Newswise — According to the American Association of Neurological Surgeons (AANS), in the United States, there are more than 6,000 hospitals, with approximately 3,300 actively practicing board-certified neurosurgeons serving a population of over 303 million people. Among its membership ranks, the AANS has 1,166 International neurosurgeon members in 95 countries and a combined total of 434 Active neurosurgeon members in Canada and Mexico. The association's international outreach efforts are expanding. The AANS is hosting the XIV World Congress of the World Federation of Neurosurgical Societies in Boston, August 30-September 4, 2009. The AANS International Visiting Surgeons Fellowship is an effort to assist colleagues in developing countries with an educational experience at a North American Neurosurgical Training Program. The William Van Wagenen Fellowship enables a post-resident neurosurgeon trained in the United States to study abroad for a period of six to 12 months.
Many American neurosurgeons participate in clinical and educational endeavors in developing countries, teaching neurosurgical techniques to their international colleagues, donating surgical devices, and performing lifesaving operations. Some of the organizations that organize these efforts are: Foundation for International Education in Neurological Surgery (FIENS), World Federation of Neurosurgical Societies, and Doctors Without Borders.
Many of the groundbreaking neurosurgical innovations that have enabled U.S. neurosurgeons to greatly improve patient outcome originated outside the United States. These innovations are numerous and include:
Stereotactic Radiosurgery: Gamma Knife (Sweden), Linac (Italy, Argentina) and Stereotactic Frames (Sweden, France, Germany, Japan)
Swedish physician and professor of neurosurgery at the Karolinska Institute in Stockholm, Lars Leksell introduced the first stereotactic instrument for human functional neurosurgery in 1949. Stereotactic radiosurgery (SRS) uses sophisticated image-guidance to precisely deliver a high, concentrated dose of radiation to an affected area. Stereotactic frames are often used to immobilize the target area during radiosurgery. SRS applications and technology have evolved greatly over the last 60 years and are utilized currently as a treatment modality for a wide array of neurosurgical conditions, including:
~ Arteriovenous malformation (AVM)
~ Benign and malignant brain tumors
~ Spinal tumors
~ Ocular tumors
~ Functional disorders such as trigeminal neuralgia and Parkinson's disease
For more information on SRS, visit: http://www.neurosurgerytoday.org/what/patient_e/stereotactic.asp.
Endovascular aneurysm surgery (England/France/Italy/Russia)
The concept of endovascular occlusion of aneurysms was introduced in the late 18th century by several clinicians who began experimenting with insertion of needles into aneurysms to induce thrombosis. Among these early innovators were Sir E. Herne and Benjamin Phillips (England), Alfred-Armand-Louis-Marie Velpeau and Joseph-Pierre Pétrequin (France), and Luigi Ciniselli (Italy). In the modern era, the father of endovascular neurosurgery, Fedor A. Serbinenko (Russia) invented the technique of balloon embolization in the mid-1960s and perfected it by the next decade. In 1989, Guido Guglielmi, an Italian neuroradiologist working in the United States, began experimenting with occluding aneurysms through an endovascular approach, using electrolytic detachable platinum coils. In January 1991, the first patient with an aneurysm was treated using this technology at the University of California, Los Angeles. On September 8, 1995, the Food and Drug Administration (FDA) approved commercial sale of the Guglielmi detachable coil (GDC).
Today, endovascular treatment of aneurysms has emerged as an acceptable alternative to open surgical clipping, particularly over the past five years. Particularly good candidates for this procedure are patients who present a high surgical risk, patients in poor neurological condition, or those with aneurysms in certain locations (such as the basilar artery).
For more information on aneurysm treatment, visit: http://www.neurosurgerytoday.org/what/patient_e/cerebral.asp.
Deep brain stimulation (France)
Deep-brain stimulation (DBS) was established as a practical therapy in France in 1987. This method evolved from ablative or lesion-producing surgeries in which physicians used heat probes to burn and permanently alter small, malfunctioning regions of the brain. This technology has proven to be a safe and effective treatment for essential tremor, as well as tremor and involuntary movements associated with Parkinson's disease, dystonia and multiple sclerosis, with more than 35,000 DBS implants worldwide.
The procedure is comparable to that of a cardiac pacemaker in which the pacemaker helps maintain an appropriate cardiac rhythm. DBS is presumed to help modulate dysfunctional circuits in the brain so that the brain can function more effectively. This is accomplished by sending continuous electrical signals to specific target areas of the brain, which block the impulses that cause neurological dysfunctions. These targets are the ventralis intermediate nucleus of the thalamus (Vim), the globus pallidus pars interna (GPi), and the subthalamic nucleus (STN).
The applications for DBS therapy are expanding rapidly and include several psychiatric conditions. In February 2009, DBS was approved by the FDA for patients with intractable obsessive compulsive disorder (OCD). DBS for major depressive disorder is currently going through multicenter clinical trial phases, as is required protocol prior to FDA approval.
For more information on DBS, visit: http://www.neurosurgerytoday.org/what/patient_e/deep%20brain%20stimulation.asp.
Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 7,600 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system, including the spinal column, spinal cord, brain, and peripheral nerves.
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