Name: So You Want to Be a NEUROSURGEON [Ep. 6]
Uploaded: 2020-08-22T19:15:18.000Z
Duration: 17 min 46 s

So you want to be a neurosurgeon. After all, it's super badass, second only to being

所以你想成為一名神經外科醫生。畢竟，它是超級壞蛋，僅次於成為... ...

a rocket surgeon. Let's debunk the public perception myths of what it means to be a

一個火箭醫生。讓我們來揭穿公眾對做火箭醫生的認識誤區

neurosurgeon, and give it to you straight. This is the reality of neurosurgery.

神經外科醫生，直接給你說。這就是神經外科的現實。

Welcome to our next installment in So You Want to Be. In this series, we highlight a

歡迎來到我們的下一期《所以你想成為》。在這個系列中，我們將重點介紹

specific specialty within medicine, such as neurosurgery, and help you decide if it's

醫學中的特定專業，如神經外科，並幫助您決定是否要選擇

a good fit for you. You can find the other specialties on our So You Want to Be playlist.

一個適合你的項目。你可以在我們的 "所以你想成為 "播放列表中找到其他專業。

A lot of you asked for neurosurgery in our poll, so that's what we're covering here.

很多人在我們的調查中問到了神經外科，所以這就是我們要報道的內容。

If you want to vote in upcoming polls to decide what future specialties we cover, make sure

如果您想在即將到來的民意調查中投票決定我們未來的專業內容，請確保

If you'd like to see what being a neurosurgeon looks like, check out my second channel, Kevin

如果你想知道作為一個神經外科醫生是什麼樣子的，請看我的第二個頻道，凱文。

Jubbal, M.D., where I do a second series in parallel called a Day in the Life. We'll

Jubbal，醫學博士，在那裡我做第二個系列 在平行的叫一天的生活。我們將

be doing a Day in the Life of a Neurosurgeon soon and you don't want to miss it. show

將做一天的神經外科醫生的生活很快，你不希望錯過它。

footage from Daniel Choi day in the life of ortho spine surgeon where he is in the operating

崔永元在手術室的脊柱矯形外科醫生的生活片段。

Neurological surgery, or neurosurgery for short, is much more than just brain surgery.

神經外科，簡稱神經外科，不僅僅是腦部手術。

The nervous system is comprised of two main components — the central nervous system,

神經系統主要由兩部分組成--中樞神經系統。

or CNS, and the peripheral nervous system, or PNS. Try saying that one 5 times as fast

或中樞神經系統，和周圍神經系統，或PNS。試著用5倍的速度說一個

as you can. The CNS includes the brain and spinal cord, whereas the PNS includes all

儘可能的。中樞神經系統包括大腦和脊髓，而初級神經系統包括所有的

other nerves within the body. Neurosurgery deals with surgical interventions of both.

體內的其他神經。神經外科學涉及到對這兩種神經的手術干預。

There are two overarching categories to neurosurgery: 1) Elective surgery, and 2) Emergent (i.e.

神經外科有兩個主要類別。1) 選擇性手術，2) 急診（即

non-elective) surgery. Elective surgeries take place on a non-emergent basis, and generally

非選擇性）手術。選擇性手術是在非緊急的基礎上進行的，一般是

involve treating conditions that are not immediately life threatening. They tend to fall into one

涉及治療不立即危及生命的疾病。它們往往屬於以下一種

of three categories: Cranial surgery, spine surgery, and peripheral nerve surgery.

的三類。顱骨手術，脊柱手術，和周圍神經手術。

Cranial surgery, as it sounds, involves operating on structures within the head (i.e. the brain).

顱骨手術，聽起來就涉及到對頭部結構（即大腦）的操作。

This category can be further subdivided into a few more subcategories: tumor surgery, vascular

這一類又可以再細分為幾個小類：腫瘤手術、血管

Tumors in the brain come in all shapes and sizes. They can be benign or malignant, slow

腦部的腫瘤有各種形狀和大小。它們可以是良性或惡性的，緩慢的。

or fast growing, life threatening or not. Some tumors can be observed without ever needing

或快速增長，是否有生命危險。有的腫瘤可以觀察到，而不需要進行

treatment, while others can be treated with radiation, but often, given the limited space

治療，而其他的則可以用放射線治療，但由於空間有限，通常

afforded by the human skull, and the sensitive nature of the brain's tissues, a neurosurgeon

人的頭蓋骨所提供的，以及大腦組織的敏感性質，神經外科醫生。

is called upon to surgically resect a tumor in the brain.

被要求通過手術切除腦部腫瘤。

Vascular neurosurgery involves treating abnormalities in blood vessels of the brain. Neurosurgeons

血管神經外科涉及治療腦血管的異常。神經外科醫生

might treat an aneurysm on a vessel, or bypass a blockage or narrowing of a vessel, much

可能會治療血管上的動脈瘤，或繞過血管的堵塞或狹窄，這一點非常重要。

the same way you would do coronary bypass in the heart. Though rather than opening the

就像你在心臟做冠狀動脈旁路手術一樣。雖然不是打開

chest, of course, neurosurgeons work through a small hole in the skull.

