Anterior Cervical Corpectomy This operation is performed in conjunction with the anterior cervical disectomy. The corpectomy is often done for multi-level cervical stenosis with spinal cord compression caused by bone spur formations. In this procedure, the neurosurgeon removes a part of the vertebral body to relieve pressure on the spinal cord. One or more vertebral bodies may be removed including the adjoining discs. The incision is generally larger. The space between the vertebrae is filled using a small piece of bone through spinal fusion. Because more bone is removed, the recovery process for the fusion to heal and the neck to become stable is generally longer than with anterior cervical discectomy. Your surgeon may select to use a metal plate that is screwed into the front of the vertebra to help the healing process.
Anterior Cervical Disectomy This operation is performed on the neck to relieve pressure on one or more nerve roots, or on the spinal cord. The cervical spine is reached through a small incision in the anterior (front) of your neck. If only one disc is to be removed, it will typically be a small horizontal incision in the crease of the skin. If the operation is more extensive, it may require a slanted or longer incision. After the soft tissues of the neck are separated, the intervertebral disc and bone spurs are removed. The space left between the vertebrae may be left open or filled with a small piece of bone through spinal fusion. In time, the vertebrae may fuse or join together.
The DBS system consists of three components:
- The lead (also called an electrode) is a thin, insulated wire inserted through a small opening in the skull and implanted in the brain.
- The extension is an insulated wire that is passed under the skin of the head, neck, and shoulder, connecting the lead to the internal pulse generator (IPG).
- The IPG or neurostimulator is the third component and is usually implanted under the skin near the collarbone. In some cases it may be implanted in the chest or under the skin over the abdomen.
A small opening is made in the skull under a local anesthetic. The patient is awake during the DBS surgery to allow the surgical team to assess his or her brain functions. While the lead (electrode) is being advanced through the brain, the patient does not feel pain because of the human brain’s unique inability to generate pain signals. Computerized brain-mapping technology is utilized to pinpoint the precise location in the brain where nerve signals generate the tremors and other symptoms. Highly sophisticated imaging and recording equipment are used to map both the physical structure and the functioning of the brain. The electrodes are connected via wires to an internal pulse generator (IPG) that is placed in the chest wall.
A magnet is used with the IPG to adjust the stimulation parameters so that the appropriate level of stimulation is applied at the electrode tip. The patient is provided with an access control device or handheld magnet to turn the IPG on and off at home. Depending on the application, the battery can last three to five years. When the battery needs to be replaced, the IPG is also replaced, usually under local anesthesia as an outpatient procedure.
Craniotomy: Surgical removal of part of the skull to expose the brain
A craniotomy is the most commonly performed surgery for brain tumor removal. It may also be done to remove a blood clot and control hemorrhage, inspect the brain, perform a biopsy, or relieve pressure inside the skull The surgeon marks with a felt tip pen a large square flap on the scalp that covers the surgical area. Following this mark, the surgeon makes an incision into the skin as far as the thin membrane covering the skull bone. Because the scalp is well supplied with blood, the surgeon will have to seal many small arteries. The surgeon then folds back a skin flap to expose the bone. Using a high speed hand drill or an automatic craniotome, the surgeon makes a circle of holes in the skull, and pushes a soft metal guide under the bone from one hole to the next. The surgeon saws through the bone until the bone flap can be removed to expose the brain.
After the surgery for the underlying cause is completed, the piece of skull is replaced and secured with titanium plates and screws. Finally, the surgeon sutures the membrane, muscle, and skin of the scalp.
Craniectomy is a procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury and stroke. The surgeon marks with a felt tip pen a large square flap on the scalp that covers the surgical area. Following this mark, the surgeon makes an incision into the skin as far as the thin membrane covering the skull bone. Because the scalp is well supplied with blood, the surgeon will have to seal many small arteries. The surgeon then folds back a skin flap to expose the bone. Using a high speed hand drill or an automatic craniotome, the surgeon makes a circle of holes in the skull, and pushes a soft metal guide under the bone from one hole to the next. The surgeon saws through the bone until the bone flap can be removed to expose the brain.
After the surgery for the underlying cause is completed, the piece of skull is NOT replaced and the surgeon sutures the membrane, muscle, and skin of the scalp. The bone flap is frozen and stored in the bone bank for replacement in the future. It can be stored up to 1 year.
Decomprssive Laminectomy in which the laminae (roof) of the vertebrae are removed to create more space for the nerves. A neurosurgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. A spinal fusion with or without spinal instrumentation may be recommended when spondylolisthesis or scoliosis occurs with spinal stenosis. Various devices (such as screws or rods) may be used to enhance fusion and support unstable areas of the spine.
