Editing Neurosurgery (section)

==Neurosurgery methods==
{{Infobox medical intervention
| Name        = Neurosurgery
| Image       =
| Caption     =
| ICD10       = {{ICD10PCS|00|0/0}}-{{ICD10PCS|01|0/1}}
| ICD9        = {{ICD9proc|01}}–{{ICD9proc|05}}
| MeshID      = D019635
| OPS301      = {{OPS301|5-01...5-05}}
| OtherCodes  =
| HCPCSlevel2 =
}}

Various Imaging methods are used in modern neurosurgery diagnosis and treatment. They include [[X-ray computed tomography|computer assisted imaging computed tomography (CT)]], [[magnetic resonance imaging]] (MRI), [[positron emission tomography]] (PET), [[magnetoencephalography]] (MEG), and [[stereotactic radiosurgery]]. Some neurosurgery procedures involve the use of intra-operative MRI and functional MRI.<ref>{{Cite book|title=Neuroradiology Companion: Methods, Guidelines, and Imaging Fundamentals |edition=3rd |last=Castillo |first=Mauricio |publisher=Lippincott Williams & Wilkins |year=2005 |location=Philadelphia |pages=1–428}}</ref>

In ''conventional neurosurgery'' the neurosurgeon opens the skull, creating a large opening to access the brain. Techniques involving smaller openings with the aid of microscopes and endoscopes are now being used as well. Methods that utilize small [[Craniotomy|craniotomies]] in conjunction with high-clarity microscopic visualization of neural tissue offer excellent results. However, the open methods are still traditionally used in trauma or emergency situations.<ref name="neurosurgery.org cybermuseum microneurohall jhardy"/><ref name=neurosurgery-surgical-power-tool/>

''Microsurgery'' is utilized in many aspects of neurological surgery. Microvascular techniques are used in EC-IC bypass surgery and in restoration [[carotid endarterectomy]]. The clipping of an aneurysm is performed under microscopic vision. [[Minimally-invasive procedures|Minimally-invasive]] spine surgery utilizes microscopes or endoscopes. Procedures such as microdiscectomy, [[laminectomy]], and artificial disc replacement rely on microsurgery.<ref name="stealthsurgical.com department neurosurgical"/>

Using ''stereotaxy'' neurosurgeons can approach a minute target in the brain through a minimal opening. This is used in functional neurosurgery where electrodes are implanted or [[gene therapy]] is instituted with high level of accuracy as in the case of Parkinson's disease or Alzheimer's disease. Using the combination method of open and stereotactic surgery, intraventricular hemorrhages can potentially be evacuated successfully.<ref name=technology-increases-precision-safety-during-neurosurgery/> Conventional surgery using image guidance technologies is also becoming common and is referred to as surgical navigation, computer-assisted surgery, navigated surgery, stereotactic navigation. Similar to a car or mobile Global Positioning System (GPS), image-guided surgery systems, like Curve Image Guided Surgery and StealthStation, use cameras or electromagnetic fields to capture and relay the patient's anatomy and the surgeon's precise movements in relation to the patient, to computer monitors in the operating room. These sophisticated computerized systems are used before and during surgery to help orient the surgeon with three-dimensional images of the patient's anatomy including the tumor.<ref>{{cite journal|author1=Duan, Zhaoliang |author2=Yuan, Zhi-Yong |author3=Liao, Xiangyun |author4=Si, Weixin |author5=Zhao, Jianhui |title=3D Tracking and Positioning of Surgical Instruments in Virtual Surgery Simulation |volume=6 |issue=6 |pages=502–509 |date=2011 |journal=Journal of Multimedia |doi=10.4304/jmm.6.6.502-509}}</ref> Real-time functional brain mapping has been employed to identify specific functional regions using [[electrocorticography]] (ECoG)<ref>{{cite journal|author1=Swift, James |author2=Coon, William |author3=Guger, Christoph |author4=Brunner, Peter |author5=Bunch, M |author6=Lynch, T |author7=Frawley, T |author8=Ritaccio, Anthony |author9=Schalk, Gerwin |title=Passive functional mapping of receptive language areas using electrocorticographic signals |volume=6 |issue=12 |pages=2517–2524 |date=2018 |journal=Clinical Neurophysiology |doi=10.1016/j.clinph.2018.09.007|pmid=30342252 |pmc=6414063}}</ref>

Minimally invasive ''endoscopic surgery'' is commonly utilized by neurosurgeons when appropriate. Techniques such as [[endoscopic endonasal surgery]] are used in pituitary tumors, [[craniopharyngioma]]s, chordomas, and the repair of cerebrospinal fluid leaks. Ventricular endoscopy is used in the treatment of intraventricular bleeds, hydrocephalus, [[colloid cyst]] and [[neurocysticercosis]]. Endonasal endoscopy is at times carried out with neurosurgeons and ENT surgeons working together as a team.{{Citation needed|date=June 2024}}