胸部，當然，神經外科醫生通過顱骨上的一個小孔工作。

Functional neurosurgery is the sexy stuff — the science fiction of the field. In functional

功能神經外科是性感的東西--該領域的科幻小說。在功能

neurosurgery, the brain is viewed as one large complicated electrical circuit, and neurosurgeons

神經外科，大腦被視為一個複雜的大電路，而神經外科醫生

try to modulate the circuit to bring about a desired outcome. This might involve placing

試圖調節電路，以達到預期的結果。這可能包括將

electrodes within the brain to stimulate certain structures, or creating lesions with radiation,

大腦內的電極來刺激某些結構，或用輻射製造病變。

ultrasonic energy or simple thermal ablation to effectively “turn off” structures that

超音波能量或簡單的熱燒蝕，以有效地 "關閉 "結構，以

might be causing a problem for a patient. Functional neurosurgery addresses pathologies

可能會給患者帶來問題。功能性神經外科解決的病理問題

such as Parkinson's disease, tremors, and obsessive compulsive disorder, among others.

如帕金森病、震顫和強迫症等。

Though what's most exciting about this subset of cranial surgery is what it hopes to treat

雖然這個顱骨手術的子集最讓人興奮的是它所希望治療的東西。

in the future - things like chronic pain, depression, PTSD, and substance addiction.

在未來--比如慢性疼痛、抑鬱症、創傷後應激障礙和藥物成癮。

Within spine surgery, there are a few subcategories as well: we'll call them “degenerative”,

在脊柱外科內部，也有一些小分類：我們稱之為 "退行性"。

The vast majority of spine surgery is done to treat good old fashioned wear and tear,

絕大多數的脊柱手術都是為了治療老式的磨損。

or degenerative disease, of the spine. As you might expect, degenerative disc disease

脊椎的退行性疾病。正如你所期望的，退行性椎間盤疾病

and osteoarthritis of the spine tend to occur in the cervical spine, or neck, and lumbar

和脊柱骨性關節炎往往發生在頸椎，或頸部，以及腰部。

spine, or lower back, which are the two most mobile parts of the spine. Your thoracic spine

脊柱或下背部，這是脊柱中最容易移動的兩個部位。你的胸椎

is less mobile because of your ribs (which create additional support and limit mobility).

因為你的肋骨（肋骨產生了額外的支撐，限制了移動性），所以移動性較差。

With these degenerative processes, the spinal cord itself or nerve roots exiting the spine

伴隨著這些退行性過程，脊髓本身或神經根從脊柱退出

can become compressed, leading to pain and weakness. Surgeons often are required to decompress

可能會被壓迫，導致疼痛和無力。外科醫生經常需要為患者減壓。

these structures by removing certain elements of the spine. When removing these bony arthritic

這些結構通過去除脊柱的某些元素。當去除這些骨性關節炎

spurs, or degenerated discs, the integrity of the spine can become compromised, which

脊椎骨刺或退化的椎間盤，其完整性可能會受到損害，而這

can require a spinal fusion to restore stability, although the fused segment has increased rigidity.

可以需要脊柱融合術來恢復穩定，雖然融合段的剛性增加。

Fusion is often achieved with rods and screws, and in some cases with disc replacement hardware.

融合通常是通過杆和螺釘來實現的，在某些情況下也可以通過椎間盤替換硬件來實現。

Spine surgery also includes repair of scoliosis, whereby curvature of the spine can become

脊柱手術還包括脊柱側彎的修復，即脊柱的彎曲可以變得更加明顯。

so severe as to cause pain, difficulty breathing, or other functional deficits. It's important

嚴重到導致疼痛、呼吸困難或其他功能障礙。重要的是

to note that spinal decompression surgeries and scoliosis repair can be performed by either

要注意的是，脊柱減壓手術和脊柱側彎修復術可以由以下兩種方式進行。

neurosurgeons or orthopedic surgeons. However, removal of tumors of the spinal cord is performed

神經外科醫生或骨科醫生。然而，脊髓腫瘤的切除是由以下醫生進行的。

exclusively by neurosurgeons. While a tumor in the liver or breast can be relatively quickly

專門由神經外科醫生進行。雖然肝臟或乳房的腫瘤可以相對快速地

resected, removing tumors around the spine can be quite involved, and take a long time

脊柱周圍的腫瘤切除術，涉及面廣，耗時長。

- even for small tumors - due to the care and precision required to leave the spinal

- 即使是小的腫瘤--由於需要小心翼翼和精確地離開脊柱。

Peripheral neurosurgery, as the name suggests, involves operating on the peripheral nervous

周圍神經外科，顧名思義，就是對周圍神經進行手術。

system. This includes all nerves outside of the brain and spinal cord. These nerves can

系統。這包括大腦和脊髓以外的所有神經。這些神經可以

sprout tumors, or become injured in an accident. In such cases, a neurosurgeon may be called

長出腫瘤，或在事故中受傷。在這種情況下，神經外科醫生可能會被稱為

upon to remove that tumor, to reconnect severed nerves, or in some cases to connect part of

移除腫瘤，重新連接被切斷的神經，或在某些情況下連接部分神經。

a healthy, working, nerve to a damaged nerve in the hopes that a patient can regain function

將健康的、可以工作的神經移植到受損的神經上，希望病人能夠恢復功能。

If you're a trauma surgeon, you take shifts and handle traumas that come in on your shift.

