How much neurology in neurosurgery?

[Gravel&Porphyry]

Hi there 🙂

I'm just wondering how much clinical neurology you are able or need to pick up during neurosurgery residency, and how much you might actually use as an attending neurosurgeon, for instance in epilepsy surgery or neurosurgical oncology. Do you tend to maintain a high level of physical examination skills?

Thank you.

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[liquidshadow22]

Sure exam skills but clinical neurology isnt that important for a neurosurgeon. Neurology treats many diff dz than neurosurgery. Neurosurgeons don't need to titrate AEDs or rx the chemotherapy for a gbm pt. Neurosurgeons are there to surgerize.

 

[kitsunepixie]

Exam skills are definitely important.

Neurosurgery boards also love to include Neurology cases. It's important for neurosurgeons be able to recognize a non-surgical neurologic condition from a surgical one. You don't want to take a ring-enhancing lesion to the OR thinking that it's a GBM and it's actually a demyelinating plaque or ischemic stroke, for instance. Many functional neurosurgeons treat neurological diseases such as Parkinson's and Essential Tremor, and are getting into psychiatric conditions as well such as OCD and addiction. It's also important to know some epilepsy because sometimes neurosurgical patients have seizures, and some neurosurgeons subspecialize in surgical treatments of epilepsy.

 

[neusu]

As a resident, neurology and neurocritical care are required rotations.

Knowing the signs and exam findings for less common disorders can be amusing, but at the end of the day, there is not much actual neurology in the day to day practice of neurosurgery.

 

[Jenghiz_Khaan]

To be honest, very little. Neurosurgery for the most part deals with purely surgical diseases of the nervous system, while neurology deals with a wider (and arguably more interesting) array of neurological conditions, from a medical perspective. Neurosurgeons will generally have little time to treat such disorders clinically and most never touch the main components that neurologists deal with regularly. The physical exam will have to be understood, but anything beyond that is what really separates the two fields. Neurosurgeons and neurologists as a result also tend to have individual referrals.

 

[longhaul3]

Hi there 🙂

I'm just wondering how much clinical neurology you are able or need to pick up during neurosurgery residency, and how much you might actually use as an attending neurosurgeon, for instance in epilepsy surgery or neurosurgical oncology. Do you tend to maintain a high level of physical examination skills?

Thank you.

The beautiful thing about neurosurgery is that we have a whole separate specialty to deal with the medical disease of the nervous system. We overlap now quite a bit in stroke for those neurosurgeons at facilities with thrombectomy capability. I don't really give a **** about Japanese encephalitis or ADEM or whatever whets neurologists' collective whistle.

I think it's too simplistic of an answer just to say that there is not much clinical neurology in neurosurgical practice. The foundation of both is an understanding of the anatomy and physiology of the nervous system, so we do think about a lot of the same stuff, especially in ICU patients.

Neurosurgery without question requires the greatest mastery of the physical exam of any specialty, because you can take someone stat to the OR or make other life/death decisions based on subtle exam findings, and due to CNS injury our critically ill patients are usually poor historians at best. But what we actually care about (and therefore master) on exam is much more limited than in other specialties, so my exam skills for the other body systems are not that strong.

 

[Maskchamp]

Does this mean that a neurosurgeon can do everything a neurologist does, but a neurologist can't do everything that a neurosurgeon does? Curious.

 

[longhaul3]

Does this mean that a neurosurgeon can do everything a neurologist does, but a neurologist can't do everything that a neurosurgeon does? Curious.

No. Neurologists primarily deal with stroke, movement disorders, seizure, inflammatory/demyelinating disorders, and neuromuscular disorders. There is some overlap with neurosurgery in stroke (neurosurgeons do thrombectomy, treat carotid stenosis, and manage malignant edema following strokes), movement disorders (we place electrodes and stuff where they ask us to), epilepsy (we place electrodes and cut out bad brain), and neurocritical care (we both do that). There is also some overlap in neurooncology.

Procedure-wise the only things they do that we don't, off the top of my head, are EMG/NCS and EEG. There may be some neuro-interventional-pain specialists who do transforaminal epidural steroid injections and stuff but that's rare, usually anesthesiologists.

But I don't know much more that even the average med student about inclusion body myositis or ADEM or anti-GAD, and frankly I don't really care to. And I sure as hell can't read an EEG.

 

[Maskchamp]

No. Neurologists primarily deal with stroke, movement disorders, seizure, inflammatory/demyelinating disorders, and neuromuscular disorders. There is some overlap with neurosurgery in stroke (neurosurgeons do thrombectomy, treat carotid stenosis, and manage malignant edema following strokes), movement disorders (we place electrodes and stuff where they ask us to), epilepsy (we place electrodes and cut out bad brain), and neurocritical care (we both do that). There is also some overlap in neurooncology.

Procedure-wise the only things they do that we don't, off the top of my head, are EMG/NCS and EEG. There may be some neuro-interventional-pain specialists who do transforaminal epidural steroid injections and stuff but that's rare, usually anesthesiologists.

But I don't know much more that even the average med student about inclusion body myositis or ADEM or anti-GAD, and frankly I don't really care to. And I sure as hell can't read an EEG.

So nice to finally hear a clear answer. Starting with 'yes' or 'no' then an actual explanation. Thank you very much. I was quite curious about it to see if the neurosurgeons had the same competences as neurologists but were 'above' in terms of skills since they can also operate. Thanks again for a clear answer. Best.