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In the United States neurosurgical training is very competitive and grueling. It usually requires a year internship in surgery, five to six years of residency, plus the option of a fellowship for sub specialization (lasting an additional one to three years). Most applicants to neurosurgery training programs have excellent medical school grades and evaluations, have published scientific and/or clinical research, and have obtained board scores in the 95th percentile or higher. Resident work hour limits are set at 88 hours per week for many programs, although many neurosurgical programs have had problems meeting these new work hour limits due to the small size of residency programs, the high volume of neurosurgical patients, and the need to provide constant coverage in the emergency room (ER), operating room (OR), and intensive care unit (ICU). On average 50-60% of medical students applying to neurosurgery match into a residency program (about 80% of US senior medical student applicants).
  Accomplished Neurosurgeons
Harvey Cushing – Known as the father of neurosurgery
Gazi Yasargil – Known as the father of modern neurosurgery
Anton Eiselsberg – Established Neurosurgery as an independent discipline
Ben Carson – Famous African American Neurosurgeon Brian Andrews (doctor) – Noted American Neurosurgeon Lars Leksell – Swedish Neurosurgeon who developed the Gamma Knife
| Gamma Knife  The principle behind the Gamma Knife is relatively simple: precisely-targeted radiation can cause certain brain tumors and AVMs to shrink and even to become obliterated over time, without harming adjacent normal tissue. The technology, however, is complex. Through advanced imaging and three-dimensional planning techniques, the Gamma Knife delivers a single, high dose of ionizing radiation by precisely pinpointing the target. It does so by sending low-intensity beams from 192 cobalt-60 sources through a device known as the collimator helmet. Only at the point where all 192 beams converge at a single, finely-focused point is enough radiation delivered to treat the diseased tissue. Other nearby healthy tissue is spared. Accurate to less than two-tenths of a millimeter, the Gamma Knife's precision is one of its greatest advantages. When conventional surgery cannot be pursued due to the location of a lesion in the brain, or to a patient's age or poor health, the Gamma Knife provides an alternative. Because treatment is performed without an incision, this procedure seldom requires general anesthesia, which eliminates many potential side effects and risks associated with conventional surgery. By avoiding the risks of postoperative complications, such as infection and hemorrhage (bleeding), the recovery phase is short. Patients avoid lengthy hospital stays and postsurgical discomfort. Expensive medication and long-term rehabilitation are unnecessary, and most patients return to their normal activities within a week. Stereotactic Neurosurgery  Aneurysms A cerebral aneurysm is a cerebrovascular disorder in which weakness in the wall of a cerebral artery or vein causes a localized dilation or ballooning of the blood vessel. A common location of cerebral aneurysms is on the arteries at the base of the brain, known as the Circle of Willis. Approximately 85% of cerebral aneurysms develop in the anterior part of the Circle of Willis, and involve the internal carotid arteries and their major branches that supply the anterior and middle sections of the brain. The most common sites include the anterior communicating artery (30-35%), the bifurcation of the internal carotid and posterior communicating artery (30-35%), the bifurcation of the middle cerebra artery (20%), the bifurcation of the basilar artery, and the remaining posterior circulation arteries (5%). Currently there are two treatment options for brain aneurysms: surgical clipping or endovascular coiling.
 Surgical clipping was introduced by Walter Dandy of the Johns Hopkins Hospital in 1937. It consists of performing a craniotomy, exposing the aneurysm, and closing the base of the aneurysm with a clip. The surgical technique has been modified and improved over the years. Surgical clipping has a lower rate of aneurysm recurrence after treatment.
Endovascular coiling was introduced by Guido Guglielmi at UCLA in 1991. It consists of passing a catheter into the femoral artery in the groin, through the aorta, into the brain arteries, and finally into the aneurysm itself. Once the catheter is in the aneurysm, platinum coils are pushed into the aneurysm and released. These coils initiate a clotting or thrombotic reaction within the aneurysm that, if successful, will eliminate the aneurysm. These procedures require a small incision, through which an catheter is inserted. In the case of broad-based aneurysms, a stent may be passed first into the parent artery to serve as a scaffold for the coils ("stent-assisted coiling"), although the long-term studies of patients with intracranial stents have not yet been done. If possible, either surgical clipping or endovascular coiling is usually performed within the first three days to occlude the ruptured aneurysm and reduce the risk of rebleeding.
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Neurosurgery |