Neurosurgeons deal with complex craniofacial trauma, tumours, and other pathologies which, on their own and after surgery, leave these patients cosmetically deformed. Traditionally, neurosurgeons have focused primarily on neurological outcomes, while aesthetic morbidity has been considered less important. However, studies show that it is aesthetic morbidity that significantly contributes to the social stigma and psychosocial adverse outcomes in these patients (1). It was to address this incongruous approach that the field of neuroplastic surgery was born. An umbrella term, this novel supersubspeciality of neurosurgery aims to provide a holistic approach to management—holistic in terms of synthesising the neurological and aesthetic needs of the patient. Furthermore, it is also holistic, as it pools the expertise of many fields, such as maxillofacial surgery, oculoplastic surgery, and plastic surgery, under the leadership of a speciality-trained neurosurgeon.
The author has been performing this cosmetic neurosurgery since 2010. He has performed a large number of cosmetic neurosurgeries in many government and private institutions in the Indian subcontinent. Surgeries performed ranged from cranioplasties to complex orbitocranial penetrating injuries requiring multidisciplinary care from a neurosurgeon and oculoplastic surgeon team (2). He also shifted the focus of neuro-oculoplastic repairs towards primary reconstructive procedures. This work culminated in his presentation at the 15th WFNS World Congress of Neurosurgery, held in Seoul in 2013, which drew widespread praise. Subsequent to this, the field bloomed in the West, with articles being published about this burgeoning speciality in 2018 (3). He has remained an active voice internationally, advocating for the establishment of neuroplastic surgery in the Asian subcontinent (4). His extensive work in this field has led him to propose a broad classification system for neuroplastic surgery, which has been dubbed “Kodeeswaran’s classification of neuroplastic surgery” (Figure 1). Neuroplastic surgery still has a long way to go and needs to address concerns such as lack of awareness, the need for a structured training programme, technology integration, and wider adoption by neurosurgeons (5).
Figure 1. Kodeeswaran’s classification of neuroplastic surgery.
In response to the call to establish this speciality in the Asian continent, Professor Yoko Kato, President of the Asian Congress of Neurological Surgeons (ACNS), has graciously agreed to the establishment of a specialist committee within the ACNS dedicated to neuroplastic surgery. This interdisciplinary committee, consisting of neurosurgeons, oculoplastic surgeons, maxillofacial surgeons, and plastic surgeons, is dedicated to addressing the needs of this growing field and championing its cause. Under the guidance of global leaders in neuroplastic surgery, such as the members of this committee and the author, the field is truly in safe hands.
References
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