The AANS Neurosurgeon is official socioeconomic publication of the American Association of Neurological Surgeons which features information and analysis for contemporary neurosurgical practice. It focuses on issues related to legislation, workforce and practice management as they affect the specialty of neurosurgery. In today’s post we are spotlighting a piece by Robert E. Harbaugh, MD, FAANS, FACS, FAHA on Neurosurgeons and Neurocritical Care. This article addresses the necessity for a continuum of neurosurgical care that extends from diagnosis through discharge for neurosurgical patients.
Robert E. Harbaugh, MD, FAANS, FACS, FAHA
Neurocritical care is part of the continuum of neurosurgical care that extends from diagnosis through discharge for many neurosurgical patients. Therefore, it is essential that neurosurgeons be fully trained to care for patients in a critical care setting and that their hospital privileges include the role of neurointensivist. We know that many neurosurgical patients with brain and spinal cord trauma, subarachnoid hemorrhage, tumors, and other diseases require evaluation and management in a critical care setting. Their condition, pre- or postoperatively, may deteriorate precipitously with devastating consequences if urgent neurosurgical intervention does not occur. Thus, perioperative critical care evaluation and management is an integral part of neurosurgical practice, not a separate subspecialty. In many ways, neurosurgery without neurocritical care is no longer neurosurgery.
Historically, neurosurgeons have been pioneers in the operative and nonoperative management of critically ill patients with neurological dysfunction. In fact, the specialty of neurocritical care, particularly in the areas of central nervous system trauma and cerebrovascular disease, was largely founded by neurological surgeons. Diagnostic modalities such as monitoring intracranial pressure, cerebral perfusion pressure, cerebral blood flow and brain oxygenation were neurosurgical innovations. Treatment modalities such as osmotic diuresis, triple-H therapy, spinal cord cooling and decompressive craniectomy were pioneered by neurosurgeons caring for their patients in a critical care environment. Today, the majority of patients in most neurocritical care units remain neurosurgical patients. Despite this, U.S. neurosurgeons are at risk of losing their role as neurointensivists.
This article addresses this problem and the efforts of organized neurosurgery to address it. The role of many organizations involved in creating and correcting this problem are described in the full article here.