Division of Neurosurgery   
Phone: 217-545-8000
FAX: 217-545-0253 
Email: neurosurgery@siumed.edu 
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Conditions

Aneurysm

Aneurysm:  A brain or cerebral aneurysm is a cerebrovascular disorder in which the wall of an artery in the brain becomes weak and balloons outward. The ballooned part of the artery is the aneurysm.  An aneurysm has thin walls and can leak or rupture easily. Aneurysms can form in many sizes and can rupture at any time

Complications of a ruptured aneurysm: The rupturing of an aneurysm is called a subarachnoid hemorrhage and causes blood to leak into the fluid-filled space around the brain.  This bleeding is very dangerous and can cause:

Treatment depends on the location of the aneurysm, and may include:

Microsurgical clipping During this surgery, a metal clip is placed at the base of the aneurysm to control the bleeding and to decrease the risk of more bleeding. This procedure often requires a small craniotomy, which is the creation of a window in the skull. This allows the doctor to go around the brain with the help of endoscopes and microscopes to detect the aneurysm and clip it.

Aneurysm coiling     

Aneurysm coiling may be an option for suitable people. Coiling is used to block the blood vessel supplying blood to the area of the brain with the aneurysm.   Metal coils are placed in the aneurysm through a catheter that is inserted in the groin area. This surgery will prevent further bleeding Your neurosurgeons may recommend a combination of surgical and non-surgical approaches to treat aneurysms.

AVM

An arteriovenous malformation (AVM) is a congenital defect between the arteries and veins. The condition affects the connection between these blood vessels, and disrupts the flow of blood between them. Although this defect can occur anywhere, AVMs are most common in the brain or spine. It is common for people not to know that they have an arteriovenous malformation for many years — or even until they reach adulthood. You may not know that you have an AVM in your brain until you experience symptoms. A ruptured AVM is a medical emergency.

Possible treatments for an arteriovenous malformation include:

Embolization to block blood flow to the AVM

Endovascular embolization is a minimally invasive procedure that involves the threading of a small catheter or tube through a blood vessel in the groin, which is then navigated to blood vessels in the brain to block blood flow

Brain tumors

There are two main types of tumors:

Cancerous brain tumors can be further classified as:

 

Brain Abscess

An abscess is a collection of pus in an enclosed area of the body. Within the brain, abscesses occur as the result of a bacterial or fungal infection.  A brain abscess is a serious, life-threatening condition. Ruptured abscesses have a high mortality rate.  The goals of treatment for brain abscesses are to reduce intracranial pressure and eliminate the infection.  Your neurosurgeons will remove or drain the abscess to relieve the pressure. After treatment, you will need to take a course of antibiotics.

Treatment for a brain abscess includes both:

 

Carpal Tunnel Syndrome

Carpal tunnel syndrome is a common problem that affects the use of your hand, and is caused by compression of the median nerve at the wrist. It most often occurs when the median nerve in the wrist becomes inflamed after being aggravated by repetitive movements such as typing on a computer keyboard or playing the piano. It also seems to affect professional artists fairly commonly – in particular, sculptors and printmakers.   The "carpal tunnel" is formed by the bones, tendons and ligaments that surround the median nerve. Since the median nerve supplies sensation to the thumb, index and middle finger, and part of the ring finger, and provides motion to the muscles of the thumb and hand, you might notice numbness and weakness in these areas.

Treatment:

If you experience severe pain that cannot be relieved through rest, rehabilitation or nonsurgical treatment, you may be a candidate for one of several surgical procedures that can be performed to relieve pressure on the median nerve. The most common procedure is called carpal tunnel release, which can be performed using an open incision or endoscopic techniques.  The open incision procedure or carpal tunnel release, involves the doctor opening your wrist and cutting the ligament at the bottom of the wrist to relieve pressure.

Cerebral Contusion

A contusion is a type of traumatic brain injury (TBI) that causes bruising of the brain tissue; a hematoma is heavy bleeding into or around the brain. The severity of a TBI can range from a mild concussion to the extremes of coma or even death.

Each year, minor incidents of TBI happen to over one million people in the United States. These minor injuries result in the treatment and release from hospital emergency departments. Another 230,000 people are hospitalized each year with TBI. Of these people, 99,000 will show a lasting disability.