如果你是一名創傷外科醫生，你要輪流值班，處理當班的創傷。

If you're a neurosurgeon, you have to operate on your scheduled cases but also take neurosurgery

如果你是一名神經外科醫生，你既要在預定的病例上做手術，又要接神經外科的手術。

trauma call on top. It's just part of the job. This includes traumatic injuries to both

外傷電話在上面。這只是工作的一部分。這包括外傷的兩個

the cranium and spine. Both are very urgent.

顱骨和脊柱。兩者都非常緊急。

Compared to other parts of the body, the skull is a fixed space, which results in its own

與身體的其他部位相比，頭骨是一個固定的空間，這就導致了它本身的

set of issues. If you bleed into your abdomen, you're concerned about exsanguination, meaning

一系列的問題。如果你的血流到了腹部，你就會擔心出血，也就是說。

you can bleed out and die, as your abdomen can distend to accommodate a large volume

你可能會失血過多而死亡，因為你的腹部可能會膨脹以容納大量的血。

of blood. In the cranium, however, a fixed space means that as you bleed, pressure increases,

的血液。然而，在顱內，固定的空間意味著當你出血時，壓力會增加。

resulting in compression of the brain. You won't ever exsanguinate as the skull is

導致腦部受壓。你永遠不會死亡，因為頭骨是

too small, but brain bleeds are deadly due to brain herniation, meaning compression and

太小，但腦出血是致命的，因為腦疝，意味著壓迫和。

pushing of critical structures through the foramen magnum outside the skull. Alleviating

通過顱骨外的大孔推送關鍵結構。緩解

pressure is key, and this is done with a decompressive hemicraniectomy, meaning removing part of

壓力是關鍵，這要通過減壓性的半顱切除術來完成，也就是說要切除一部分。

the skull to create space for the brain to swell after it has been injured. The excised

顱骨，為受傷後的大腦創造膨脹的空間。被切除的

segment is kept in the freezer and the neurosurgeons can put it back weeks or months later when

段保存在冰箱裡，神經外科醫生可以在幾周或幾個月後將其放回，當

There are four main types of brain bleeds — epidural hematomas, subdural hematomas,

腦出血主要有四種類型--硬膜外血腫、硬膜下血腫。

subarachnoid hemorrhages, and intraparenchymal hemorrhages. Epi- means above and -dural refers

蛛網膜下腔出血和腦膜內出血。Epi-是指上面的意思，-dural是指...。

to the dura, the outermost layer of the meninges covering the brain. Epidural hematomas are

到硬膜，即覆蓋大腦的腦膜最外層。硬膜外血腫是

bleeds most commonly from the middle meningeal artery in the space below the skull but above

最常見的是腦膜中動脈出血，位於顱骨下方但高於顱骨的空間。

the dura. With an arterial source, these bleed quickly, and usually result from blunt trauma

動脈源，這些出血很快，通常是由於鈍性創傷造成的。如果有動脈來源，這些出血很快，通常是由鈍性創傷造成的。

to the head. Subdural hematomas are below the dura and are more common amongst elderly

到頭部。硬膜下血腫在硬膜下，在老年人中比較常見。

patients on blood thinners. These are venous bleeds and slower in nature, but can be equally

使用血液稀釋劑的患者。這些都是靜脈出血，性質較慢，但同樣可以是

urgent and life threatening Subarachnoid hemorrhages result from an aneurysm rupturing, and because

蛛網膜下腔出血是由於動脈瘤破裂造成的，具有緊迫性和生命危險性，而且由於蛛網膜下腔出血是由於動脈瘤破裂造成的。

it's below the arachnoid layer of the meninges, the blood fills the sulci of the brain, meaning

它在腦膜蛛網膜層以下，血液充滿了大腦的溝壑，也就是說... ...

all the nooks and crannies, effectively coating the brain in blood, which can be toxic. Intraparenchymal

所有的犄角旮旯，有效地將血液塗抹在大腦中，而血液可能是有毒的。髓內

hemorrhages are bleeds within the actual tissue of the brain, and this can result from long

出血是指腦部實際組織內的出血，這可能是由於長期的

standing hypertension resulting in arteriosclerosis, or other reasons.

靜止性高血壓導致動脈硬化，或其他原因。

Ruptured aneurysms are usually handled by neurosurgeons, but sometimes by endovascular

動脈瘤破裂通常由神經外科醫生處理，但有時由血管內科醫生處理。

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So You Want to Be a NEUROSURGEON [Ep. 6]

trauma

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traumatic