Endovascular Embolization is a minimally invasive technique performed to cut off the blood supply to a specific part of an artery. The goal of the treatment is to prevent bleeding in the problem area and to reduce the risk that the blood vessel will break open (rupture).
This procedure may be used to treat:
- Arteriovenous malformation (AVM)
- Brain aneurysm
- Carotid artery cavernous fistula (a problem with the large artery in the neck)
- Certain tumors
You may have general anesthesia and a breathing tube. Or, you may be given medication to relax you, but not enough to put you to sleep.
- A small surgical needle hole will be made in the groin area. The health care provider will use a needle to create a hole in the femoral artery, a large blood vessel.
- A tiny, flexible tube called a catheter is passed through the open skin and into the artery.Dye is injected through this tube so that the blood vessel can be seen on x-ray images.
- The health care provider gently moves the catheter through the blood vessel up to the area being studied.
- Once the catheter is in place, the health care provider places small plastic particles, glue, metal coils, foam, or a balloon through it to seal off the bad blood vessel. (If coils are used, it is called coil embolization.)
An EVD is: the temporary drainage of cerebrospinal fluid (CSF) from the lateral ventricles of the brain into an external collection bag. An EVD system drains CSF by using a combination of gravity and intercerebral pressure. The drainage rate depends on the height at which the EVD system is placed relative to the patient’s anatomy.
Purpose of EVD
- Relieve elevated intracranial pressure (ICP)
- Drain infected CSF
- Drain bloody CSF or blood after surgery or hemorrhage
- Monitor the flow rate of CSF
A foraminotomy is a decompression surgery that is performed to enlarge the passageway where a spinal nerve root exits the spinal canal. The term foraminotomy is derived from the medical term for a hollow passageway—foramen. The latter half of the term foraminotomy—otomy—means to open.During a foraminotomy, the surgeon removes bone or tissue that obstructs the passageway and compresses (pinches) the spinal nerve root, which can cause inflammation and pain. The nerve (neuro) passageways are called neuroforamen.
Medial facetectomy is a spinal procedure that partially removes one or both of the facet joints on a set of vertebrae. The procedure intends to decompress the spinal nerves being pinched by degenerated facet joints. Patients requiring medial facetectomy have facet joint syndrome, which means the cartilage around their facet joints have worn down. These joints normally help with the spine's range of motion and aid the patient's ability to bend, twist, and stand up. Patients with facet joint syndrome have worn down facet joints rub against the spinal nerves, causing pain and other debilitating symptoms.
Posterior Cervical Laminectomy This procedure requires a small incision in the middle of your neck to remove bone spur formations or disc material. The foramen, the passage in the vertebrae of the spine through which the spinal nerve roots travel is enlarged, to allow the nerves to pass through.Your neurosurgeon will remove a section of the lamina (the back bony part of the vertebrae) and ligament to find the exact area of the compression. An operating microscope is used to create an opening, and part of the lamina is removed to take pressure off the nerves and spinal cord. If needed, bone spurs, tissue and any disc fragments causing the compression are also removed
Spinal Cord Stimulation (SCS) is a pain relief technique that delivers a low-voltage electrical current continuously to the spinal cord to block the sensation of pain. SCS is the most commonly used implantable neurostimulation technology for management of pain syndromes. As many as 50,000 neurostimulators are implanted worldwide every year. SCS is a widely accepted FDA-approved medical treatment for chronic pain of the trunk and limbs (back, legs and arms).
- Chronic pain is longstanding pain that persists beyond the usual recovery period or that accompanies a chronic health condition. Because this pain is not protective and is not a result of an ongoing injury, it is referred to as "pathological" and is therefore treated as a condition, not as a symptom. Chronic pain may prevent people from working, eating properly, participating in physical activity, or enjoying life.
Implantation of SCS: the patient will likely be under general anesthesia the entire time. The leads are inserted in the epidural space above the spinal cord after a small laminectomy has been performed. The exact location of the lead or leads depends on the specificity of the patient’s pain. The generator is usually implanted in the abdominal or buttock region, but the physician/patient may determine other comfortable areas in which to place it.
- Once the leads and generator are in place, connected and working, the incision will be closed, a dressing applied, and the patient will be taken to recovery, where he or she will be slowly withdrawn from the anesthesia. Most patients go home the same day. Before being released from the hospital, the patient will receive instructions on caring for the incision area and how to program and regulate the SCS device.
- Following implantation, lifting, bending, stretching, and twisting should be avoided. However, light exercise, such as walking can be helpful to build strength and relieve pain.
- Although there may be some discomfort while the surgical incision heals, most patients say that they cannot feel the presence of the device under the skin after healing takes place.
