Name: So You Want to Be a NEUROSURGEON [Ep. 6]
Uploaded: 2020-08-22T19:15:18.000Z
Duration: 17 min 46 s
Description: Thousands of YouTube videos with English-Chinese subtitles! Now you can learn to understand native speakers, expand your vocabulary, and improve your pronunciation...

So you want to be a neurosurgeon. After all, it's super badass, second only to being

a rocket surgeon. Let's debunk the public perception myths of what it means to be a

neurosurgeon, and give it to you straight. This is the reality of neurosurgery.

Welcome to our next installment in So You Want to Be. In this series, we highlight a

specific specialty within medicine, such as neurosurgery, and help you decide if it's

a good fit for you. You can find the other specialties on our So You Want to Be playlist.

A lot of you asked for neurosurgery in our poll, so that's what we're covering here.

If you want to vote in upcoming polls to decide what future specialties we cover, make sure

If you'd like to see what being a neurosurgeon looks like, check out my second channel, Kevin

Jubbal, M.D., where I do a second series in parallel called a Day in the Life. We'll

be doing a Day in the Life of a Neurosurgeon soon and you don't want to miss it. show

footage from Daniel Choi day in the life of ortho spine surgeon where he is in the operating

Neurological surgery, or neurosurgery for short, is much more than just brain surgery.

The nervous system is comprised of two main components — the central nervous system,

or CNS, and the peripheral nervous system, or PNS. Try saying that one 5 times as fast

as you can. The CNS includes the brain and spinal cord, whereas the PNS includes all

other nerves within the body. Neurosurgery deals with surgical interventions of both.

There are two overarching categories to neurosurgery: 1) Elective surgery, and 2) Emergent (i.e.

non-elective) surgery. Elective surgeries take place on a non-emergent basis, and generally

involve treating conditions that are not immediately life threatening. They tend to fall into one

of three categories: Cranial surgery, spine surgery, and peripheral nerve surgery.

Cranial surgery, as it sounds, involves operating on structures within the head (i.e. the brain).

This category can be further subdivided into a few more subcategories: tumor surgery, vascular

Tumors in the brain come in all shapes and sizes. They can be benign or malignant, slow

or fast growing, life threatening or not. Some tumors can be observed without ever needing

treatment, while others can be treated with radiation, but often, given the limited space

afforded by the human skull, and the sensitive nature of the brain's tissues, a neurosurgeon

is called upon to surgically resect a tumor in the brain.

Vascular neurosurgery involves treating abnormalities in blood vessels of the brain. Neurosurgeons

might treat an aneurysm on a vessel, or bypass a blockage or narrowing of a vessel, much

the same way you would do coronary bypass in the heart. Though rather than opening the

chest, of course, neurosurgeons work through a small hole in the skull.

Functional neurosurgery is the sexy stuff — the science fiction of the field. In functional

neurosurgery, the brain is viewed as one large complicated electrical circuit, and neurosurgeons

try to modulate the circuit to bring about a desired outcome. This might involve placing

electrodes within the brain to stimulate certain structures, or creating lesions with radiation,

ultrasonic energy or simple thermal ablation to effectively “turn off” structures that

might be causing a problem for a patient. Functional neurosurgery addresses pathologies

such as Parkinson's disease, tremors, and obsessive compulsive disorder, among others.

Though what's most exciting about this subset of cranial surgery is what it hopes to treat

in the future - things like chronic pain, depression, PTSD, and substance addiction.

Within spine surgery, there are a few subcategories as well: we'll call them “degenerative”,

The vast majority of spine surgery is done to treat good old fashioned wear and tear,

or degenerative disease, of the spine. As you might expect, degenerative disc disease

and osteoarthritis of the spine tend to occur in the cervical spine, or neck, and lumbar

spine, or lower back, which are the two most mobile parts of the spine. Your thoracic spine

is less mobile because of your ribs (which create additional support and limit mobility).

With these degenerative processes, the spinal cord itself or nerve roots exiting the spine

can become compressed, leading to pain and weakness. Surgeons often are required to decompress

these structures by removing certain elements of the spine. When removing these bony arthritic

spurs, or degenerated discs, the integrity of the spine can become compromised, which

can require a spinal fusion to restore stability, although the fused segment has increased rigidity.

Fusion is often achieved with rods and screws, and in some cases with disc replacement hardware.

Spine surgery also includes repair of scoliosis, whereby curvature of the spine can become

so severe as to cause pain, difficulty breathing, or other functional deficits. It's important

to note that spinal decompression surgeries and scoliosis repair can be performed by either

neurosurgeons or orthopedic surgeons. However, removal of tumors of the spinal cord is performed

exclusively by neurosurgeons. While a tumor in the liver or breast can be relatively quickly

resected, removing tumors around the spine can be quite involved, and take a long time

- even for small tumors - due to the care and precision required to leave the spinal

Peripheral neurosurgery, as the name suggests, involves operating on the peripheral nervous

system. This includes all nerves outside of the brain and spinal cord. These nerves can

sprout tumors, or become injured in an accident. In such cases, a neurosurgeon may be called

upon to remove that tumor, to reconnect severed nerves, or in some cases to connect part of

a healthy, working, nerve to a damaged nerve in the hopes that a patient can regain function

If you're a trauma surgeon, you take shifts and handle traumas that come in on your shift.

If you're a neurosurgeon, you have to operate on your scheduled cases but also take neurosurgery

trauma call on top. It's just part of the job. This includes traumatic injuries to both

the cranium and spine. Both are very urgent.

Compared to other parts of the body, the skull is a fixed space, which results in its own

set of issues. If you bleed into your abdomen, you're concerned about exsanguination, meaning

you can bleed out and die, as your abdomen can distend to accommodate a large volume

of blood. In the cranium, however, a fixed space means that as you bleed, pressure increases,

resulting in compression of the brain. You won't ever exsanguinate as the skull is

too small, but brain bleeds are deadly due to brain herniation, meaning compression and

pushing of critical structures through the foramen magnum outside the skull. Alleviating

pressure is key, and this is done with a decompressive hemicraniectomy, meaning removing part of

the skull to create space for the brain to swell after it has been injured. The excised

segment is kept in the freezer and the neurosurgeons can put it back weeks or months later when

There are four main types of brain bleeds — epidural hematomas, subdural hematomas,

subarachnoid hemorrhages, and intraparenchymal hemorrhages. Epi- means above and -dural refers

to the dura, the outermost layer of the meninges covering the brain. Epidural hematomas are

bleeds most commonly from the middle meningeal artery in the space below the skull but above

the dura. With an arterial source, these bleed quickly, and usually result from blunt trauma

to the head. Subdural hematomas are below the dura and are more common amongst elderly

patients on blood thinners. These are venous bleeds and slower in nature, but can be equally

urgent and life threatening Subarachnoid hemorrhages result from an aneurysm rupturing, and because

it's below the arachnoid layer of the meninges, the blood fills the sulci of the brain, meaning

all the nooks and crannies, effectively coating the brain in blood, which can be toxic. Intraparenchymal

hemorrhages are bleeds within the actual tissue of the brain, and this can result from long

standing hypertension resulting in arteriosclerosis, or other reasons.

Ruptured aneurysms are usually handled by neurosurgeons, but sometimes by endovascular

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So You Want to Be a NEUROSURGEON [Ep. 6]

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