 

Cervical Disc disease

Age, injury, poor posture, or diseases such as arthritis can lead to degeneration of the bones or joints of the cervical spine, causing disc herniation or bone spurs to form. Sudden severe injury to the neck may also contribute to disc herniation, whiplash, blood vessel destruction, vertebral injury, and, in extreme cases, permanent paralysis. Herniated discs or bone spurs may cause a narrowing of the spinal canal or the small openings through which spinal nerve roots exit.

Cervical stenosis  

Cervical stenosis occurs when the spinal canal narrows and compresses the spinal cord and is most frequently caused by aging. The discs in the spine that separate and cushion vertebrae may dry out. As a result, the space between the vertebrae shrinks, and the discs lose their ability to act as shock absorbers. At the same time, the bones and ligaments that make up the spine become less pliable and thicken. These changes result in a narrowing of the spinal canal. In addition, the degenerative changes associated with cervical stenosis can affect the vertebrae by contributing to the growth of bone spurs that compress the nerve roots. Mild stenosis can be treated conservatively for extended periods of time as long as the symptoms are restricted to neck pain. Severe stenosis requires referral to a neurosurgeon.

Treatment:

There are several different surgical procedures which can be utilized, the choice of which is influenced by the severity of your case

 

Chiari Malformation 

Chiari malformations in adults occur when there is a lack of space for the cerebellum, which is the part of the brain that controls balance and coordination.  When the space at the bottom back of the skull is smaller than it should be, the cerebellum and the brainstem may be pushed downward. The pressure on the cerebellum can block the flow of cerebrospinal fluid and cause an array of symptoms.

To help diagnose Chiari malformation, our experts will ask about your symptoms and conduct a thorough physical
exam, as well as order MRI imaging. The treatment for Chiari malformation depends on the severity of your condition. For people who show symptoms, decompression surgery is often the best option.

The goals of Chiari malformation treatment include:

Surgery to Reduce Pressure

The most common operation for Chiari malformation in adults — called posterior fossa decompression —
involves removing a small section of bone in the back of the skull.

Other treatment options may include:

Shunting — Rarely, we may need to use a shunt to drain the cerebrospinal fluid from the brain to the
abdomen to control the problem in adults.

 

Concussion

A concussion is an injury to the brain that results in temporary loss of normal brain function. It usually is caused by a blow to the head. Cuts or bruises may be present on the head or face, but in many cases, there are no signs of trauma. Many people assume that concussions involve a loss of consciousness, but that is not true. In most cases, a person with a concussion never loses consciousness.   People with concussions often cannot remember what happened immediately before or after the injury, and they may act confused. A concussion can affect memory, judgment, reflexes, speech, balance and muscle coordination. Paramedics and athletic trainers who suspect a person has suffered a concussion may ask the injured person what year it is or direct them to count backwards from 10 in an attempt to detect altered brain function.

Even mild concussions should not be taken lightly. Neurosurgeons and other brain-injury experts emphasize that although some concussions are less serious than others, there is no such thing as a "minor concussion." In most cases, a single concussion should not cause permanent damage. A second concussion soon after the first one, however, does not have to be very strong for its effects to be deadly or permanently disabling.Treatment: The standard treatment for concussion is rest. For headaches, acetaminophen (Tylenol) can be taken.  Postconcussive headaches often are resistant to stronger narcotic-based medications.

Postconcussive Syndrome

People who suffer a head injury may suffer from side effects that persist for weeks or months. This is known as postconcussive syndrome. Symptoms include memory and concentration problems, mood swings, personality changes, headache, fatigue, dizziness, insomnia and excessive drowsiness. Patients with postconcussive syndrome should avoid activities that put them at risk for a repeated concussion. Athletes should not return to play while experiencing these symptoms. Athletes who suffer repeated concussions should consider ending participation in the sport.

 

Degenerative disc disease

Degenerative disc diseaseoccurs when spinal discs degenerate, or wear down. The discs of the spine cushion the interlocking vertebrae and act as shock absorbers for the back, allowing it to bend, flex and twist. They break down over time as a natural part of the aging process.  Spinal discs are composed of two layers – a tough, firm outer layer and a soft, jelly-like core.  Small tears in the outer layer may cause the soft material in the center to leak out, causing a disc to bulge or rupture. This is a leading cause of back pain, primarily in the lower back and the neck. However, not everyone who has degenerative disc disease experiences pain.

