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Overview of Types of Neurosurgeons

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Neurosurgery is a broad field covering the surgical treatment of disease impacting the central and peripheral nervous system. Neurosurgeons complete 7 years of residency training. During this training, they learn the skills and techniques required to care for neurosurgical patients. Following residency, neurosurgeons can subspecialize by completing a fellowship in a specific domain of neurosurgery.

Fellowship options include vascular/endovascular neurosurgery, neurosurgical oncology, spine neurosurgery, functional neurosurgery, pediatric neurosurgery, and peripheral nerve neurosurgery. While all neurosurgeons receive training in the treatment of disorders within these domains during residency, fellowship training allows for further practice to develop mastery and better prepare neurosurgeons to manage the most complex diseases within these domains. In this series of articles, we will discuss the different types of neurosurgeons and what is included in their practice. In this summary, we briefly outline all areas of neurosurgery and encourage you to visit the links within to learn more.

During residency, neurosurgery residents work together with master surgeons who teach the skills and techniques necessary to cover the entire breadth of neurosurgery. Following residency, neurosurgeons have the option to subspecialize in a specific area of neurosurgery by completing a fellowship. A fellowship is an additional year or two of training that is focused on one specific area of neurosurgery.

During fellowship, neurosurgeons train under another neurosurgeon who has dedicated their practice and career to that specific domain of neurosurgery. While residency prepares someone to cover the entirety of neurosurgery, a fellowship is designed for specialization in one specific domain of neurosurgery. By focusing on a narrow part of neurosurgery, fellowship trained surgeons are best prepared to manage even the most challenging cases within their subfield or subspecialty.

General Neurosurgery

General neurosurgery includes the surgical treatment of disease that affects the brain, spinal cord, and peripheral nerves. General neurosurgeons are individuals who have completed 7 years of residency training after completion of 4 years of medical school. This training prepares neurosurgeons to treat a wide range of diseases including vascular disorders, brain and spine tumors, congenital abnormalities, traumatic injuries, and degenerative spine disease.

General neurosurgeons are individuals who have decided not to specialize in one specific area of neurosurgery, instead choosing to practice across the wide range of neurosurgical disorders. General neurosurgeons are most often found in underserved areas or small communities who do not necessarily have the staff or resources to support multiple subspecialists. In these instances, general neurosurgeons can provide quality care across the entirety of neurosurgery, though may decide to refer a patient to a fellowship trained subspecialist in particularly challenging cases that they do not often encounter.

Vascular Neurosurgery

Vascular neurosurgery includes the treatment of diseases involving the arteries and veins of the brain and spinal cord. This may include stroke, aneurysms, cavernous malformations, arteriovenous malformations (AVMs), and some types of brain tumors.

Vascular neurosurgeons complete 7 years of neurosurgical training before completing additional fellowship training in the treatment of vascular disease. By completing a fellowship in open or endovascular neurosurgery, individuals receive advanced training that allows them to take care of especially complex disease. Vascular neurosurgeons are most often found in large academic centers that allow them to see patients that are referred from smaller hospitals.

Vascular neurosurgeons use a combination of open surgical approaches and minimally invasive endovascular techniques to treat vascular neurological disease. Open surgical approaches involve gaining access to the brain and associated blood vessels through a traditional surgical approach called a craniotomy. A craniotomy involves removing a section of the skull and replacing it after surgery is complete. In comparison, endovascular techniques utilize wires and catheters inserted into arteries of the wrist or groin to gain access to blood vessels within the brain or spinal cord. Many vascular conditions of the brain and spinal cord can be treated with both endovascular and open approaches and a decision on which to use depends on individualized factors.

Neurosurgical Oncology

Neurosurgical oncology includes the surgical treatment of tumors involving the nervous system. Neurosurgical oncologists are neurosurgeons who have completed a neurosurgical residency followed by a fellowship in neurosurgical oncology. During this fellowship, these surgeons receive specialized training in the treatment of tumors affecting the nervous system such as gliomas, meningiomas, pituitary tumors, and acoustic neuromas.