Posterior Lumbar Interbody Fusion (PLIF): Removal of the posterior bone of the spinal canal, retraction of the nerves and removal of the disc material from within the disc space, followed by insertion of bone graft and sometimes hardware in order to fuse the bones. This procedure is called an 'interbody fusion' because it is performed between the 'bodies' of the vertebral bones and across the diseased disc space. This procedure typically is performed on both sides of the spine.
Stereotactic Radiosurgery uses sophisticated 3-D computerized imaging to precisely target a narrow X-ray beam and deliver a highly concentrated dose of radiation to the affected area. Stereotactic radiosurgery is not surgery in the conventional sense because there is no incision involved, and general anesthesia is not required for adults.
- Staged radiosurgery, also known as fractionated stereotactic radiosurgery (FSR), is a process in which the total dose of stereotactic radiation is divided into several smaller doses of radiation, on separate days of treatment. Typically, this consists of two to five treatments. In some cases, staged treatment effectively kills the tumor while seemingly decreasing potential side effects compared with single-dose radiosurgery.
- The treatment team is comprised of a number of specialized medical professionals, including a radiation oncologist, neurosurgeon, medical radiation physicist, radiation therapist, radiation therapy nurse, and neurologist or neuro-oncologist. The radiation oncologist and neurosurgeon oversee treatment and interpret the results of these procedures.
Endoscopic third ventriculostomy is an alternative surgical procedure that creates a bypass for the cerebrospinal fluid in the head that eliminates the need for a shunt. It is helpful only to people with hydrocephalus that is caused by a blockage of the flow of cerebrospinal fluid.
Endoscopic means that the surgery is performed with the use of an endoscope. An endoscope is a thin tube that has a strong light, a powerful magnifying lens and a passage through which tiny instruments are passed.
Endoscopic endonasal surgery is a minimally invasive technique that allows a surgeon to go through the nose to correct problems or remove a tumor in various areas of the brain and the top of the spine.
A thin tube called an endoscope is threaded through your nose and sinuses, giving your surgeon access to parts of your brain that would be difficult to reach using traditional surgical approaches. Those techniques are more complicated and require large incisions and removal of parts of the skull. With the endoscopic endonasal approach, your recovery is often quicker and less painful.
The intention of this procedure is to gather more precise data on areas of the brain not obtainable by conventional scalp EEG.
By placing electrodes over the surface of the brain or within the brain more details are available as to where seizure activity occurs. By knowing this the neurosurgeon can be more confident in removing the diseased tissue without removing functioning brain tissue. Electrodes are placed by either a craniotomy or burr holes. A craniotomy is a surgical procedure where the skull is opened by a piece of bone being removed, burr holes are small holes drilled into the skull. Both the insertion and removal of the electrodes are performed in the operating room by a neurosurgeon. Following placement electrodes are connected to continuous EEG equipment and seizures are monitored in the intensive care unit. Once sufficient seizure activity has been successfully captured the electrodes are surgically removed. Depending on the facility Epilepsy surgery may coincide with electrode removal thereby completing the surgical procedures. If not then another date will be set for the surgical intervention requiring a second hospitalization.
The monitoring of intracranial pressure is used in treating severe traumatic brain injury patients. This process is called intracranial pressure monitoring. All current clinical available measurement methods are invasive and use various transducer systems (most used is insertion of a catheter into the cranium). Some non-invasive intracranial pressure measurement methods are currently being studied; these would facilitate diagnostics of traumatic brain injury or other causes of intracranial hypertension without the risks associated with invasive modalities.
When the brain suffers severe trauma it begins to swell inside the skull. If the brain swelling goes undetected and is not treated the brain becomes deprived of oxygen-rich blood and "starves". This secondary injury causes permanent brain damage. As ICP monitoring allows doctors to determine how much swelling the brain has sustained, cerebrospinal fluid can be drained accordingly in order to prevent oxygen deprivation.
Baclofen is a medication commonly used to decrease spasticity related to multiple sclerosis, spinal cord injuries, or other neurological diseases. Spasticity is a muscle problem characterized by tight or stiff muscles that may interfere with voluntary muscle movements.
Normally, muscles receive electrical signals via nerves to contract and relax. Spasticity is caused by an imbalance of electrical signals coming from the spinal cord through the nerves to the muscle. This imbalance causes the muscle to become hyperactive, resulting in involuntary spasms. Baclofen works by restoring the normal balance and reducing muscle hyperactivity. In this way, it allows for more normal muscle movements.
Laminotomy is the surgical incision and removal of a small part of a bony area of the spine called the lamina. The lamina is the back part of each vertebra and forms the back wall of your spinal canal. Your spinal cord runs through your spinal canal in the center of your vertebrae. Certain conditions of the spine can compress the spinal cord and cause pain. A laminotomy can relieve pressure in your spinal canal and on spinal nerves.
