Neurosurgery (or neurological surgery), constitutes a medical discipline and surgical specialty that provides care for adult and pediatric patients in the treatment of pain or pathological processes that may modify the function or activity of the central nervous system (e.g. brain, hypophysis, and spinal cord), the peripheral nervous system (e.g. cranial, spinal, and peripheral nerves), the autonomic nervous system, the supporting structures of these systems (e.g. meninges, skull & skull base, and vertebral column), and their vascular supply (e.g. intracranial, extracranial, and spinal vasculature).
Treatment encompasses both non-operative management (e.g. prevention, diagnosis – including image interpretation – and treatments such as, but not limited to neurocritical intensive care and rehabilitation) and operative management with its associated image use and interpretation (e.g. endovascular surgery, functional and restorative surgery, stereotactic radiosurgery, and spinal fusion – including its instrumentation.
It is a highly specialized service that, because of high costs, is often centralized.
Neurosurgery is one of the fastest developing medical specialities, and results are continuously improving through the introduction of new treatment methods. Recent major advancements in neurosurgery include the application of microsurgery, the advancements in Imaging techniques and the high quality and increased amount of a intensive care unit.
To improve the cost transparency of the local health care system, treatment cost was recently referenced to disease related groups (DRG). To define a valid case mix index (CMI), patient status at admission must be well documented. Concurrently, treatment quality must be closely monitored to provide transparency between health care providers with respect to the clinical outcome and the complications during the treatment process 1) 2) 3).
The most important changes have occured in the fields of neurooncology, vascular neurosurgery and spinal surgery. Inter-specialty collaboration is establishing itself as a model of care. These data may guide resource allocation for a population increasing both in number and in age 4)
Trephining was practiced by neolithic man. But neurosurgery as a speciality arose only during the second half of the 19th century. Its first pioneers were Sir William Macewen, Sir Victor Horsley, Fedor Krause, Antoine Chipault from France, and Ludvig Puusepp from Russia.
The leaders of the second generation were Harvey Cushing, Walter Dandy, Charles Elsberg and Charles Frazier. Mention deserve also Otfried Foerster, Thierry de Martel, Clovis Vincent, René Leriche.
In 1927 nearly every medical school had a well-organized department of neurological surgery. The pioneers have asbaulted barriers of prejudice, inexperience, and technical difficulties almost insurmountable 5).
Since the mid-1950s, neurosurgery has benefited from the remarkable progress due to tremendous advances in neuroimaging techniques, neuroanesthesia, neurostimulation, and brain-computer interfaces, as well as breakthroughs in operating microscopes and surgical instruments. Yet, this specialty has to do with delicate human structures and is hence considered as highly risky by insurance companies.
Globally, the lack of access to basic surgical care causes 3 times as much deaths as HIV/AIDS, tuberculosis, and malaria combined. The magnitude of this unmet need has been described recently, and the numbers are startling. Major shifts in global health agenda have highlighted access to essential and emergency surgery as a high priority. A broad examination of the current global neurosurgical efforts to improve access has revealed some strengths, particularly in the realm of training; however, the demand grossly outstrips the supply; most people in low-income countries do not have access to basic surgical care, either due to lack of availability or affordability. Projects that help create a robust and resilient health system within low- and middle-income countries require urgent implementation. In this context, concurrent scale-up of human resources, investments in capacity building, local data collection, and analysis for accurate assessment are essential. In addition, through process of collaboration and consensus building within the neurosurgical community, a unified voice of neurosurgery is necessary to effectively advocate for all those who need neurosurgical care wherever, whenever 6).