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Neurosurgery

Q: What is neurosurgery?
Q: What is a neurosurgeon?
Q: Who sees a neurosurgeon?
Q: What might neurological care involve?
Q: What areas of care are available?
Q: Who is a neurosurgeon?
Q: What does neuroscience care involve?
Q: Where is the neuroscience patient cared for?
Q: What medical conditions require brain surgery?
Q: What risks are associated with brain surgery?
Q: How is brain surgery done?
Q: What are other names for brain surgery?
Q: How do I prepare for brain surgery?
Q: How are university hospitals different from community hospitals?
Q: What happens after I am discharged from the hospital after brain surgery?
Q: What possible problems should I look for after brain surgery?

Q: What is neurosurgery?

Neurosurgery is the surgical care of the brain and spinal cord. This includes many diseases and injuries of the brain, spinal cord, and nerves such as:
* Cerebral hemorrhages
* Cerebrovascular conditions including aneurysms and vascular malformations
* Brain and spinal cord tumors
* Spinal cord injuries
* Traumatic brain injuries
* Spinal surgeries including laminectomies and fusions

Who is a neurosurgeon?

A neurosurgeon is a physician who has met rigorous educational requirements including 4 hears of college, 4 years of medical school, a one-year general surgical internship, and 6 to 7 years as a neurosurgical resident.

http://www.bcm.edu/neurosurgery/residency/clinical_trng.htm The resident spends time in research, basic sciences, neurology, neuroradiology, neuropathology and neurosurgery.

This specialist:

* diagnoses and treats surgical disorders or injuries of the nervous system
* performs a detailed examination of the neurological structure of the body
* performs surgery on the brain, spinal cord, and nerves
* performs radiosurgery which is a way of treating brain abnormalities, tumors or other functional disorders with a precise delivery of a single high dose of radiation in a one-day session

Who sees a neurosurgeon?

You may need to see a neurosurgeon if you have been examined by a primary care physician and told that your symptoms are neurological in nature and require surgery. Your primary care physician will consult a neurosurgeon and schedule an appointment for an exam and possible tests. Once your exam and tests are completed, the neurosurgeon will work with you to determine the plan of care and schedule surgery if necessary.

What does neuroscience care involve?

Care for the neuroscience patient requires a multidisciplinary team approach. The neurosurgeon works as the team leader to provide the very latest in neurological care. The neuroscience team also includes:

* Neuroscience registered nurses
* Case management
* Social workers
* Chaplains
* Respiratory therapists
* Physical therapists
* Occupational therapists
* Speech pathologists
* Neuroradiologists
* Neurodiagnostic technicians
* Physiatrist (rehabilitation physician)
* Neuropsychologists

Where is the neuroscience patient cared for?

Neuroscience patients are cared for in both the inpatient and outpatient settings.

Inpatient settings include:

* Trauma 5 (emergency department)
* Critical care (ICUs and neuro acute/stroke units)
* General neuroscience unit
* Acute rehabilitation

Outpatient settings include:

* Outpatient therapies
* Outpatient clinics
* Neuroscience Specialty Clinics
* Support groups

Craniotomy

What is it?

Craniotomy is an operation that involves removing a piece of bone from the skull (cranium) to provide access to the brain and its surrounding structures. The term craniotomy is derived from the Latin words cranium (head) and -otomy (act of cutting, incision). The human skull, which is formed by the union of several cranial and facial bones, is anatomically divided into five regions: an upper region or vertex, a lower region or base, two side regions, and a frontal region, the face. The region of the skull through which the surgeon selects to perform a craniotomy is based on the type of condition requiring treatment. A skull base craniotomy is performed, for example, to treat Chiari (kee-ar-ee) malformations - congenital abnormalities of the base of the brain where the spinal column joins the skull. Named after Professor Hans Chiari - the German pathologist who in 1890 first described these abnormalities of the brain, these malformations usually cause a protrusion of the cerebellum through the bottom of the skull into the spinal canal, which results in poor circulation of cerebrospinal fluid from the brain to the spinal cord.

Why is it done?

