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neurosurgery

Neurosurgery

Neurosurgery requires certain personality traits to provide the best possible outcomes for patients. This stems from the fact that neurosurgery is one of the most complex forms of surgery and therefore demands a high level of skill, precision, confidence, and leadership capabilities. However, certain personalities and associated attitudes may be harmful to patients and could result in inferior outcomes. The belief that certain personality traits could result in potentially dangerous outcomes was first recognized in aviation, as ‘‘Arrogance got more pilots in trouble than faulty equipment1).


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.


They require precise and dexterous manipulation of a surgical suture in narrow and deep spaces in the brain. This is necessary for surgical tasks such as the anastomosis of microscopic blood vessels and dura mater suturing.

Neurosurgical procedures lead to great psychological stress. In the past decade, several strategies and techniques have been implemented in order to minimize the patient's emotional stress 2) 3).

The esthetic aspect, not considered so important in the past, is now an important feature in the recovery and the quality of life in the postoperative period 4)


Today, neurosurgery is part of the portfolio of all university hospitals. 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 5) 6) 7).

Subspecialties

Brain Tumor Surgery

Cerebrovascular Surgery

Epilepsy Surgery

Neurotraumatology

Pediatric neurosurgery

Peripheral nerve surgery

Skull Base Surgery

Spinal Neurosurgery

Functional Neurosurgery

Stereotactic Neurosurgery


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 8)

History

Books

see Books

Journal

Neurosurgery Journal

see Neurosurgery Journal

Impact Factor: 3.780

Future

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 9).

1)
Yeager C, Janos L. Yeager. New York, NY, USA: Bantam; 1985
2)
Angelini GD, Butchart EG, Armistead SH, Breckenridge IM. Comparative study of leg wound skin closure in coronary artery bypass graft operations. Thorax. 1984;39:942–5.
3)
Bekar A, Korfali E, Dogan S, Yilmazlar S, Baskan Z, Aksoy K. The effect of hair on infection after cranial surgery. Acta Neurochir (Wien) 2001;143:533–6. discussion 537.
4)
Cho J, Harrop J, Veznaedaroglu E, Andrews DW. Concomitant use of computer image guidance, linear or sigmoid incisions after minimal shave, and liquid wound dressing with 2-octyl cyanoacrylate for tumor craniotomy or craniectomy: Analysis of 225 consecutive surgical cases with antecedent historical control at one institution. Neurosurgery. 2003;52:832–40. discussion 840-1.
5)
Clark JC, Spetzler RF. Creating a Brave New World for Neurosurgery. World Neurosurgery. 2011; 75 (5):608–9. doi: 10.1016/j.wneu.2010.12.032
6)
Scho¨b O, Kocher T, Langer I. Fu¨nf Fragen an die Medizinische Qualita¨tssicherung: Die Selbststeuerung erhalten. Bulletin des me´decins suisses. 2014; 95(39):1446–8.
7)
OECD/WHO. OECD Reviews of Health Systems: Switzerland 2011.
8)
Kamat AS, Parker A. The evolution of neurosurgery: how has our practice changed? Br J Neurosurg. 2013 Dec;27(6):747-51. doi: 10.3109/02688697.2013.786805. Epub 2013 Apr 24. PubMed PMID: 23611638.
9)
Park KB, Johnson WD, Dempsey RJ. Global Neurosurgery: The Unmet Need. World Neurosurg. 2016 Apr;88:32-5. doi: 10.1016/j.wneu.2015.12.048. Epub 2015 Dec 28. PubMed PMID: 26732963.
neurosurgery.txt · Last modified: 2019/04/24 00:25 by administrador