Treatment:

Surgery may be considered when patients do not respond to conservative treatment and are severely limited in performing activities of daily life.   Spinal fusion can reduce pain by stopping the motion at a painful segment of the spine. The disc is removed from between two vertebrae, then the vertebrae are fused together. This procedure is performed through a single incision in the back.

Diffuse Axonal Injury

Diffuse axonal injury occurs in about half of all severe head traumas, making it one of the most common traumatic brain injuries. It can also occur in moderate and mild brain injury. A diffuse axonal injury falls under the category of a diffuse brain injury. This means that instead of occurring in a specific area, like a focal brain injury, it occurs over a more widespread area.

In addition to being one of the most common types of brain injuries, it’s also one of the most devastating. As a matter of fact, severe diffuse axonal injury is one of the leading causes of death in people with traumatic brain injury.

Dystonia

Dystonia is a movement disorder, meaning it affects parts of the brain that control body movement (motor function). It causes involuntary muscle spasms (contractions), sometimes repeatedly, that can twist the body and be painful.  Dystonia symptoms often start in childhood or early adulthood and can range from mild to severe. In about half of cases, dystonia is a symptom of a disease or a result of being exposed to toxins or certain drugs. In most other cases where dystonia is not linked to a specific illness or problem, it is thought to be hereditary.  Many cases of dystonia are temporary, such as those brought on by medication. Although there is no cure for dystonia, several treatment options can help control symptoms and allow people to live independently.

These treatment options include:

Epidural Hematoma

Epidural hematoma (EDH) is a traumatic accumulation of blood between the inner table of the skull and the stripped-off dural membrane. The inciting event often is a focused blow to the head, such as that produced by a hammer or baseball bat. In 85-95% of patients, this type of trauma results in an overlying fracture of the skull. Blood vessels in close proximity to the fracture are the sources of the hemorrhage in the formation of an epidural hematoma. Because the underlying brain has usually been minimally injured, prognosis is excellent if treated aggressively. Outcome from surgical decompression and repair is related directly to patient's preoperative neurologic condition.

Epilepsy

Epilepsy is a disorder of the brain that causes repeated, unpredictable seizures, generally beginning in childhood or early adulthood. Epilepsy can lead to serious complications, including injury to the brain.  Epilepsy means the brain has formed abnormal electrical connections that disrupt normal brain function and cause seizures. It can be caused by an injury or illness that affects the brain, such as a stroke or brain tumor, or its cause can be unknown.In adults, medication can frequently control epilepsy. However, if seizures persist after trying two drugs, our expert neurosurgeons may offer epilepsy surgery

Treatment:

surgical treatment may be considered if your seizures continue after trying two different medications.  Your neurosurgeon offers a diagnostic surgery for detection of difficult to localize seizures, also called intracranial EEG monitoring – this is to localize the seizure area and to map brain function.  Procedure: A craniotomy is performed and Sterile EEG leads are placed directly on the brain.  The bone flap is placed back on the patient and secured.  The wound is then closed with the tails of the EEG leads coming out through the wound.  These leads are connected to EEG monitors that are available in special rooms in the hospital.  The patient is then monitored continuously for several days for seizure activity.   

There are several types of treatment surgery for adults:

 

Essential tremor

Essential tremor is a movement disorder, meaning it affects parts of the brain that control body movement (motor function).   It is a type of involuntary shaking movement for which no cause can be identified, and it is often a symptom of another condition, such as:

The shaking is very rapid, generally more than five times a second Essential tremor is the most common type of tremor and is mainly found in people over age 65. An essential tremor is not dangerous or life-threatening, but it can be annoying and embarrassing for many people.

In some cases, it may be dramatic enough to interfere with:

Several treatment options can help control symptoms of essential tremor. People whose symptoms have not responded well to medication alone may be candidates for deep brain stimulation Essential tremor, like many movement disorders, can be treated but not cured.   