Patients who suffer from the following cranial conditions are potential candidates for this operation:

* Tumors (e.g., brain, pituitary, optic nerve, acoustic neuroma)
* Cysts (e.g., arachnoid, colloid)
* Bleeding (hemorrhage)
* Blood clots (hematomas) from injuries (subdural hematomas or epidural hematomas)
* Weaknesses in blood vessels (cerebral aneurysms)
* Abnormal blood vessels (AVMs or arteriovenous malformations)
* Damage to the tissue covering the brain (dura)
* Cerebrospinal fluid (CSF) leaks
* Chiari malformations
* Premature fusion of the normally separate bones of the skull (craniosynostosis)
* Infection in the brain (brain abscesses)
* Skull trauma (e.g., fractures)

The Operation

An understanding of what a craniotomy involves will help you to approach your operation and recovery with confidence.

Incision

Part of the scalp is shaved and cleaned. An incision is then made through the scalp to the skull.

Exposure

A small hole, called a burr hole, is drilled through the skull to the brain. In some cases, several burr holes are drilled to allow your surgeon to lift and remove a piece of the bone. The bone between these holes is cut to create a flap in the skull through which the surgeon can access the brain and its surrounding structures. Next, the dura is cut to expose the brain.

Related Procedure

At this point in the operation, depending on the condition for which you are receiving treatment, several different procedures are performed. For example, your surgeon may remove tumors, clip aneurysms, drain cysts or shunt blood clots (a passage created between two natural bodies, such as blood vessels, shunts divert or permit flow from one body to the other).

Closure

The dura is then sutured closed, and the bone that was removed from the skull is put back in place and secured with metal plates and screws. The operation is completed when your surgeon closes and dresses the incision.

Recovery

Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan.

As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection and blood loss, are some of the potential adverse risks of cranial surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.

Q: What medical conditions require brain surgery?
Brain surgery may be done if you have: •Brain tumor •Bleeding (hemorrhage) in the brain •Blood clots (hematomas) in the brain •Weaknesses in blood vessels (See: Brain aneurysm repair) •Abnormal blood vessels in the brain (arteriovenous malformations; AVM) •Damage to tissues covering the brain (dura) •Infections in the brain (brain abscesses) •Severe nerve or face pain (such as trigeminal neuralgia or tic douloureux) •Skull fracture •Pressure in the brain after an injury or stroke •Epilepsy •Certain brain diseases (such as Parkinson’s disease) that may be helped with an implanted electronic device Hydrocephalus
How is hydrocephalus diagnosed?

How do I prepare for brain surgery?

•Your neurosurgeon may ask you to see your internist (or a specialist such as a cardiologist) in order to get "medically cleared" for surgery. The intent is to reduce the risk of anesthesia by identifying and optimally treating medical conditions. For patients with a history of heart problems or who may be at increased risk of a heart attack, this may involve specific tests to assess the blood flow to the heart.

In order to reduce the risk of bleeding during or immediately following brain surgery, it is important to tell your neurosurgeon if you are taking any medications that thin the blood (anticoagulants) or if you have a natural tendency for bleeding (hemophilia). Always tell your neurosurgeon if you take aspirin (even baby aspirin) because in most cases aspirin should be stopped at least eight days prior to surgery. Other medications, including herbs, vitamins, or nonsteroidal anti-inflammatories such as Motrin, may also have to be stopped prior to surgery.

•Although the chances of a serious complication are usually low with most brain surgeries, surgery of any type carries risks. Consider having a discussion with family members about your wishes in the event something unexpected occurs and you are not able to make decisions for yourself. Ideally, all patients having surgery of any kind should have a Living Will or Advance Directive completed prior to undergoing the surgical procedure. Your primary care doctor may be a good resource for advice.

What happens after I am discharged from the hospital after brain surgery?

What possible problems should I look for after brain surgery?

•You should call your neurosurgeon in the following situations: seizure, severe headache, worsening neurological problems, fever or chills, swelling of the ankles, bleeding or bruising, severe nausea or vomiting, and skin rash.
If seizures continue for over one minute or there is a serious medical condition, call 911.

Here are further guidelines.

Here are further guidelines.