The word laminotomy is often used interchangeably with laminectomy. However, in a laminotomy only a small part of the lamina is removed, while in a laminectomy most of the lamina is removed.
Laminotomy is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options available depending on your specific circumstances. You should consider getting a second opinion about all your treatment choices before having a laminotomy.
Microdiscectomy uses a special microscope to view the disc and nerves. This larger view allows the surgeon to use a smaller cut. This causes less damage to surrounding tissue.
During discectomy, the surgeon removes the part of the disc that is herniated and is pushing into the spinal canal. Any loose fragments of disc are also removed.
It is usually done in a hospital. You are asleep or numb during the surgery. You will probably stay in the hospital overnight.
The operation to remove a brain tumor located near the bottom of the skull is known as Posterior Fossa Craniotomy and Tumor removal. The goal of the surgery is to remove the tumor and get rid of the pressure on the cerebellum, spinal cord, and brain stem. The cerebellum is the smaller part of the brain that is important for balance and coordination, and it is located in the lower part of the skull in an area known as the posterior fossa.
Spinal fusion is surgery to permanently connect two or more vertebrae in your spine, eliminating motion between them.
Spinal fusion involves techniques designed to mimic the normal healing process of broken bones. During spinal fusion, your surgeon places bone or a bone-like material within the space between two spinal vertebrae. Metal plates, screws and rods may be used to hold the vertebrae together, so they can heal into one solid unit.
Image-guided surgery (IGS) is the use of a real-time correlation of the operative field to a preoperative imaging data set that reflects the precise location of a selected surgical instrument to the surrounding anatomic structures. Although first developed for neurosurgery, endoscopic sinus surgery (ESS) rapidly became one of the leading indications for this technology.
Transforaminal Lumbar Interbody Fusion (TLIF): Removal of the posterior bone of the spinal canal, retraction of the nerves, and removal of the disc material from within the disc space, followed by insertion of bone graft and sometimes hardware in order to fuse the bones. Similar to a PLIF, but frequently performed from only one side.
The vagus nerve is one of 12 pairs of cranial nerves that originate in the brain and is part of the autonomic nervous system, which controls involuntary body functions. The nerve passes through the neck as it travels between the chest and abdomen and the lower part of the brain. It is connected to motor functions in the voice box, diaphragm, stomach and heart, and sensory functions in the ears and tongue. It is connected to both motor and sensory functions in the sinuses and esophagus.
Vagus nerve stimulation (VNS) sends regular, mild pulses of electrical energy to the brain via the vagus nerve, through a device that is similar to a pacemaker. There is no physical involvement of the brain in this surgery and patients cannot generally feel the pulses. It is important to keep in mind that VNS is a treatment option limited to select individuals with epilepsy or treatment-resistant depression
The Food and Drug Administration (FDA) approved VNS as a seizure treatment in 1997. VNS may be considered as a treatment option in patients who have tried two or more anti-epileptic drugs (AEDs) without adequate control of their seizures, or in patients who have not responded to AEDs and cannot undergo brain surgery. It is important to keep in mind that VNS is used in conjunction with AEDs, not instead of them. VNS can take up to two years to have an effect on a patient’s seizures. If VNS proves effective, it may enable a patient to decreases dosages of AEDs over time.
The goal of VNS is to reduce the number, length and severity of seizures. VNS may also reduce the time it takes to recover after a seizure. However, VNS is not successful in all patients. The success of this treatment differs – some patients report less frequent seizures, others report a slight reduction, while some patients do not respond at all. The following results have been noted in select patients with epilepsy:
- Less severe or shorter seizures
- Better recovery after seizures (postictal period)
- Improved sense of well-being
- Improved mood
- Improved alertness, memory, and cognitive skills
- Fewer emergency room visits
Surgery – VNS
- The procedure usually takes about 50 to 90 minutes with the patient under general anesthesia and in such cases, a hospital stay of one night may be required. However, some physicians perform the procedure using local anesthesia on an outpatient basis. As with all surgeries, there is a small risk of infection. Other surgical risks of VNS include inflammation or pain at the incision site, damage to nearby nerves, and nerve constriction.
- The procedure requires two small incisions. The first one is made on the upper left side of the chest where the pulse generator is implanted. A second incision is made horizontally on the left side of the lower neck, along a crease of skin. This is where the thin, flexible wires that connect the pulse generator to the vagus nerve are inserted.
- The device or implant is a flat, round piece of metal that measures about an inch and a half (4 cm) across and 10 to 13 millimeters thick, depending on the model used. Newer models may be somewhat smaller. The stimulator contains a battery, which can last from one to 15 years. When the battery is low the stimulator needs to be replaced via a surgical procedure that is similar to, but less involved than the original implantation.
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.