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KEY POINTS

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  1. Neurologic surgery specializes in primarily surgical management of central, peripheral, and autonomic nervous system disorders.

  2. Although clinical examination is paramount, neurosurgical diagnosis and treatment are aided largely by a variety of modalities, such as MRI and intracranial pressure monitoring.

  3. The common treatment goals for traumatic brain and spinal injury are aimed at preventing secondary insults of hypoxia and hypotension.

  4. Aneurysmal subarachnoid hemorrhage remains one of the most morbid and intensive neurosurgical diseases. Endovascular therapy is a growing technology that allows for safer securing of ruptured aneurysms.

  5. Brain tumors can arise from primary or metastatic tissues. Treatment typically involves resection, followed by radiation and/or chemotherapy, depending on the type and grade of tumor.

  6. Spinal instrumentation is used for surgical stabilization of many types of spinal instability, including traumatic, infectious, oncologic, and degenerative.

  7. Infection of the nervous system is a serious and prevalent medical problem. Operative management is indicated for most conditions in which there is symptomatic compression of neural structures.

  8. Functional neurosurgery via device implantation is a rapidly evolving discipline that has already become the standard of care in treating medically refractory Parkinson’s disease and essential tremor. A wider variety of deep brain stimulation targets will treat additional neuropsychiatric diseases.

  9. Stereotactic radiosurgery is a powerful treatment option for intracranial disease, whether it is primary or adjunct. Gamma knife surgery can be used to treat tumors, vascular malformations, and cranial neuralgias.

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OVERVIEW

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Neurologic surgery provides the operative and nonoperative management (i.e., prevention, diagnosis, evaluation, treatment, critical care, and rehabilitation) of disorders of the central, peripheral, and autonomic nervous systems (ANSs). Such disorders include those of the brain, meninges, skull and skull base, and their blood supply, including surgical and endovascular treatment of disorders of the intracranial and extracranial vasculature supplying the brain and spinal cord; disorders of the pituitary gland; disorders of the spinal cord, meninges, and vertebral column, including those that may require treatment by fusion, instrumentation, or endovascular techniques; and disorders of the cranial and spinal nerves throughout their distribution.

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An accurate history is the first step toward neurologic diagnosis. A history of trauma or of neurologic symptoms is of obvious interest, but general constitutional symptoms are also important. Neurologic disease may have systemic effects, while diseases of other systems may affect neurologic function. The patient’s general medical ability to withstand the physiologic stress of anesthesia and surgery should be understood. A detailed history from the patient and/or family, along with a reliable physical examination, will clarify these issues.

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NEUROANATOMY

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An understanding of neuroanatomy is the foundation of comprehensive neurologic examination and diagnosis. Salient features will be considered, from cephalad to caudad. The cerebral hemispheres (or telencephalon) consist of the cerebral cortex, underlying white matter, the basal ganglia, hippocampus, and amygdala. The cerebral cortex is the most recently evolved part of the nervous system. Its functions are mapped to discrete anatomic areas. The frontal ...

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