The Different Types of Neurosurgeons & Revisiting my Neurosurgery Training Program
By: Brian Hoeflinger, MD
April 8, 2025 | #41
Forwarded this email? Sign up here.
Disclaimer: Opinions are my own. Not medical advice.
Medical Trivia of the Week
Although the human brain makes up only about 2% of the body’s weight, it consumes a disproportionate amount of the body’s energy. What percentage of the body’s total energy does it typically use? (the correct answer is at the end of this email)
- A) 10%
- B) 15%
- C) 20%
- D) 25%
My Weekend at the University of Rochester
What an amazing experience my son, Kevin, and I had at the University of Rochester in Rochester, NY, this past weekend. I trained at this neurosurgery program over 30 years ago, and it was wonderful to return and see just how much everything has evolved, boy, have things changed. Over a two-day span, we had the opportunity to speak with and interview ten of the eighteen attending neurosurgeons on staff. The fascinating part is how each one is both similar and distinctly unique.
The Subspecialties of Neurosurgery
Neurosurgery is a field that encompasses many specialized skills and areas of expertise. Becoming a neurosurgeon typically takes 15 years beyond high school, including four years of college, four years of medical school, and a typical seven-year residency. Moreover, each neurosurgeon at the University of Rochester has pursued an additional 1-2 year fellowship after residency to hone their specialty. These specializations include vascular, trauma, spine, peripheral nerve, oncology (treating tumors of the brain and spine), functional neurosurgery (including deep brain stimulation), skull base surgery, and pediatric brain and spine surgery, to name a few. It was incredibly exciting to learn about the nuances of each field through our conversations.
Vascular Neurosurgery
A vascular neurosurgeon treats the blood vessels in the brain and spine, addressing issues such as strokes, aneurysms, and AVMs (arteriovenous malformations). What sets the University of Rochester’s program apart is that it boasts four fellowship-trained endovascular neurosurgeons. These specialists operate from within the blood vessels themselves, treating diseases without directly incising brain tissue. And, if necessary, they possess the skills to operate directly on the brain. In essence, it’s like having two surgeons in one.
Trauma Neurosurgery
Next, we sat down with a trauma neurosurgeon who manages life-threatening injuries to the brain and spine. Severe head injuries, spine fractures, and spinal cord injuries are everyday challenges in this field. Not only does this surgeon save lives, but they also contribute to cutting-edge research aimed at enhancing recovery outcomes for injured patients.
Functional Neurosurgery
We then met the neurosurgeon specializing in functional neurosurgery. This field includes procedures such as deep brain stimulation to treat Parkinson’s disease and brain neuromodulation to address tremors. In these surgeries, electrodes are placed deep within the brain with extraordinary precision, typically when medications fail to control the symptoms. For example, Parkinson’s disease, like the kind experienced by Michael J. Fox, is being successfully managed with deep brain stimulation in many patients.
Oncologic Neurosurgery
Cancer remains a major cause of disability and death worldwide, underlining the need for neurosurgeons who specialize in treating tumors and cancers of the brain and spine. Tumors can originate in the brain or metastasize from other parts of the body, and they can lead to significant disability, paralysis, and even death. In addition to their surgical expertise, the University of Rochester Neuro-oncology program is engaged in groundbreaking research to treat these cancers, aiming ultimately to halt tumor growth before it jeopardizes the patient's well-being.
Skull Base Surgery
We also spoke with a skull base neurosurgeon, a highly specialized expert who treats complex conditions and tumors located at the base of the brain and skull. This area is densely packed with vital nerves and blood vessels that must be meticulously protected during surgery. Skull base procedures are renowned for being lengthy, complex, and challenging.
Pituitary Tumor Surgery
Along similar lines, our next interview was with a surgeon who specializes in pituitary tumors. These tumors occur at the base of the skull and are often removed via a transsphenoidal approach, that is, through the nose. This method provides access to the tumor, which is then excised using very fine instruments under a microscope. Although this technique has a high success rate, it carries risks, including potential injury to the brain, blood vessels, and optic nerves located near the tumor. If the tumor cannot be removed through the nose, the surgeon may resort to a traditional craniotomy, where a portion of the skull is opened.
Seizure Surgery
Epilepsy, a seizure disorder, can be incapacitating and make it difficult for patients to lead a normal life. While medications are always the first line of defense, surgery becomes a consideration when they fail. The University of Rochester has over 30 years of experience in treating epilepsy surgically. Many procedures are performed with the patient awake, allowing the surgical team to map the brain’s surface in real time. This mapping helps identify which areas can be safely removed and which should be preserved. Thanks to the expertise of these specialized teams, many patients go on to enjoy significantly improved lives, free from relentless seizures.
Pediatric Neurosurgery
Our final interview was with a pediatric neurosurgeon who specializes in brain and spine surgery for children. Operating on children is markedly different from operating on adults because age-related anatomical differences must be carefully considered, often making the difference between life and death. Additionally, the interactions with families are more delicate and emotionally charged, as there is nothing more precious to a parent than their child. Although pediatric neurosurgery is demanding, it is also immensely rewarding.
Peripheral Nerve Neurosurgery
We even met a neurosurgeon specializing in treating peripheral nerve diseases and disorders. Peripheral nerves are all the nerves in our arms and legs and even our chest wall that control sensation and movement. For instance, he told us of a procedure where a nerve in the chest wall can be moved and then grafted directly into a persons arm so they can move the arm again. Or taking an injured nerve that was cut with a knife or glass and directly splicing it back together to restore function to that limb. These are extremely delicate and intricate surgeries that can bring much needed quality back to a person’s life.
My Final Thoughts
The field of neurosurgery is incredibly diverse, encompassing numerous specific disease processes that affect the human body. Training future neurosurgeons demands a program staffed by surgeons who can cover the entire spectrum of neurosurgical specialties. While we did not have the chance to meet all 18 neurosurgeons on staff, we connected with many highly accomplished professionals who are making a real difference in patients’ lives every day. I hope that after reading this newsletter, you have gained a greater appreciation for what it takes to be a fellowship-trained neurosurgeon and what it takes to mentor the next generation of neurosurgical experts.
Impactful Quote of the Week
"In every neurosurgical challenge, we are invited to uncover not only the intricacies of the human brain but also the strength within ourselves.”
- Dr. Evelyn Carter
All my best,
Brian Hoeflinger
P.S. - if you enjoyed this newsletter, you may enjoy my book that details my life as neurosurgeon and the loss of my oldest son, Brian (see below a synopsis).
My Book
Life and Death . . . Two words with such opposite meaning and which inflict such contradictory emotions and yet are so closely intertwined in our lives. As parents, we bring meaning and life into this world through our children. Our lives become defined as a result. We learn the joy, hardship, and responsibility of shaping an innocent life. But a day will come when that life will be taken. For some, death will come too soon. This is the story of my son, Brian Nicholas Hoeflinger, who died unexpectedly at age 18.
https://doctorhoeflinger.com/products/the-night-he-died-the-harsh-reality-of-teenage-drinking
Interested in Sponsoring the Newsletter?
Please reply with any questions you may have or future topics that you want me to write about.
If you enjoyed this newsletter or previous editions, please share it with a friend. You can use this link: https://pages.doctorhoeflinger.com/posts
Medical Trivia Answer:
The correct answer is C) 20%
