The Neurosurgical Intensive Care Unit and the Unique Role of the Neurosurgeon

Beginning with the contributions of Harvey Cushing, neurosurgeons have always had a significant role in managing patients in critical condition. The field of neurocritical care has evolved over decades, but the involvement and participation of neurosurgeons has been a continued necessity. However, with neuro-intensive care units (neuro-ICUs) showing the potential for decreased resource utilization, and improved patient outcomes, there is an increasing prevalence of dedicated neuro-ICUs requiring greater involvement of neurosurgeons to manage critical neurological patients. A considerable portion of neurosurgical training includes critical care skills and knowledge, which can be further amplified through fellowship training. Several models of neurocritical care exist, with variations in neurosurgical and intensivist responsibility. Care in the neuro-ICU includes not only thorough examination and review of imaging studies, but also a systematic approach in addressing clinical needs. Neuro-ICUs have specialized to treat a variety of pathologies including acute stroke, subarachnoid hemorrhage, traumatic brain injury, status epilepticus—all needing the direct involvement of neurosurgeons. Neurosurgeons are particularly well equipped to evaluate not only for neurological changes but also for pathologies, presentations, or changes requiring surgical interventions.