Neurosurgery: what the specialty covers, conditions treated and what to expect

Neurosurgery treats structural and mechanical problems of the nervous system: tumours, bleeding, blood vessel abnormalities, fluid circulation problems, trauma, spinal compression and some pain and movement disorders. It is practised in neuroscience centres, usually large hospitals with neuroradiology, neurology, intensive care and rehabilitation on site.

A neurosurgeon is a doctor who has completed medical school, foundation training and a long surgical training programme in neurosurgery, often followed by fellowships in a subspecialty. Many surgeons focus on one area, such as spine, brain tumours, vascular disease, paediatric neurosurgery, functional neurosurgery or skull base surgery.

The team around the surgeon is large: neuroanaesthetists, theatre staff, specialist nurses, physiotherapists, occupational therapists, neuro-oncologists and, for children, paediatric specialists. Decisions are often made in a multidisciplinary meeting.

The NHS describes a brain aneurysm as a swelling in a blood vessel in the brain, most of which are small and cause no symptoms. It describes hydrocephalus as a build-up of fluid in the brain that puts pressure on it, which can be fatal if untreated. Brain tumours are described as abnormal growths, which can be non-cancerous or cancerous.

• Brain tumours, including meningioma, glioma and pituitary and skull base tumours.

• Aneurysms and other blood vessel conditions, and bleeding on the brain.

• Hydrocephalus, where a shunt or other procedure may be used to drain fluid.

• Trigeminal neuralgia and other conditions of nerve compression.

• Degenerative and compressive spine disease, including cervical radiculopathy and myelopathy, slipped discs and spinal stenosis, when non-surgical treatment has not worked or there are warning signs.

• Spinal tumours, spinal cord injury and spinal deformity such as scoliosis.

• Functional procedures such as deep brain stimulation and epilepsy surgery.

• Head injury and traumatic bleeding, in emergency care.

Imaging is central. MRI shows soft tissue such as the brain, spinal cord and discs in detail, while CT is quick and shows bone and acute bleeding. Angiography images blood vessels. These scans are often combined with neurophysiology, such as EEG or nerve studies, and with neuropsychology when a decision depends on memory and language function.

The NHS notes for slipped disc that the diagnosis can usually be made from symptoms and examination, and that an MRI scan may be considered if symptoms do not get better. Most back pain and sciatica improve without surgery, so a surgical opinion is usually reserved for people with persistent symptoms, progressive weakness or red-flag features.

For brain aneurysm, the NHS says small unruptured aneurysms may just need follow-up scans, and that where there is a risk of bursting or it has burst, surgery is usually needed: either clipping or endovascular coiling or mesh. Both are carried out under general anaesthetic. For trigeminal neuralgia, the NHS says anticonvulsant medicines, mainly carbamazepine, are the usual treatment and that surgery may be considered if medicine is ineffective or causes too many side effects.

Other options include craniotomy for tumours, shunts for hydrocephalus, stereotactic radiosurgery such as Gamma Knife for selected tumours and facial pain, spinal decompression and fusion, and deep brain stimulation. Risk depends on the condition, location and your general health, so ask your surgeon to describe both the chance of benefit and the chance of harm for your case.

Recovery ranges from a day or two for some spinal procedures to weeks or months for major brain surgery, often followed by rehabilitation.

On the NHS, referral to neurosurgery usually comes from a neurologist, spinal or musculoskeletal service, emergency department or another specialist, rather than directly from a GP. Neurosurgery is delivered in regional centres, so travel is common. Emergency cases, such as bleeding or cauda equina syndrome, are dealt with immediately.

Private neurosurgery is available in selected hospitals for elective conditions, particularly spinal and some cranial problems, and some surgeons work in both sectors. Because the operations are complex, ask about the surgeon’s experience with your procedure, the availability of intensive care on site, what happens if there are complications and whether follow-up is included.

• Scan images and reports on disc or via the hospital portal, plus letters from other specialists.

• A list of medicines, especially blood thinners, which may need adjusting before surgery.

• Questions: is surgery needed or optional, what are the alternatives, what is the realistic benefit, and what are the main risks?

• Ask about recovery time, driving, work, rehabilitation and when to call after the operation.

• Consider bringing someone with you to remember the discussion and help with decisions.

The NHS says to call 999 for a sudden, extremely painful headache that does not go away, weakness in the face or one side of the body, speech problems, or blurred vision or loss of sight, which can indicate a burst aneurysm or stroke. For back pain, call 999 or go to A&E if there is numbness around the bottom or genitals, you cannot pee or cannot control your bladder or bowels, or you have lost feeling in one or both legs. Ask for an urgent GP appointment or NHS 111 for persistent worsening headaches or pain around the eye.