Neurosurgical emergencies from the viewpoint of a double board–certified neurosurgeon/acute care physician

Abstract

  Many patients transferred to tertiary critical care centers are due to neurological emergencies. Neurosurgeons are involved in such emergencies, which include not only neurosurgical injuries such as stroke and head/spinal cord trauma but also generalized convulsions and impaired consciousness of various causes. However, in the author’s survey, board‒certified neurosurgeons were found to account for only 3.4％ of staff doctors in emergency medical facilities approved as supervision institutes. The number of specialists in neurological diseases has been decreasing for the last 10 years. Our facility is an independent tertiary critical care center; thus, neurosurgeons work as acute care physicians, unlike in North American‒style emergency room systems. Neurosurgeons are responsible for neurosurgical procedures as well as for the primary care and intensive care unit management of critically ill neurological patients. This role enables prompt decision‒making and definitive treatment in emergencies such as an impending brain herniation or rerupture of a cerebral aneurysm. It is essential to evaluate a neurological patient’s condition using the most advanced monitoring equipment for brain‒oriented intensive care. Therefore, the involvement of neurointensivists, specialists in neurology and intensive care, is warranted. In the United States, the Neurocritical Care Society (NCS) has developed rapidly, and neurointensivists play a central role in the treatment of critically ill neurological patients in conjunction with specialists in related professions. Many researchers have reported the effectiveness of neurocritical care in improving patient outcomes. Double‒boarded physicians in acute care medicine and neurosurgery support the care of patients with neurosurgical emergencies in Japan. With the current decrease in the number of neurosurgeons and emergency physicians, more should be trained in the field of neurological emergencies. Further development of neurocritical care is expected through off‒the‒job training courses in neuroresuscitation simulation training, hands‒on seminars on neurointensive care, seminars on post‒cardiac arrest syndrome, and Emergency Neurological Life Support provided by the NCS.