Treatment options depend on:

Herniated Disc

The spinal bones (vertebrae) are separated by discs, which cushion the spine and allow movement between the vertebrae. A herniated disc, often called a slipped disc, occurs when a part of the vertebrae pushes into the adjoining disc, putting pressure on the nearby nerves and causing pain or other symptoms. Discs may move out of place (herniate) or break open (rupture) as a result of an injury or strain. This causes pressure that can lead to pain, numbness, or weakness.   

Treatment:

Patient whose symptoms are not improved by conservative therapy may benefit from surgery.  Additionally patients who experience progressive muscle weakness from a compressed nerve can get relief from surgery.  

 

Hydrocephalus

The term hydrocephalus is derived from two words: "hydro" meaning water, and "cephalus" referring to the head. Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles (fluid-containing cavities) of the brain and may increase pressure within the head. Although hydrocephalus is often described as "water on the brain," the "water" is actually CSF, a clear fluid surrounding the brain and spinal cord. CSF has three crucial functions: 1) it acts as a "shock absorber" for the brain and spinal cord; 2) it acts as a vehicle for delivering nutrients to the brain and removing waste; and 3) it flows between the cranium and spine to regulate changes in pressure within the brain. Hydrocephalus can occur at any age, but is most common in infants and adults age 60 and older

Treatment:

Hydrocephalus can be treated in a variety of ways. The problem area may be treated directly (by removing the cause of CSF obstruction), or indirectly (by diverting the fluid to somewhere else; typically to another body cavity).

 

Intracerebral hemorrhage; non-traumatic:

Non-traumatic Intracerebral hemorrhage is bleeding in the brain caused by a rupture or leak of a blood vessel within the head. This causes:

Common cause of  intracerebral hemorrhage

Treatment for intracerebral hemorrhage depends on:

Kyphosis

Kyphosis is a spinal deformity characterized by a rounding of the back. While some rounding of the back is normal, kyphosis refers to exaggerated rounding of more than 50 degrees. This condition is also referred to as round back or hunchback. Patients may develop kyphosis as a result of developmental problems, bad posture, osteoporosis, spinal trauma, spinal fracture, or arthritis. Kyphosis can affect both children and adults and can start at any age.

Treatment:

Surgery is reserved for severe cases of kyphosis. Surgeons will straighten the spine by fusing the backbones (vertebrae) together. This is done using a metal rod inserted into the spine to straighten it.

 

Low Back Pain

Low Back Pain: If you are experiencing low back pain, you are not alone. An estimated 75 to 85 percent of all Americans will experience some form of back pain during their lifetime. Although low back pain can be quite debilitating and painful, in about 90 percent of all cases, pain improves without surgery. However, 50 percent of all patients who suffer from an episode of low back pain will have a recurrent episode within one year. 

Causes of low back pain: 

When Surgery Is Necessary :

When conservative treatment for low back pain does not provide relief, surgery may be needed. You may be a candidate for surgery if:

 

Lumbar spinal stenosis

Lumbar spinal stenosis may or may not produce symptoms, depending on the severity of your case. The narrowing of the spinal canal itself does not produce these symptoms. It is the inflammation of the nerves due to increased pressure that may cause noticeable symptoms to occur. When present, symptoms may include:

Treatment - Nonsurgical

Anti-inflammatory medications to reduce swelling and pain, and pain medication to relieve pain. Most pain can be treated with nonprescription medications, but if your pain is severe or persistent, your doctor may recommend prescription medications.Epidural injections of cortisone may be prescribed to help reduce swelling. This treatment is not recommended repeatedly and usually provides only temporary pain relief. Physical therapy and/or prescribed exercises may help stabilize your spine, build your endurance and increase your flexibility. Therapy may help you resume your normal lifestyle and activities. If non-surgical techniques do not work then surgery may be recommended.