Neurosurgical oncologists commonly work with a multi-disciplinary team of medical oncologists, radiation oncologists, neurologists, and physical medicine and rehabilitation doctors. These multi-disciplinary teams can most often be found at large academic centers that have the resources to support the complex treatment of brain tumors.

Pediatric Neurosurgery

Pediatric neurosurgery focuses on the surgical treatment of neurological and neurosurgical disease in children. Pediatric neurosurgeons complete neurosurgical residency followed by a fellowship in pediatric neurosurgery. A fellowship in pediatric neurosurgery prepares them to treat a wide range of neurological disorders in children including cancers, hydrocephalus, vascular malformations, and congenital abnormalities of the brain and spine. Pediatric neurosurgeons commonly work within multi-disciplinary teams of other physicians focused on the care of pediatric patients. These teams are most often found at large children’s hospitals.

Neurosurgical Spine

Neurosurgical spine surgery focuses on the surgical treatment of spinal disorders. Neurosurgical spine surgeons complete a fellowship in spine surgery upon completion of their neurosurgical residency. Spine neurosurgeons treat a range of pathology including spinal fractures, degenerative disease, spinal deformities, spinal tumors, and spinal infections.

There is a significant amount of overlap in expertise between neurosurgical spine surgeons and orthopedic spine surgeons. Orthopedic spine surgeons complete an orthopedic residency before completing an orthopedic spine fellowship. Orthopedic spine surgeons focus primarily on restoring the mechanics and repairing degenerative conditions impacting the spine.

Although neurosurgical spine surgeons similarly focus on restoring the proper mechanics and treating degenerative disease, they are also trained to perform surgery on the spinal cord itself. Surgery on the spinal cord includes the removal of spinal cord tumors, treatment of spinal infections, and repair of spinal congenital malformations. Due to the high prevalence of disease pertaining to the spine, neurosurgical spine surgeons may be found in a variety of different settings from large academic centers to community hospitals.

Functional Neurosurgery

Functional neurosurgery is the surgical treatment of chronic disorders that impact and interrupt a person’s day-to-day function of the brain and peripheral nerves. Following the completion of residency, functional neurosurgeons complete a fellowship that provides them with specialized training in the treatment of functional neurological disease.

This includes treatment of epilepsy, movement disorders such as Parkinson’s disease, chronic pain conditions, spasticity disorders, or psychiatric illnesses such as depression and obsessive-compulsive disorder. Functional neurosurgery is a rapidly growing field as more discoveries are continuing to be made in how surgical treatment can improve the lives of patients experiencing the relevant neurological disease.

Peripheral Nerve Neurosurgery

Peripheral nerve neurosurgery is the surgical treatment of disease involving the peripheral nervous system. The peripheral nervous system includes the nerves that exist outside of the brain and spinal cord. Upon completion of residency, peripheral nerve neurosurgeons complete a fellowship that prepares them to manage conditions that impact the peripheral nervous system such as entrapped nerves, repair of traumatically damaged nerves, chronic pain, and nerve tumors. Peripheral nerve neurosurgeons may be found at academic centers or community hospitals.

As you can see, neurosurgery is an exceptionally broad field that requires years of training. Upon completion of residency, neurosurgeons are prepared to deal with managing diseases across all spectra of neurosurgery. However, neurosurgeons can decide to complete a fellowship training program in a specific area of neurosurgery that further prepares them to take care of the most complex patients in their chosen domain.

Key Takeaways

  • Neurosurgeons complete an extensive residency training that prepares them to care for patients with disorders across the spectrum of neurosurgery.
  • Neurosurgeons can opt to complete a fellowship that provides further training to obtain a higher level of mastery, preparing them to treat the most complex of neurosurgical disease in a specific domain.