Neurosurgery is a branch of medicine that uses surgical methods to treat diseases of the central and peripheral nervous system. Neurosurgeons always work as part of a large team, which includes anesthesiologists, resuscitators, neurologists, radiologists, ophthalmologists, otoneurologists, physiologists, radiologists, radiotherapists, chemotherapists, pathologists and, if necessary, other medical specialists. Moreover, in some cases, neurosurgical intervention is only one, and not the most important stage of complex treatment of the patient.
The specifics of neurosurgery are determined by the peculiarities of the anatomy and physiology of the nervous system. Main of them is the complex structure of the central nervous system, the high functional significance of many structures, the intensity of blood supply to the brain in combination with the terminal anatomical variant of many small arteries supplying isolated pools of the brain stem and subcortical structures, the difficulty to access deeply located formations, fragility, vulnerability of the brain, especially in conditions of its pathology, and much more.
For a long time, the main problems in neurosurgery were the difficulty and sometimes the impossibility of making an accurate topical diagnosis, the lack of effective bleeding control, adequate wound illumination, convenient optical magnification, and appropriate tools. Based on the needs of neurosurgery, computed and magnetic resonance imaging, angiography and endovascular surgery, an operating microscope, vacuum suction and an ultrasonic aspirator, bipolar coagulation, absorbable hemostatic materials were developed and put into practice.
As a result, not only the techniques were changed but also the principles of performing neurosurgical interventions. While in the last century general surgical principles prevailed, which were fast, rough and risky, modern neurosurgical interventions are distinguished by careful handling of anatomical structures and are minimally traumatic. The principles of minimally invasive interventions formulated in neurosurgery are now being applied in other areas of surgery. The needs of neurosurgery stimulated the development of anesthesiology and intensive care. Ideal anesthesia and respiratory equipment have been developed, drugs for anesthesia that do not increase intracranial pressure have been put into practice, postoperative wards and later intensive care units have been created, and much more.
The contribution of neurosurgery to fundamental medicine is of great importance. It is in the neurosurgical clinic that a number of complex brain mechanisms have been studied. Many details of the mechanism of tumorigenesis were discovered during the study of meningioma — a tumor of the meninges, which is now considered the most studied in molecular biological terms.
Neurosurgery is a complex science, the development of which requires many years, in fact, a lifetime. For some readers, this textbook will be the first on the way to profession. We wish you success, but we warn you that the information contained in the textbook is only a small part of what a novice neurosurgeon should know and be able to do.
Creating this textbook, the authors pursued two main goals. The first one is to familiarize students with the current state of neurosurgery, with its capabilities to diagnose and successfully treat many previously incurable diseases. Therefore, we usually focus only on the basic principles of diagnosis and do not detail the surgical technique. Ultimately, any doctor with the slightest suspicion of a neurosurgical pathology should only refer the patient to an objective examination and then to a neurosurgeon.
However, every doctor can get into a situation where a patient needs emergency neurosurgical care, and there is no neurosurgeon nearby, and no evacuation is possible. This situation is most real in disaster medicine and military field conditions. Therefore, the authors considered their second goal to teach a doctor of any specialty to act adequately in standard situations with traumatic brain injury, spinal injury, with a sharp increase in intracranial pressure. Let us recall that since the 18th century, the mastery of the technique of craniotomy was obligatory for all Russian doctors, and today — ventricular puncture is also a compulsory skill. Therefore, the relevant sections are written in detail and can be used as a guide when performing the described neurosurgical interventions.
It should be borne in mind that the descriptions of neurological symptoms given in this volume are incomplete and are presented to focus attention on the most fundamental aspects from the neurosurgical point of view. The most detailed issues of clinical manifestations, diagnosis and conservative treatment of diseases of the nervous system are covered in Volume 1 of this textbook.