By Barbara Buccilli MD
Trauma is an omnipresent force in our lives, manifesting in various forms and degrees of severity. We encounter it in our patients, our neighbors, sometimes within our own families, and we can also experience it first hand. As a medical professional, I am acutely aware of the diverse nature of trauma, raging from physical injuries to the psychological wounds inflicted by life’s hardships.
Neurosurgical trauma is a field characterized by its fast pace, high stakes, and the necessity for precise decision-making under pressure. When I’m working with one of the most delicate organs in the body, in which every nucleus and every fiber has its precise and often irreplaceable function, my actions can have an immediate and tangible impact on a patient’s survival and quality of life.
Trauma to the brain and nervous system is multifaceted, and despite advances in medical science, we often lack definitive treatments. In addition, physical trauma is only the most evident kind of trauma our patients have to face, and no doctor can be entirely prepared to face every possible aspect of trauma, especially the ones that have no physical counterpart. However, what I can do is treat the trauma I can see and have the opportunity to address. My goal is to provide patients with the immediate care they need, stabilizing their conditions, and giving their bodies and minds the strength and resources to fight the battles I cannot directly intervene in.
This might sound like science fiction, but I can’t help but wonder about the potential functional neurosurgery could have in these patients. Functional neurosurgery is a specialized field within neurosurgery that focuses on restoring or improving the function of the nervous system. This is achieved through surgical interventions that modulate, restore, or replace dysfunctional neural circuits, often using techniques like neurostimulation, lesioning, or the implantation of devices. Combining trauma neurosurgery and functional neurosurgery, could hold immense potential to address both the physical and mental aspects of trauma comprehensively. Trauma neurosurgery focuses on the immediate, life-saving interventions required to stabilize patients with critical injuries, while functional neurosurgery delves into advanced techniques such as Deep Brain Stimulation (DBS) to treat neurological disorders and alleviate chronic pain, depression, and other psychological conditions. DBS uses low-dose electrical impulses delivered through an implantable device to specific brain regions, modulating abnormal neural activity and leading to therapeutic changes. It allows for adjustable, reversible stimulation, meaning its parameters can be fine-tuned over time for the best therapeutic response. DBS targeting the central thalamus has been explored to improve arousal and consciousness in patients with severe TBI, particularly in those who are in a minimally conscious state. Stimulation of regions such as the fornix or hippocampus has been explored experimentally to improve memory functions in patients who experience cognitive impairments post-TBI, while targeting areas like the nucleus accumbens or ventral striatum has shown potential to modulate behavior and emotional regulation. Spinal cord stimulation, which involves implanting electrodes near the spinal cord to modulate pain signals, can provide relief for post-traumatic pain syndromes or aid in rehabilitation efforts for spinal cord injuries. Intrathecal baclofen pumps or selective dorsal rhizotomy can help manage spasticity and improve mobility. DBS targeting the globus pallidus interna or the subthalamic nucleus can also improve spasticity. Vagal nerve stimulation has been explored in the treatment of cognitive impairments and mood disorders. Additionally, functional neurosurgery plays a key role in the development of brain-computer interfaces, further expanding its potential to restore function in patients affected by trauma. By researching ways to integrate these two fields, we could not only repair the acute physical damage caused by trauma but also enhance the long-term recovery and quality of life for patients by both speeding up physical recovery and addressing the underlying neuropsychological effects. This holistic approach could lead to more effective and enduring outcomes, bridging the gap between immediate surgical care and long-term mental health support.
One of the most profound aspects of trauma surgery is the ability to make a difference in moments of crisis. We all experience trauma in our lives, whether big or small, public or private. We understand the significance of a kind, extended hand during times of need. In my career, I aspire to be that hand for my patients. However, more than just offering compassion, I aim to provide them with the expertise and precision that neurosurgery demands. I want my patients to learn the value of a kind, precise blade the same way they learned to value a kind, extended hand.
In conclusion, my interest in neurosurgery and trauma is fueled by a desire to make a meaningful difference in the lives of patients during their most vulnerable moments. As I said before, my idea could sound like science fiction, but science fiction is only such until it becomes reality; then it’s just science.
Dr. Buccilli is a Neurosurgical ICU pre-residency fellow at the Icahn School of Medicine at Mount Sinai and 2025 match applicant. With prior neurosurgical residency training at the University of Ferrara in Italy and 2 years of clinical and research work in the Neurosurgery department at Policlinico Umberto I, the academic hospital associated with Sapienza University of Rome, Dr. Buccilli brings a wealth of international experience to her practice. Currently, heavily involved in research, Dr. Buccilli’s is committed to advancing the field of neurosurgery through innovation and comprehensive patient care.