Treatment - Surgical

 

Myelomeningocele/Lipomyelomeningocele

Myelomeningocele/Lipomyelomeningocele: Tethered spinal cord syndrome is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord within the spinal column. These attachments cause an abnormal stretching of the spinal cord. This syndrome is closely associated with spina bifida. It is estimated that 20 to 50 percent of children with spina bifida defects repaired shortly after birth will require surgery at some point to untether the spinal cord.  The lower tip of the spinal cord is normally located opposite the disc between the first and second lumbar vertebrae in the upper part of the lower back. In people with spina bifida (myelomeningocele), the spinal cord fails to separate from the skin of the back during development, preventing it from ascending normally, so the spinal cord is low-lying or tethered. In patients with a lipomyelomeningocele, the spinal cord will have fat at the tip and this may connect to the fat which overlies the thecal sac (a fluid filled sac that the spinal cord “floats” within.)  Although the skin is separated and closed at birth, the spinal cord stays in the same location after the closure. As the child continues to grow, the spinal cord can become stretched, causing damage and interfering with the blood supply to the spinal cord.

Treatment:

Untethering is generally performed only if there are clinical signs or symptoms of deterioration. The surgery involves opening the scar from the prior closure down to the covering (dura) over the myelomeningocele. Sometimes a small portion of the bony vertebrae (the laminae) are removed to obtain better exposure or to decompress the spinal cord. The dura is then opened, and the spinal cord and myelomeningocele are gently dissected away from the scarred attachments to the surrounding dura. Once the myelomeningocele is freed from all its scarred attachments, the dura and the wound are closed. The child usually can resume normal activities within a few weeks. Recovery of lost muscle and bladder function depends upon the degree and length of preoperative implications. The combined complication rate of this surgery is usually only 1 to 2 percent. Complications include infection, bleeding, damage to the spinal cord or myelomeningocele, which may result in decreased muscle strength or bladder or bowel function. Many children require only one untethering procedure. However, since symptoms of tethering can occur during periods of growth, 10 to 20 percent require repeated surgery.

 

Normal Pressure Hydrocephalus

Normal Pressure Hydrocephalus results from the gradual blockage of the CSF draining pathways in the brain. The ventricles enlarge to handle the increased volume of CSF, thus compressing the brain from within and eventually damaging or destroying the brain tissue. NPH owes its name to the fact that the ventricles inside the brain become enlarged with little or no increase in pressure. However, the name can be misleading, as some patients' CSF pressure does fluctuate from high to normal to low when monitored.

NPH can occur as the result of head injury, cranial surgery, hemorrhage, meningitis or tumor. Unfortunately, the cause of the majority of NPH cases is unknown, making it difficult to diagnose and understand. Compounding this difficulty is the fact that some of the symptoms of NPH are similar to the effects of the aging process, as well as diseases such as Alzheimer's and Parkinson’s.  The majority of the NPH population is older than 60, and many of these people believe their symptoms are just part of the aging process. Unfortunately, many cases go unrecognized, are never properly treated or are misdiagnosed.

Treatment:

Ventriculo-peritoneal shunt:  implanting a device known as a shunt to divert the excess CSF away from the brain. The body cavity in which the CSF is diverted is usually the peritoneal cavity (the area surrounding the abdominal organs). The surgeon makes a hole in the skull and another small surgical cut is made in the  belly.  A small hole is drilled in the skull. A small thin tube called a catheter is passed into a ventricle of the brain. This can be done with or without a computer as a guide. It can also be done with an endoscope that allows to see inside the ventricle. Another catheter is placed under the skin behind the ear and moved down the neck and chest, and usually into the belly area. Sometimes, it stops at the chest area. The doctor may make a small cut in the neck to help position it.  A valve (fluid pump) is placed underneath the skin behind the ear. The valve is connected to both catheters. When extra pressure builds up around the brain, the valve opens, and excess fluid drains out of it into the belly or chest area. This helps decrease intracranial pressure.  The valves can be programmed to drain more or less fluid from the brain.

Third Ventriculostomy:

An alternative operation called endoscopic third ventriculostomy utilizes a tiny camera to look inside the ventricles, allowing the surgeon to create a new pathway through which CSF can flow.

 

Parkinson's Disease

Parkinson’s disease:  is a progressive disorder that is caused by degeneration of nerve cells in the part of the brain called the substantia nigra, which controls movement. These nerve cells die or become impaired, losing the ability to produce an important chemical called dopamine. Studies have shown that symptoms of Parkinson's develop in patients with an 80 percent or greater loss of dopamine-producing cells in the substantia nigra.

