Neuroplastic surgery

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Medical specialty	neurology
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Neuroplastic or neuroplastic and reconstructive surgery is the surgical specialty involved in reconstruction or restoration of patients who undergo surgery of the central or peripheral nervous system. The field includes a wide variety of surgical procedures that seek to restore or replace a patient’s skull, scalp, dura (the protective covering of the brain and spinal cord), the spine and/or its overlying tissues.

History of the field

Neuroplastic surgery has adapted reconstructive principles from the fields of craniofacial surgery, and plastic and reconstructive surgery and refined them in order to address challenging deformities which result from Neurosurgical Procedures. The first center for Neuroplastic and Reconstructive Surgery was started at Johns Hopkins University Hospital in Baltimore, Maryland by a formal collaboration between the Department of Plastic and Reconstructive Surgery, under the guidance of plastic surgeon Chad Gordon, and the Department of Neurosurgery under the guidance of neurosurgeon Judy Huang. Upon arrival to Johns Hopkins Hospital, Dr. Chad Gordon formed a multi-disciplinary team of physicians, scientists and engineers. The team’s unified goal was to develop techniques and devices to treat neurosurgical patients. These advances led to several publications and patents, and allowed for the establishment of the first formal fellowship training program in Neuroplastic and Reconstructive Surgery.<ref>Gordon CR, Huang J, Brem H. Neuroplastic Surgery. J Craniofac Surg. 2018 Jan;29(1):4-5. doi: 10.1097/SCS.0000000000004063. .</ref><ref>Gordon CR. Understanding Cranioplasty. J Craniofac Surg. 2016 Jan;27(1):5.doi: 10.1097/SCS.0000000000002312. . </ref><ref>Berli JU, Thomaier L, Zhong S, Huang J, Quinones A, Lim M, Weingart J, Brem H, Gordon CR. Immediate Single-Stage Cranioplasty Following Calvarial Resection for Benign and Malignant Skull Neoplasms Using Customized Craniofacial Implants. J Craniofac Surg. 2015 Jul;26(5):1456-62. doi: 10.1097/SCS.0000000000001816. .</ref><ref>Gordon CR, Murphy RJ, Grant G, Armand M. Commentary on "A Multicenter Experience With Image-Guided Surgical Navigation: Broadening Clinical Indications in Complex Craniomaxillofacial Surgery". J Craniofac Surg. 2015 Jun;26(4):1140-2.doi: 10.1097/SCS.0000000000001673. .</ref><ref>Murphy RJ, Wolfe KC, Liacouras PC, Grant GT, Gordon CR, Armand M.Computer-assisted single-stage cranioplasty. Conf Proc IEEE Eng Med Biol Soc.2015 Aug;2015:4910-3. doi: 10.1109/EMBC.2015.7319493. .</ref><ref>Murphy RJ, Liacouras PC, Grant GT, Wolfe KC, Armand M, Gordon CR. A Craniomaxillofacial Surgical Assistance Workstation for Enhanced Single-Stage Reconstruction Using Patient-Specific Implants. J Craniofac Surg. 2016 Nov;27(8):2025-2030. doi: 10.1097/SCS.0000000000003106. .</ref><ref name=":0">Zhong S, Huang GJ, Susarla SM, Swanson EW, Huang J, Gordon CR. Quantitative analysis of dual-purpose, patient-specific craniofacial implants for correction of temporal deformity. Neurosurgery. 2015 Jun;11 Suppl 2:220-9; discussion 229. doi: 10.1227/NEU.0000000000000679. </ref><ref name=":1">Gordon CR, Yaremchuk MJ. Temporal augmentation with methyl methacrylate. Aesthet Surg J. 2011 Sep;31(7):827-33. doi: 10.1177/1090820X11417425. . </ref><ref>Ibrahim Z, Santiago GF, Huang J, Manson PN, Gordon CR. Algorithmic Approach to Overcome Scalp Deficiency in the Setting of Secondary Cranial Reconstruction. J Craniofac Surg. 2016 Jan;27(1):229-33. doi: 10.1097/SCS.0000000000002289. .</ref><ref name=":2">Gordon CR, Santiago GF, Huang J, Bergey GK, Liu S, Armand M, Brem H, Anderson WS. First In-Human Experience With Complete Integration of Neuromodulation Device Within a Customized Cranial Implant. Oper Neurosurg (Hagerstown). 2017 Oct 6. doi: 10.1093/ons/opx210. [Epub ahead of print] .</ref><ref>Gordon CR, Fisher M, Liauw J, Lina I, Puvanesarajah V, Susarla S, Coon A, Lim M, Quinones-Hinojosa A, Weingart J, Colby G, Olivi A, Huang J. Multidisciplinary approach for improved outcomes in secondary cranial reconstruction: introducing the pericranial-onlay cranioplasty technique. Neurosurgery. 2014 Jun;10 Suppl 2:179-89; discussion 189-90. doi: 10.1227/NEU.0000000000000296. ; PMC 4703091.</ref> In March 2018, Dr. Gordon was appointed the Director of Neuroplastic and Reconstructive Surgery at Johns Hopkins.

The first peer reviewed journal to recognize neuroplastic and reconstructive surgery as its own field was the Journal of Craniofacial Surgery which dedicated its January 2018 issue to introducing the new field of neuroplastic surgery to its readership. In that issue, the editor-in-chief, Mutaz Habal, published an editorial on neuroplastic surgery where he stated: "Based on the desire to present the fact that neuroplastic surgery is there, we have a dedicated this issue of the Journal of Craniofacial Surgery. This presentation mostly involves surgical procedures that will be termed ‘‘neuroplastic’’ in the years to come."<ref>Habal MB. Neuroplastic Surgery: The New Innovation in the Educational Process of Craniofacial Surgery. J Craniofac Surg. 2018 Jan;29(1):1-3. doi: 10.1097/SCS.0000000000004342. .</ref>

Training

Training in neuroplastic surgery requires completion of a neuroplastic and reconstructive surgery fellowship which lasts 1–2 years. Such fellowships are available to individuals who have completed a residency in Plastic and Reconstructive Surgery, ENT Surgery, Neurosurgery or Oral and Maxillofacial surgery. As of today, the only formal fellowship training program in neuroplastic and reconstructive surgery is located at the Johns Hopkins School of Medicine and Johns Hopkins Hospital.<ref>

Neuroplastic and Reconstructive Surgery Fellowship(link). '.

Accessed February 21, 2018.

</ref> The fellowship is co-sponsored by both Departments of Plastic Surgery and Neurosurgery. The first surgeon formally trained in "Neuroplastic and Reconstructive Surgery" was Dr. Gabriel Santiago [2016-18], who completed ENT surgery residency in the US Navy prior to starting the fellowship. ^{(August 2018)}

The first Neuroplastic Surgery Research Fellow was Dr. Amir Wolff [2017-18], an attending oral-maxillofacial surgeon from Rambam Medical Center in Haifa, Israel.

^{(August 2018)}

Neuroplastic surgery procedures

• Cranioplasty (or skull reconstruction)
• Temporal Hollowing Repair <ref name=":0" /><ref name=":1" />
• Removal of Neurofibroma Tumors in Neurofibromatosis
• Complex Scalp Reconstruction
• Craniofacial Approaches to brain tumors
• Removal of skull and craniofacial tumors
• Complex Approaches to the spine and spinal cord
• Complex closures of the back following spine surgery
• Ventricular Shunt Revision
• Repair of Cerebrospinal Fluid (CSF) leaks
• Dural Reconstruction
• Implantation of Functional Neural Devices <ref name=":2" />

References

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