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Introduction to Neurosurgery PowerPoint Presentation

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Description : Check out this medical presentation on Neurology, which is titled "Introduction to Neurosurgery", to know about Neurosurgery.

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Published on : Aug 23, 2021 | Views : 1714 | Downloads : 3

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Slide 1-

Introduction to Neurosurgery Brian L. Hoh, MD1 and Gregory J. Zipfel, MD2 1University of Florida, 2Washington University
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Disclosures No commercial interests Acknowledgements Katie Orrico, AANS/CNS Washington Committee
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Definition of Neurosurgery
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Neurosurgery 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). American Board of Neurological Surgery, Definition of Neurological Surgery
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History of Neurosurgery
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History of Neurosurgery Evidence suggests that the first trepanations may have occurred up to 10,000 years ago 460-370 BC Hippocrates describes types of trauma in which trepanation may be performed 129-200 AD Galen describes trepanation for hydrocephalus
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History of Neurosurgery Pierre Paul Broca localizes and drains brain abscess 1876 in Paris Sir William Macewan excises meningioma in 1879, performs laminectomy in 1883
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History of Neurosurgery 1918 Walter Dandy develops pneumoencephalography 1927 Egas Moniz performs cerebral angiography 1971 Godfrey Hounsfield & Allan Cormack develop CT scan; won Nobel Prize in 1972
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History of Neurosurgery Sir Victor Horsley (1857-1916) Intraoperative cortical stimulation to localize epileptic foci Bone wax Transcranial approach to pituitary Ligation of carotid artery to treat aneurysm Intracranial division of trigeminal nerve root to treat trigeminal neuralgia Horsley-Clarke stereotactic frame
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History of Neurosurgery Harvey Cushing (1869-1939) Developed anesthesia record Cushing response to intracranial hypertension With Bovie developed electrocautery Function of the pituitary gland – Cushing’s disease Reduced mortality from neurosurgical operations from 80-90% down to 10% Father of American Neurosurgery
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History of Neurosurgery Walter Dandy (1886-1946) Trained under Cushing Described CSF physiology and hydrocephalus Developed pneumoencephalography Dandy-Walker malformation/syndrome First described clipping of cerebral aneurysm 1938
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History of Neurosurgery Wilder Penfield (1891-1976) Modernized epilepsy surgery Research utilizing intraoperative electrical cortical stimulation Published first homunculus Penfield’s syndrome
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Neurosurgery Practice Demographics
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Neurosurgeons in US Approximately 3800 practicing neurosurgeons in the US
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Demographic Profiles
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Demographic Profiles
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Maldistribution of Surgeons 25% of the U.S. population lives in county w/out a neurosurgeon 50% percent of the U.S. population lives in counties w/ 15.5% of neurosurgeons Source: American College of Surgeons Health Policy Research Institute
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Number of Neurosurgeons by Age 44% of practicing neurosurgeons over the age of 55 Source: American Board of Neurological Surgery 100 0 200 300 800 34‐39 40‐44 45‐49 50‐54 55‐59 Age Range 60‐64 65‐69 70‐74 182 718 666 667 487 359 161
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Neurosurgical Workforce Shortages Only 83% of neurosurgeons take emergency call 24/7/365 178 board certified pediatric neurosurgeons 42% will retire within the next decade Only 6 enter workforce each year, falling short of demand 305 vacant neurosurgery positions in the U.S. in 2011 192 generalists, spine‐focused neurosurgeons, or unidentified 113 subspecialists, including neurovascular, endovascular, pediatric Sources: Neurosurgery Statement to IOM ‐‐ Ensuring an Adequate Neurosurgical Workforce American Board of Neurological Surgery
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Neurosurgery Compensation Sources :NERVES 2014 report based on 2013 data
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Neurosurgery Malpractice Insurance Sources :NERVES 2014 report based on 2013 data
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Neurosurgery Residency Match Data Source: National Residency Matching Program
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Neurosurgical Subspecialties Spine Peripheral Nerve Surgery Vascular Neurosurgery (open and endovascular) Neuro-Oncology Neuroendocrinology Skull Base Neurosurgery Pediatrics Functional Neurosurgery Neurocritical Care
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Residency Training: Year 1: Internship year: May include some rotations outside neurosurgery like ICU, trauma surgery, neurology. Year 2: Junior resident: Learning the basics of neurosurgical assessment, patient management, and surgical procedures Year 3: Senior resident: Learning more advanced degrees of patient care and surgical procedures Year 4/5/6: There are frequently some permutation of pediatric neurosurgery, neurological electives, research (3mons to 2 years), and directing some services at a Chief Resident level of management Year 7: Chief Resident: Learning how to direct a large neurosurgical service, transition toward being able to independently do the routine neurosurgical procedures
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The Spectrum of Neurosurgery Residencies Residencies vary in size with some programs matching 1 resident a year up to 4 residents per year Residencies vary in regard to the cities in which they reside: Some are in large metropolitan centers with many large academic centers while others are in relatively smaller cities Residencies vary in regard to the degree of research time that is incorporated into the curriculum however research is a part of all residency programs With more than 105 programs, there are a wide range of “personalities” of residencies
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Conclusions Neurosurgery is a rewarding and intellectually stimulating career Opportunity to profoundly affect the lives of patients, often times to save lives Multiple subspecialties with diverse diseases and different types of procedures, or general neurosurgeon who can have a broad practice Current and future shortage of neurosurgeons so need for more neurosurgeons