Normally, dopamine operates in a delicate balance with other neurotransmitters to help coordinate the millions of nerve and muscle cells involved in movement. Without enough dopamine, this balance is disrupted, resulting in tremor (trembling in the hands, arms, legs and jaw); rigidity (stiffness of the limbs); slowness of movement; and impaired balance and coordination – the hallmark symptoms of Parkinson's. The cause of Parkinson's essentially remains unknown. However, theories involving oxidative damage, environmental toxins, genetic factors, and accelerated aging have been discussed as potential causes for the disease. In 2005, researchers discovered a single mutation in a Parkinson’s disease gene (first identified in 1997), which is believed responsible for 5 percent of inherited cases.

Deep brain stimulation:

Neurosurgeons relieve the involuntary movements of conditions like Parkinson's by operating on the deep brain structures involved in motion control – the thalamus, globus pallidus and subthalamic nucleus. To target these clusters, neurosurgeons use a technique called stereotactic surgery. This type of surgery requires the neurosurgeon to fix a metal frame to the skull under local anesthesia. Using diagnostic imaging, the surgeon precisely locates the desired area in the brain and drills a small hole, about the size of a nickel. A deep brain stimulating electrode is implanted which delivers electircal stimulation to the targeted area, blocking the neuronal signals that cause the abnormal movements;  thereby helping to relieve the symptoms associated with Parkinson's.

Pituitary tumor

 
The pituitary is a small gland attached to the base of the brain (behind the nose) in an area called the pituitary fossa or sella turcica. The pituitary is often called the "master gland" because it controls the secretion of hormones. A normal pituitary gland weighs less than one gram, and is about the size and shape of a kidney bean.  The function of the pituitary can be compared to a household thermostat. The thermostat constantly measures the temperature in the house and sends signals to the heater to turn it on or off to maintain a steady, comfortable temperature. The pituitary gland constantly monitors body functions and sends signals to remote organs and glands to control their function and maintain the appropriate environment. The ideal "thermostat" setting depends on many factors such as level of activity, gender, body composition, etc.

The pituitary is responsible for controlling and coordinating the following:

Treatment – surgical

The transsphenoidal approach involves making an incision in the upper gum line or nasal cavity and accessing the tumor through the base of the skull. This approach is usually the procedure of choice because it is less invasive, has fewer side effects, and patients generally recover more quickly. Patients can often leave the hospital as early as two to four days after surgery. 

The transcranial approach through the upper part of the skull is used for larger tumors that cannot be safely removed through the transsphenoidal approach. 

Endonasal Endoscopic surgery:  is a newer, minimally invasive approach which allows neurosurgeons to utilize a tiny endoscope with a camera on the end. A tiny endoscope inserted through the nostril is placed in front of the tumor in the sphenoid sinus, and the tumor is removed with specially designed surgical tools. Postoperative discomfort is usually minimal. Endoscopic brain surgery is another surgical option for removing pituitary adenomas, but can only be utilized in certain cases.

Pseudotumor cerebri

Pseudotumor cerebri occurs when the pressure inside your skull (intracranial pressure) increases for no obvious reason. Symptoms mimic those of a brain tumor, but no tumor is present. Pseudotumor cerebri can occur in children and adults, but it's most common in obese women of childbearing age.

When no underlying cause for the increased intracranial pressure can be discovered, pseudotumor cerebri may also be called idiopathic intracranial hypertension.

The increased intracranial pressure associated with pseudotumor cerebri can cause swelling of the optic nerve and result in vision loss. Medications often can reduce this pressure, but in some cases, surgery is necessary.

 

Subdural Hematoma

Subdural hematomas are usually the result of a serious head injury. When one occurs in this way, it is called an "acute" subdural hematoma. Acute subdural hematomas are among the deadliest of all head injuries. The bleeding fills the brain area very rapidly, compressing brain tissue. This often results in brain injury and may lead to death.

Subdural hematomas can also occur after a very minor head injury, especially in the elderly. These may go unnoticed for many days to weeks, and are called "chronic" subdural hematomas. With any subdural hematoma, tiny veins between the surface of the brain and its outer covering (the dura) stretch and tear, allowing blood to collect. In the elderly, the veins are often already stretched because of brain atrophy (shrinkage) and are more easily injured.

