Establishing reconstructive neurosurgery as a subspecialty

Neurosurg Focus. 2017 Jul;43(1):E7. doi: 10.3171/2017.5.FOCUS17102.

Abstract

Neurosurgery is experiencing the emergence of a new subspecialty focused on function restoration. New, evolving, and reappraised surgical procedures have provided an opportunity to restore function to many patients with previously undertreated disorders. Candidates for reconstruction were previously limited to those with peripheral nerve and brachial plexus injuries, but this has been expanded to include stroke, spinal cord injury, and a host of other paralyzing disorders affecting both upper and lower motor neurons. Similar to the recent evolution of the well-established subdisciplines of spinal and vascular neurosurgery, reconstructive neurosurgery requires the adaptation of techniques and skills that were not traditionally a part of neurosurgical training. Neurosurgeons-as the specialists who already manage this patient population and possess the requisite surgical skills to master the required techniques-have a unique opportunity to lead the development of this field. The full development of this subspecialty will lay the foundation for the subsequent addition of emerging treatments, such as neuroprosthetics and stem cell-based interventions. As such, reconstructive neurosurgery represents an important aspect of neurosurgical training that can ameliorate many of the deficits encountered in the traditional practice of neurosurgery.

Keywords: AFO = ankle-foot orthosis; ASIA = American Spinal Injury Association; AVM = arteriovenous malformation; CMAP = compound motor action potential; EMG = electromyography; LMN = lower motor neuron; SCI = spinal cord injury; TBI = traumatic brain injury; UMN = upper motor neuron; brachial plexus injury; electrodiagnostics; free functional muscle transplant; nerve transfer; peripheral nerve surgery; reconstructive neurosurgery; spinal cord injury; stroke; tendon transfer.

MeSH terms

  • Adult
  • Brachial Plexus / surgery
  • Female
  • Humans
  • Male
  • Motor Neurons / physiology
  • Neurosurgical Procedures* / methods
  • Peripheral Nerves / surgery*
  • Reconstructive Surgical Procedures* / methods
  • Spinal Cord Injuries / surgery*
  • Treatment Outcome