Brain Surgeons & Information on Brain Surgery

A doctor who specializes in brain surgery works in the field of neurosurgery. Neurosurgical procedures are necessary for disorders of the nervous system when conservative treatments or radiation therapy are not an option—even if these forms of treatment have not been successful.

The nervous system consists of a central and a peripheral part.

The central nervous system (CNS) includes:

• The brain and
• The spinal cord

The peripheral nervous system begins with the nerve tracts that emerge from the spinal cord. As they extend, these nerve branches continue to branch out until they supply all parts of the body. Brain surgery exclusively involves the surgical treatment of brain disorders.

Neurosurgery deals with diseases of the central and peripheral nervous systems that require surgery @ romaset /AdobeStock

Like most other parts of the body, the brain is composed of a variety of tissues. As a result, potential brain disorders are diverse and arise from various causes.

Brain surgery is necessary in cases of brain tumors, nerve damage, muscle or metabolic disorders, as well as bone fractures or vascular diseases.

Common conditions that lead to brain surgery include:

• Brain tumors
• Metastases in brain tissue
• Aneurysms (dilatation of cerebral blood vessels)
• Brain injuries or nerve damage caused by accidents or trauma
• Brain hemorrhages
• Circulatory disorders of cerebrospinal fluid (CSF)
• Pituitary problems (disorders of the pituitary gland)
• Epilepsy
• Congenital malformations

To perform brain surgery, the neurosurgeon opens the patient’s skull (craniotomy). The incision does not always have to be large.

Sometimes a tiny opening near the sinuses is sufficient for the surgeon to insert instruments (endoscope). Open brain surgery is also possible.

This is necessary, for example, to completely remove a large tumor. In cases of brain swelling following trauma, the surgeon also removes part of the skull (craniectomy). This allows them to minimize pressure caused by the inflammation.

In brain surgery, the treatment method depends on the type of condition. Whether it’s a tumor, a cerebrospinal fluid drainage disorder, or epilepsy—there are specific procedures for each condition.

In epilepsy surgery and tumor treatment, the neurosurgeon must remove portions of the brain tissue.

In cases of cerebrospinal fluid drainage disorders, a ventricular puncture is sufficient to allow the fluid to drain.

Aneurysms can be sealed by the surgeon inserting a small coil into the affected blood vessel.

The treatment methods in neurosurgery are diverse.

Other specific methods include:

• Placement of shunts (for example, a cerebral shunt for hydrocephalus)
• Exposure or severing of nerves
• Sectioning of brain areas or connections (for example, in cases of severe psychiatric disorders)
• Brain stimulation with electrical impulses
• Catheter implantation

Neurosurgery employs state-of-the-art medical techniques. Every surgical procedure involves tissue trauma.

However, microsurgical techniques and intensive monitoring ensure that even the smallest blood vessels and delicate brain structures are spared.

Most treatments are computer-assisted. The neurosurgeon operates using a precise 3D image. Today, even computer-guided instrument manipulation is possible for some procedures.

Deep brain stimulation is a treatment for conditions such as Parkinson’s disease, in which doctors surgically implant fine electrodes into the patient’s brain @ Silver Place /AdobeStock

To diagnose a condition that requires neurosurgical treatment, the doctor uses various procedures.

These include:

• Medical history
• A detailed discussion with the patient and
• The physical examination

After evaluating the patient’s general health and bodily functions, the doctor expands the examination to include neurological tests. These tests can identify nerve damage or nerve dysfunction.

For brain surgery, the patient must be able to undergo anesthesia. General anesthesia is required for most neurosurgical procedures.

To ensure the anesthesia is tailored to the patient, the doctor monitors blood pressure and blood values. Measuring organ function, such as kidney and liver function, helps the anesthesiologist plan an infusion regimen to stabilize circulation.

Before surgery, the neurosurgeon must know exactly how far the disease has progressed. In the case of a malignant tumor, for example, it is crucial to determine which parts of the brain are affected.

To determine the progression of the disease and plan the surgery, the doctor uses imaging techniques.

These usually include:

• A computed tomography (CT) scan or
• Magnetic resonance imaging (MRI)

The brain is visualized in all planes. Even the smallest changes are visible and can be measured precisely.

Other diagnostic procedures for brain disorders may include:

• EEG (electroencephalogram)
• Ventriculocentesis and cerebrospinal fluid analysis
• Angiography (imaging of blood vessels)
• Ultrasound-based methods
• Positron Emission Tomography (PET)

The type of condition and the extent of the changes indicate to the neurosurgeon how large the surgical field needs to be. This determines which procedure (minimally invasive or open surgery) will be used.

For patients, any brain surgery involves a certain period of rehabilitation. After the operation, patients can expect a hospital stay of at least ten to twenty days. If a minimally invasive procedure is used, the recovery time is generally shorter.

Computed tomography (CT) is an X-ray examination that provides detailed cross-sectional images of the brain @ Yakobchuk Olena /AdobeStock

Brain surgery, a subspecialty of neurosurgery, deals with the surgical treatment of a wide range of conditions. Brain surgeons can be found in specialized hospitals. Often, these doctors focus on a specific area within head and brain surgery. 

For example, you can search for doctors who specialize in minimally invasive techniques. Others may specialize in neurotraumatology or pediatric surgery, for instance.

Brain specialists receive full authorization to practice medicine upon obtaining their medical license. Starting as a resident physician enables further training to become a board-certified neurologist. Only physicians who have completed several years of specialty training may call themselves “specialists in neurology.”

Specialty training lasts five to six years. During this training, the physician must spend at least 24 months providing inpatient neurological care. 

Furthermore, they must work for twelve months in the following settings:

• Child and adolescent psychiatry and psychotherapy
• Psychiatry and psychotherapy and/or 
• Psychosomatic medicine and psychotherapy

During their residency, they must also spend six months providing intensive care to neurological patients.