 

Spasticity

Spasticity is a condition in which certain muscles are continuously contracted. This contraction causes stiffness or tightness of the muscles and can interfere with normal movement, speech, and gait. Spasticity is usually caused by damage to the portion of the brain or spinal cord that controls voluntary movement. The damage causes a change in the balance of signals between the nervous system and the muscles. This imbalance leads to increased activity in the muscles. Spasticity negatively affects muscles and joints of the extremities, and is particularly harmful to growing children.

Spacticity can occur in the following conditions:

Treatment includes

Oral Medications:

Surgery

 

Spinal Stenosis

Spinal Stenosis is a narrowing of the spinal canal that compresses the nerves traveling through the lower back into the legs. While it may affect younger patients due to developmental causes, it is more often a degenerative condition that affects people age 60 and older. The discs may become less spongy as you age, resulting in reduced disc height and bulging of the hardened disc into the spinal canal.  

 

Spinal Tumor

Spinal Tumor is an abnormal mass of tissue within or surrounding the spinal cord and spinal column. These cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. Spinal tumors can be benign (non-cancerous) or malignant (cancerous). Primary tumors originate in the spine or spinal cord, and metastatic or secondary tumors result from cancer spreading from another site to the spine. Spinal tumors may be referred to by the area of the spine in which they occur. These basic areas are cervical, thoracic, lumbar and sacrum. Additionally, they also are classified by their location in the spine — anterior (front) and posterior (back). Clinically, they are divided into three major groups according to location: intradural-extramedullary, intramedullary and extradural.

Non-surgical treatment:   Nonsurgical treatment options include observation, chemotherapy and radiation therapy. Tumors that are asymptomatic or mildly symptomatic and do not appear to be changing or progressing may be observed and monitored with regular MRIs. Some tumors respond well to chemotherapy and others to radiation therapy. However, there are specific types of metastatic tumors that are inherently radiation resistant (i.e. gastrointestinal tract and kidney), and in those cases, surgery may be the only viable treatment option.

Surgical Treatment: Indications for surgery vary depending on the type of tumor.

 

Spondylolisthesis

Spondylolisthesis is a condition of the spine in which a vertebra slips out of alignment, moving forward on the vertebra below. The condition is usually caused by degenerative disease, such as arthritis. Other causes include bone diseases, trauma, and stress fractures.

Treatment:

A decompression laminectomy removes bony spurs in the spinal canal, freeing up space for the nerves and spinal cord. Spinal fusion is a technique in which two vertebrae (back bones) are fused together. This provides stronger support for the spine

Stroke

Stroke: is an abrupt interruption of constant blood flow to the brain that causes loss of neurological function. The interruption of blood flow can be caused by a blockage, leading to the more common ischemic stroke, or by bleeding in the brain, leading to the more deadly hemorrhagic stroke. Ischemic stroke constitutes an estimated 87 percent of all stroke cases. Stroke often occurs with little or no warning, and the results can be devastating.  

It is crucial that proper blood flow and oxygen be restored to the brain as soon as possible. Without oxygen and important nutrients, the affected brain cells are either damaged or die within a few minutes. Once brain cells die, they generally do not regenerate, and devastating damage may occur, sometimes resulting in physical, cognitive, and mental disabilities.

There are two types of stroke

Ischemic Stroke

Hemorrhagic Stroke

Transient ischemic attack (TIA):

This is a warning sign of a possible future stroke, and is treated as a neurological emergency. Common temporary symptoms include difficulty speaking or understanding others, loss or blurring of vision in one eye, and loss of strength or numbness in an arm or leg. Usually these symptoms resolve in less than 10 to 20 minutes, and almost always within one hour. Even if all the symptoms resolve, it is very important that anyone experiencing these symptoms call 911 and immediately be evaluated by a qualified physician.

Subarachnoid Hemorrhage

When a brain aneurysm ruptures, it causes bleeding into the compartment surrounding the brain, the subarachnoid space and is therefore also known as a subarachnoid hemorrhage (SAH). Often the aneurysm heals over, bleeding stops, and the person survives. In more serious cases, the bleeding may cause brain damage with paralysis or coma. In the most severe cases, the bleeding leads to death.

