Not unlike wired networks in our physical world, the nervous system uses electric currents and pulses to energize and communicate with the entire organism.

Structural damage can occur through mechanical wear and tear, or from a tumor compressing the nerve cables. Initial symptoms may include pain, numbness or weakness in the affected body parts.

Other conditions result from hyperexcitation of the nervous system, including epilepsy and excessive sweating (palmar hyperhidrosis). 

Nerves are resilient and have the capacity for self repair (different from the brain and spinal cord that have limited repair mechanisms in the adult).

If the problem persists or worsens, mechanical decompression or tumor removal may become necessary.

Progressive nerve symptoms require diagnostics from an expert neurologist, including electric testing (EMG) and imaging (MRI) to check for nerve impingements or tumors.

Most of the time, the tests do not confirm a structural problem that surgery can fix.

Should a nerve compression or tumor impinging the nerve be found, and non-surgical treatments have not improved the situation, a referral to neurosurgery will be made for decompression surgery or tumor removal.

In addition to decompression and tumor removal, neurosurgeons are sometimes asked to implant nerve stimulation devices to alleviate chronic pain or to help control certain forms of epilepsy or depression.

Nerve root stimulators are also used to enable bladder control for patients with spinal cord injury.

In addition to nerve decompression and modulation, removal or destruction of nerves may be indicated, such as rhizotomy for pain or for excessive sweating of the hands (palmar hyperhidrosis).

Long time ago, surgeons were told early in their training that “surgeons know how to operate, good surgeons know when to operate, the best surgeons know when not to operate”.

Measuring twice is particularly important in nerve surgery, because the nerve is a very delicate structure (like the brain and spinal cord) and surgery can trigger scar formation or inflammation.

The neurologist will guide the decision, after utilizing a variety of non-surgical methods and medications first. The neurosurgeon will then be asked to evaluate the situation, once non-surgical methods have been exhausted.

Check out our non exhaustive list of nerve diagnoses potentially requiring neurosurgery.

Routine nerve decompressions such as carpal tunnel release will be scheduled as an outpatient procedure.

Make sure to ask someone to be the designated driver because the medications used by anesthesia will have to wear off for a few hours.

Surgical access to the nerve depends on the location of the problem. Some nerve conditions require the neurosurgeon to access the skull base, spine, or a body cavity.

Tumor surgery necessitates resources only available in the hospital (pathology, high power microscope or endoscope, nerve monitoring).

Click on the nerve image below to check out a non-exhaustive list of conditions that may require nerve surgery.