neurosurgery

Neurosurgeons study and treat congenital, acute, and degenerative spinal problems, pinched nerves, sciatica, low back pain, epilepsy, carpal tunnel syndrome, stroke, Parkinson's disease, brain tumors, pituitary tumors, and brain arterial disorders.

Because the nervous system -- and the battery of techniques used to treat it -- is so complex, neurosurgery is one of the most difficult and time-consuming medical specialties to enter. A neurosurgeon, after graduating medical school and completing a one-year surgical internship program must then complete at least five years in a neurosurgical residency. Next, to become board certified, the ABNS (American Board of Neurological Surgery) reviews the candidate's educational and training, professional practice, the opinions of colleagues, and academic and practical examinations. Finally, once board certified, a neurosurgeon can be come an member of the American Association of Neurological Surgeons (AANS). AANS members are required to maintain current levels of knowledge throughout their career.

Source: American Association of Neurological Surgeons

Because of the rarity of these tumors, there are no randomized, controlled trials or even single-arm prospective trials assessing different treatment approaches. Only small, retrospective, single-institution series and literature reviews are available to guide therapy. As a result, no consensus exists on optimum treatment.

A variety of chemotherapy regimens, particularly platinum-based ones, produce responses in advanced recurrent disease, but survival remains poor in this situation. Recent series have advocated neoadjuvant chemo- and radiotherapy, but supportive studies are lacking. All data regarding treatment of esthesioneuroblastomas constitutes weak Class III (case series with historical controls) or Class IV (uncontrolled case series and expert opinion) evidence, and none of the treatment approaches carries more weight than a Practice Option. Multi-institution controlled trials are essential. In their absence, radical surgery followed by radiation therapy is an appropriate therapeutic approach for newly diagnosed patients. In patients with histologically high-grade tumors and metastatic disease at the time of diagnosis, or in patients in whom tumor cytoreduction could facilitate more complete surgical removal, 2-4 cycles of neoadjuvant chemotherapy may be considered. While many single- and multiagent regimens have shown some activity, conventional doses of cisplatin and etoposide are currently preferred.