -- then we could deduce the correct dx: biconcave hematoma etc...

lata - fat tony

 

[Ratch]

golly gee forbid he make it entertaining - take off your doctor glasses for a sec and drop back down to earth with the rest of us simply-minded folk!

 

[ItalianScrubs]

golly gee forbid he make it entertaining - take off your doctor glasses for a sec and drop back down to earth with the rest of us simply-minded folk!

Obviously You have no intellectual input on the matter!!!
Ur such a tool - go into primary care; but before you do ... learn something about neuroanatomy/neurology and look up what an epidural vs subdural hematoma is.

fat tony

 

[Jak Stat]

The article states that the films revealed a subdural. Lucid intervals can be associated with traumatic ASDH. Surgery revealed no epidural bleeding, large clot UNDER the dura. What more do you want? But hey, if you want to call it an epidural go ahead.

 

[ItalianScrubs]

Yes Mr. Signaling Pathway ... up to 1/3 of patients with an acute subdural hematoma can have a lucid interval before coma supervenes, but most are drowsy or comatose from the get go. A lucid interval of minutes to an hour are said to be most characteristic of acute epidural hematomas- although not common. And by the same token they are not the only cause of these lucid intervals. I missed the part about no epidural blood during the surgery but whatever... maybe you need to not be such a pretentious tightwad Jak and go play with Ratch's *******.

bests,
fat tony
"If you like my meatballs, then You'll love my sausage"

 

[ecpiii]

Hey Cool Dreams. You have inquired about a field that many love to comment on, some with elements of truth (SoulRflare, Carbon Klein) and disbelief (sledge, pir8, logos), some in a more stupid fashion than others (see Italian Scrubs, in most posts on this forum I suspect). Bottom line, it is being comfortable in the unknown and unsure. Unfortunately, this sometimes breeds dinguses, but the far majority I know are realistic doctors who are aloof not because they feel superior, but rather they are SO ****ing oveworked. How else (besides hours upon hours) do you think you get comfortable making decisions about someone's future quality of life and deciding when or when not to operate? There is often more than 50% spine, which in my opinion fulfills the "power tool" aspect of surgery quite well, sort of like being a closet orthopod, with less blood loss. The secret key to neurosurgery: hemostasis...

Good luck in your decisions.

 

[ItalianScrubs]

what was so stupid about my reply.... what I mentioned was all true --- and my original message was only put up to provoke some thinking and possible dicussion about one point of the article -- only to get responses like "gee why can't you just enjoy it" - fom ratch and then Jak Stat trying to throw in his 2 cents in a very pretentious way. and then you have the nerve to tell me that I don't have a right to be like - "piss off" -- please ... the only people I feel that should be giving advice about the field (esp one like neurosurgery) are neurosurgeons or residents. No 1st,2nd,3rd,or 4th year medical student has the sufficient experience to answer any question esp. regading lifestyle issues, what it is that they do and other of the sort. Don't ask what you can look up and when you have to ask ... ask the right people.

 

[AmebicMeningoencephalitis]

what exactly does a neurosurgeon do versus neurology??

thanks

They typically spend a significant amount of time dealing/treating (thrombolytic-thrombolysis-craniotomy-cranioplasty) with the 3rd highest cause of death: stroke. My wife had ACA/MCA severe occlusion and 20mm ICP with published 80% mortality rate and survived with brilliant neurosurgery.

 

[thedrjojo]

They typically spend a significant amount of time dealing/treating (thrombolytic-thrombolysis-craniotomy-cranioplasty) with the 3rd highest cause of death: stroke. My wife had ACA/MCA severe occlusion and 20mm ICP with published 80% mortality rate and survived with brilliant neurosurgery.

Great outcome. Worth necrobumping an 11yr old thread?

 

[Winged Scapula]

Moving to NSGY subforum.