Repair of craniofacial disorders and disturbance of cerebrospinal fluid circulation is done by neurosurgeons who also occasionally team up with maxillofacial and plastic surgeons. Cranioplasty for [[craniosynostosis]] is performed by pediatric neurosurgeons with or without plastic surgeons.<ref>{{Citation|author=Albright, L. |author2=Pollack, I. |author3=Adelson, D. |year=2015 |title=Principles and practice of pediatric neurosurgery |edition=3rd |publisher=Thieme Medical Publishers, Inc.}}</ref>

Neurosurgeons are involved in ''stereotactic radiosurgery'' along with radiation oncologists in [[tumor]] and [[arteriovenous malformation|AVM]] treatment. Radiosurgical methods such as [[Gamma knife]], [[Cyberknife (device)|Cyberknife]] and [[Novalis radiosurgery|Novalis Radiosurgery]] are used as well.<ref name="brown BI108 neurology">{{Cite web |title=Neurosurgery |url=http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/neurology.html |archive-url=https://web.archive.org/web/20130605215617/http://biomed.brown.edu/Courses/BI108/BI108_2005_Groups/04/neurology.html |archive-date=June 5, 2013 |website=Division of Biology and Medicine, [[Brown University]] |access-date=February 11, 2016 |url-status=dead }}</ref>

''[[Interventional neuroradiology|Endovascular neurosurgery]]'' utilize endovascular image guided procedures for the treatment of [[aneurysm]]s, AVMs, [[Carotid artery stenosis|carotid stenosis]], strokes, and spinal malformations, and vasospasms. Techniques such as [[angioplasty]], stenting, clot retrieval, embolization, and diagnostic angiography are endovascular procedures.<ref>{{Cite web | url=http://www.mir.wustl.edu/neurorad/internal.asp?NavID=74 | title=Neuroradiology Patients & Families: Washington University Radiologist | access-date=2010-06-20 | archive-date=2010-06-02 | archive-url=https://web.archive.org/web/20100602213247/http://www.mir.wustl.edu/neurorad/internal.asp?NavID=74 | url-status=dead }}</ref>

A common procedure performed in neurosurgery is the placement of ventriculo-peritoneal shunt (VP shunt). In pediatric practice this is often implemented in cases of congenital [[hydrocephalus]]. The most common indication for this procedure in adults is normal pressure hydrocephalus (NPH).<ref>{{Citation|last=Kombogiorgas|first=D.|title=The cerebrospinal fluid shunts}} New York: Nova Medical. 2016</ref>

''Neurosurgery of the spine'' covers the cervical, thoracic and lumbar spine. Some indications for spine surgery include spinal cord compression resulting from trauma, arthritis of the spinal discs, or spondylosis. In cervical cord compression, patients may have difficulty with gait, balance issues, and/or numbness and tingling in the hands or feet. [[Spondylosis]] is the condition of spinal disc degeneration and arthritis that may compress the spinal canal. This condition can often result in bone-spurring and [[Spinal disc herniation|disc herniation]]. Power drills and special instruments are often used to correct any compression problems of the spinal canal. Disc herniations of spinal vertebral discs are removed with special [[rongeur]]s.  This procedure is known as a ''discectomy''. Generally once a disc is removed it is replaced by an implant which will create a bony fusion between vertebral bodies above and below. Instead, a mobile disc could be implanted into the disc space to maintain mobility. This is commonly used in cervical disc surgery. At times instead of disc removal a Laser discectomy could be used to decompress a nerve root. This method is mainly used for lumbar discs. ''Laminectomy'' is the removal of the [[Lamina of the vertebral arch|lamina]] of the vertebrae of the spine in order to make room for the compressed nerve tissue.<ref>{{Cite web|title=Laminectomy - Health Encyclopedia - University of Rochester Medical Center|url=https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=92&contentid=P07681|access-date=2021-05-06|website=www.urmc.rochester.edu}}</ref>

Surgery for chronic pain is a sub-branch of functional neurosurgery. Some of the techniques include implantation of deep brain stimulators, spinal cord stimulators, peripheral stimulators and pain pumps.<ref>{{Cite web|title=How Neurosurgeons Treat Chronic Pain|url=https://www.aans.org/|access-date=2021-05-06|website=www.aans.org|language=en|archive-date=2021-04-22|archive-url=https://web.archive.org/web/20210422023706/https://www.aans.org/|url-status=live}}</ref>

Surgery of the peripheral nervous system is also possible, and includes the very common procedures of carpal tunnel decompression and peripheral nerve transposition. Numerous other types of nerve entrapment conditions and other problems with the peripheral nervous system are treated as well.<ref>{{Cite journal|last=Cutts|first=Steven|date=January 2007|title=Cubital tunnel syndrome|journal=Postgraduate Medical Journal|volume=83|issue=975|pages=28–31|doi=10.1136/pgmj.2006.047456|issn=0032-5473|pmc=2599973|pmid=17267675}}</ref>