General Neurosurgery

Neurosurgeons are physicians who specialize in the diagnosis and surgical treatment of diseases and disorders of the brain (central) and nerves (peripheral nervous system). Such diseases and disorders may include congenital abnormalities, tumors, traumatic injuries, vascular pathologies and strokes, degenerative spine conditions, and infections of the brain and/or spinal cord. One of the main differences between neurologists and neurosurgeons is that neurosurgeons specialize in the surgical management of such diseases, whereas neurologists specialize in medical management of these diseases.

Neurosurgeons complete a 7-year integrated residency in their specialty, meaning that the entirety of their residency training is focused on developing clinical and scientific skillsets to diagnose and treat the aforementioned conditions. During their residency, neurosurgery trainees assist with and perform over a thousand surgical cases involving various neurosurgical pathologies and disciplines under a number of mentors (a full professor or an associate/assistant professor).

They also spend one to two years of protected time conducting research, which may be in a scientific lab or in a clinical research setting, or to pursue an enfolded-fellowship, which is dedicated time to gain deeper proficiency in a specific area of neurosurgery (such as neuro-oncology, skull base, pediatrics, neurovascular, spine, functional and stereotactic, etc.). 

Given that neurosurgeons receive training in all areas of neurosurgery, general neurosurgeons can practice broadly by diagnosing and surgically treating diseases and disorders of the brain, spine, and peripheral nervous system. General neurosurgeons may be found in a variety of settings, from academic centers to community hospitals to private practices. Neurosurgeons may encounter their patients in the clinic setting, where the patients are referred to the neurosurgeon for evaluation of a neurosurgical diagnosis or symptom.

Patients may also be encountered in the Emergency Room setting, where they present due to an emergent issue such as trauma, stroke, or other rapidly developing neurological issue. Most neurosurgeons may partake in “call” or “coverage,” which is when the neurosurgeon is available to respond to any neurosurgical evaluation or emergency that needs to be rapidly attended to.

As far as availability for second opinions, different trends are seen in different health systems. For example, academic centers may have longer waitlists for a particular neurosurgeon who conducts research, is involved in teaching, and also performs surgery. However private practice neurosurgeons are often mostly clinical physicians, seeing patients in clinic and performing surgeries, so they may have shorter waitlists to see patients. Moreover, urban centers may have a higher density of neurosurgeons and therefore more opportunities to obtain a second opinion than in the rural setting.

In the era of tele-medicine which has greatly evolved during and after the COVID pandemic, it has become easier to get on the phone or a computer to chat with a consultant neurosurgeon. General neurosurgeons are especially valuable in rural or medically underserved areas, where they may encounter a broad range of diseases, so their clinical practice may include various areas of neurosurgery in any given day or week. However, in particularly challenging and rare cases, general neurosurgeons may choose to refer the patient to a subspecialist neurosurgeon who has earned a fellowship in a more specific area of neurosurgery.

After 7 years of training, neurosurgeons may choose to pursue a clinical fellowship, which allows them to spend extra time subspecializing in one of the specific areas of neurosurgery mentioned previously. Neurosurgical subspecialists often practice primarily in their subspecialty field, such as pediatric neurosurgeons performing surgery mostly on children, albeit being trained broadly to treat adults and children.

Neurosurgeons, whether general or subspecialized, often work in collaboration with other healthcare professionals. For example, a neurosurgeon may perform surgery to remove a brain tumor and will work with radiation oncologists who can perform radiation treatments to supplement the surgical removal of the tumor and improve patient outcomes.

On a day-to-day basis, neurosurgeons consult various physicians from other fields, such as radiologists whilst interpreting challenging brain or spine scans, neurologists whilst managing a disease that has surgical and medical implications, and palliative care physicians whilst managing a terminally ill patient.

Moreover, in the operating room, neurosurgeons work closely with ear, nose, and throat (ENT) surgeons to approach tumors of the skull-base region. They also work with plastic surgeons to tackle complex wound closures, and with general surgeons to gain surgical access to the anterior part of the spine through the chest or abdomen.

As previously stated, general neurosurgeons can treat a wide range of diseases and disorders of the central and peripheral nervous system. Such pathologies may include but are not limited to: benign and malignant brain tumors (i.e., Gliomas, Meningiomas, Pituitary tumors, Craniopharyngiomas, Acoustic neuromas, and Ependymomas), vascular disease (Brain Aneurysms as well as AVMs and Cavernous Malformations), brain trauma (i.e., Epidural Hematoma, Subdural Hematoma, Subarachnoid Hemorrhage, Intraparenchymal Hemorrhage, and Diffuse axonal injury), bony spine and spinal cord tumors (i.e., Chordoma, Chondrosarcoma, Spinal Metastatic Tumors, and Schwannomas), stroke (i.e., Hemorrhagic or Ischemic Strokes), and spine trauma and degeneration (i.e., Injured Spinal Cord, Herniated Discs, and Scoliosis).

There are many more diseases and disorders treated by neurosurgeons and their multidisciplinary teams, and as always patients are encouraged to do their research on which neurosurgeon, whether general or subspecialized, best fulfills their needs, and in what clinical setting they should receive their care (academic center, community hospital, or private practice).

• Neurosurgeons treat surgical conditions of the brain, spine, and peripheral nervous system. Although many neurosurgeons treat a broad array of diseases in their respective field, some neurosurgeons have more expertise in certain aspects of their profession.