As recently as in 2018, the American Medical Association (AMA) noted that only three surgical specialties were left without enough room to house all applicants of the match cycle. This list included neurosurgery, a consistently popular and competitive field among soon-to-be medical residents. It can certainly be a strong magnet, pulling hard at those fascinated with human behavior when careers like psychology and neurology are just too hands-off. But to the uninitiated, much like the nervous system it studies, a lot can remain obscured about what exactly a neurosurgeon does and what their life looks like.
Let’s start with the basics—it’s common enough to reduce neurosurgery to simply brain surgery. But the nervous system comprises an intricate network that extends from the brain, to the spine, and throughout the body as individual nerves. Neurosurgery is classified accordingly into cranial, spinal, and peripheral nervous system (PNS) work. Tumor resections are done all throughout. More specifically, though, cranial operations can also treat vascular problems, and even alter the function of the brain. Moving lower down the system, spinal procedures can help patients suffering with problems in their vertebrae, spinal cord—what lies inside of the bony spine—, and the points where nerves sprout from. Throughout the rest of the body, peripheral neurosurgery seeks to manually resolve a wide range of issues in the PNS. Due to the nervous system’s delicacy, conditions that afflict it and require surgical intervention are seen almost exclusively by neurosurgeons, despite the occurrence of similar pathologies in various organ systems. Tumors, for instance, can be treated throughout the body by an array of diverse kinds of surgeons. But those living within the nervous system are largely only given to neurosurgeons. However, for as rare as it can be, other specialists may sometimes take neurosurgical cases. For example, plastic surgeons or orthopedic surgeons may be called onto a nerve or spinal case, respectively. The former may reconstruct nerves during an operation, while the latter may be whom scoliosis patients are referred to.
Unlike many other specialties, neurosurgeons treat both emergent and non-emergent cases, rotating between being on call—in other words, at a hospital, ready to treat higher-risk conditions as they come—and in a clinic. Emergent patients are much more urgent and likely to need surgery. On-call neurosurgeons may handle ruptured aneurysms and other kinds of brain bleeds, cerebral herniations, spinal fractures, and other similar cases. Regardless of their condition, though, it’s necessary to understand that, in comparison to other specialties, a larger proportion of neurosurgical patients are seriously ill. This can make the job incredibly taxing on a physician, especially in subspecialties like pediatric neurosurgery. Over the long term, it can make the career miserable. On the flip side, however, the rewarding sensation from seeing a patient thrive into recovery may be more than enough to overcome that gloom. It’s also important to keep in mind that surgical intervention isn’t always necessary. Many degenerative spinal ailments can be treated by lifestyle changes, physical therapy, or pain management techniques. Even aneurysms can be left untreated if it’s the better choice for a patient. Such is the case with many other conditions. Surgery is always a risky endeavor, a fact only magnified by how sensitive and critical the nervous system is. A caring neurosurgeon should always take a per-patient approach to ensure that the right job is done at the right time. It is therefore imperative that neurosurgeons become adept at both surgical and clinical patient care. Neurosurgeons aren’t butchers—they’re doctors.
But just as with most other surgical branches, physicians can choose to remain general neurosurgeons or become experts of smaller niches. Common neurosurgical subspecialties include: functional neurosurgery, where the brain’s behavior and other neurological functions are modified by physically changing the brain; genetic neurosurgery, which studies and treats genetically inherited neurological conditions; vascular neurosurgery, which involves very detail-oriented work on nervous system blood vessels, treating aneurysms, embolisms and other blockages, and hemorrhages and hematomas; pediatric neurosurgery, a branch focusing solely on children and their unique neurological physiologies and pathologies; peripheral nervous system neurosurgery, an often overlooked sub-specialty that can feature exciting innovation, like robotic limb development and attachment; skull-base neurosurgery, another highly meticulous branch dealing with the lowest part of the cranium, typically treating tumors in the region; spinal neurosurgery, which largely concentrates on degenerative conditions and scoliosis; surgical neuro-oncology, a research-driven field that investigates the pathology of and treats tumors in the nervous system; and trauma neurosurgery, which cares for patients with acute conditions requiring sudden neurosurgical intervention.
How exactly is a neurosurgeon made, though? It starts even before finishing med school. Applicants to neurosurgical residency programs make the top of their classes, scoring high on their USMLE or COMLEX exams and participating in extensive amounts of research. This kind of work ethic transitions well into the career. These residencies are among the longest, lasting six years at minimum. This is an amount of time tied only by vascular surgery, and beat only by thoracic surgery. Neurosurgical residencies are tough, too, pushing—or, in some cases, exceeding through special permission—the eighty-hour resident work limit set by the American Council for Graduate Medical Education (ACGME). It goes without saying that the neurosurgeons that are best equipped to handle that workload are those who are head-over-heels in love with their jobs and all the duties and preparation that come bundled with it. Neurosurgery is a difficult career to undertake, but only because of how intricate the section of the body that it studies is. Even with modern medical advances and extraordinary research breakthroughs, much remains unknown about the nervous system. Despite being so burdensome at times, though, neurosurgery and all its sub-specialties remain a tactile way to jump aboard the ship of exploration as we map out what makes us human. It’s an expansive field that provides many avenues to participate in and contribute to our collective understanding of human behavior and the ever-elusive mind.
References
- American Association of Neurological Surgeons. “So, You Want to Be a Neurosurgeon?” American Association of Neurological Surgeons, originally written by Karin Muraszko and Deborah Benzil, https://www.aans.org/pdf/WINS/SYWTBANS.pdf.
- American College of Surgeons. “How Many Years of Postgraduate Training Do Surgical Residents Undergo?” American College of Surgeons, https://www.facs.org/for-medical-professionals/education/online-guide-to-choosing-a-surgical-residency/guide-to-choosing-a-surgical-residency-for-medical-students/faqs/training/.
- Jubbal, Kevin. “So You Want to Be a Neurosurgeon.” Med School Insiders, 8 March 2020, https://medschoolinsiders.com/medical-student/so-you-want-to-be-a-neurosurgeon/.
- Murphy, Brendan. “Residency Match: The 7 Most Competitive Medical Specialties.” American Medical Association, 21 Nov. 2018, https://www.ama-assn.org/medical-students/specialty-profiles/residency-match-7-most-competitive-medical-specialties.
- “Neurosurgical Specialties.” Harvard, https://residents.neurosurgery.mgh.harvard.edu/Specialties.html
- Selden, Nathan. “Duty-Hour Exceptions for Neurosurgery Residency Programs, Commentary 1.” AMA Journal of Ethics, American Medical Association, Jan. 2015, https://journalofethics.ama-assn.org/article/duty-hour-exceptions-neurosurgery-residency-programs-commentary-1/2015-01
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