Synovial Cyst

A synovial cyst is a fluid-filled sac that develops as a result of degeneration in the spine. Because a synovial cyst develops from degeneration it is not often seen in patients younger than 45 and is most common in patients older than 65 years old.  The fluid-filled sac creates pressure inside the spinal canal and this in turn can give a patient all the symptoms of stenosis of the spine. Spinal stenosis is a condition that occurs when degeneration in the facet joint causes pressure on the nerves as they exit the spine.  It is typically a process that only happens in the lumbar spine, and it almost always develops at the L4-L5 level (rarely at L3-L4). The pain probably comes from the venous blood around the nerves not being able to drain and this leads to pain and irritation of the nerves. Sitting down allows the blood to drain and relieves the pressure.

Traumatic Brain Injury (TBI)

Traumatic brain injury (TBI) is defined as a blow to the head or a penetrating head injury that disrupts the normal function of the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of damage to the brain. Mild cases may result in a brief change in mental state or consciousness, while severe cases may result in extended periods of unconsciousness, coma, or even death.

Many patients with moderate or severe head injuries are taken directly from the emergency room to the operating room. In many cases, surgery is performed to remove a large hematoma or contusion that is significantly compressing the brain or raising the pressure within the skull. After surgery, these patients are usually observed and monitored in the intensive care unit (ICU). Other head-injured patients may not go to the operating room immediately, but instead are taken from the emergency room to the ICU. Contusions or hematomas may enlarge over the first hours or days after head injury, so some patients are not taken to surgery until several days after an injury. Delayed hematomas may be discovered when a patient's neurological exam worsens or when their ICP increases. On other occasions, a routine follow-up CT scan that was ordered to determine if a small lesion has changed in size indicates that the hematoma or contusion has enlarged significantly.

At the present time, there is no medication or "miracle treatment" that can be given to prevent nerve damage or promote nerve healing after TBI. The primary goal in the ICU is to prevent any secondary injury to the brain. The "primary insult" refers to the initial trauma to the brain, whereas the "secondary insult" is any subsequent development that may contribute to neurological injury. For example, an injured brain is especially sensitive and vulnerable to decreases in blood pressure that might otherwise be well tolerated. One way of avoiding secondary insults is to try to maintain normal or slightly elevated blood pressure levels. Likewise, increases in ICP, decreases in blood oxygenation, increases in body temperature, increases in blood glucose, and many other disturbances can potentially worsen neurological damage. The prevention of secondary insults is a major part of the ICU management of head-injured patients.

Various monitoring devices may assist healthcare personnel in caring for the patient. Placement of an ICP monitor into the brain itself can help detect excessive swelling of the brain. One commonly used type of ICP monitor is a ventriculostomy, which is a narrow, flexible, hollow catheter that is passed into the ventricles, or fluid spaces in the center of the brain, to monitor ICP and to drain CSF if ICP increases. Another commonly used type of intracranial pressure monitoring device involves placement of a small fiberoptic catheter directly into the brain tissue.

External ventricular drain (EVD) a catheter is inserted into a lateral ventricle which will allow drainage of CSF (cerebral spinal fluid). A hole is drilled through the skull. The catheter is inserted through the brain into the lateral ventricle. This area of the brain contains liquid (cerebrospinal fluid or CSF) that protects the brain and spinal cord.

Intracranial pressure (ICP) monitor: Intracranial pressure monitoring uses a device, placed inside the head, which senses the pressure inside the skull and sends its measurements to a recording device.  Normal measurement are between 0-20mm Hg.

Brain injury types:

 

Trigeminal Neuralgia

Trigeminal neuralgia: The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye. This intense, stabbing, electric shock-like pain is caused by irritation of the trigeminal nerve, which sends branches to the forehead, cheek and lower jaw.  It usually is limited to one side of the face.  Although trigeminal neuralgia cannot always be cured, there are treatments available to alleviate the debilitating pain. Normally, anticonvulsive medication are the first treatment choice. Surgery can be an effective option for those who become unresponsive to medications or for those who suffer serious side effects from the medications. 

There are several effective ways to alleviate the pain, including a variety of medications.

Surgery:

If medications have proven ineffective in treating trigeminal neuralgia, there are several surgical procedures that may help control the pain. Surgical treatment is divided into two categories: percutaneous (through the skin) and open.