Types of Surgery
Craniotomy is surgery involving opening the skull temporarily, allowing an operation to be performed on or around the underlying brain.The main reasons for this surgery are tumors, aneurysms, head injury, and infection.
- Endoscopic/Minimally Invasive Neurosurgery
- Skull Base Tumors
- Brain Tumors including Pituitary Tumors
- Head Injuries
- Brain Aneurysms and Arteriovenous Malformations
- Skull Growth Defects, Deformities
- Cranial Nerve Lesions including Trigeminal Neuralgias and Hemifacial Spasm
The normal way of performing a craniotomy, or cranial surgery, begins by making an cut through the bone to allow the surgeon to access the brain. The patient’s head is held in a 3-pin head holder so that there can be absolutely no movement of the head during the delicate parts of the surgery.
There are minimally invasive ways to perform craniotomy. This method emphasize on making the smallest possible incision to minimize risk and ensure a fast recovery.There are minimally invasive ways to perform craniotomy. This method emphasize on making the smallest possible incision to minimize risk and ensure a fast recovery.
Most difficult technique allow the patient to remain awake during the procedure. This is done by numbing the scalp with a local anesthetic. This method is particularly helpful when the surgeon is trying to remove tumors in more important areas of the brain where removal would result in an obvious loss of function.
As with all surgeries, cranial surgery has its risks. The brain is a major organ in your body and should be treated as such.
Peripheral Nerve Surgeries
Peripheral nerve injury assists in prognosis and determination of treatment strategy. Classification of nerve injury was described by Seddon in 1943 and by Sunderland in 1951. The lowest degree of nerve injury in which the nerve remains intact but signaling ability is damaged is called neurapraxia. The second degree in which the axon is damaged but the surrounding connecting tissue remains intact is called axonotmesis. The last degree in which both the axon and connective tissue are damaged is called neurotmesis.
- Nerve Injuries including Brachial Plexus Injuries
- Entrapment Syndromes like Carpal Tunnel Syndrome
Functional neurosurgery is concerned with the treatment of conditions where the central nervous system (brain and spinal cord) physiology (normal function) is altered but the anatomy may or may not be normal. Examples of conditions treated by functional neurosurgery are chronic pain (including cancer pain and failed back surgery syndrome), spasticity, movement disorders (Parkinson’s disease, dystonia, tremor etc), psychiatric conditions and epilepsy etc. Recently addiction is being added as an indication.
Deep Brain Stimulation
Deep brain stimulation (DBS) is a surgical treatment involving the implantation of a medical device called a brain pacemaker, which sends electrical impulses to specific parts of the brain. DBS in select brain regions has provided therapeutic benefits for otherwise treatment-resistant movement and affective disorders such as chronic pain, Parkinson’s disease, tremor and dystonia. Despite the long history of DBS, its underlying principles and mechanisms are still not clear. DBS directly changes brain activity in a controlled manner, its effects are reversible (unlike those of lesioning techniques) and is one of only a few neurosurgical methods that allows blinded studies.
Epilepsy surgery is an operation on the brain to control seizures and improve the person’s quality of life. There are two main types of epilepsy surgery:
- Surgery to remove the area of the brain producing seizures
- Surgery to interrupt the nerve pathways through which seizure impulses spread within the brain
Surgery is considered only if the area of the brain where the seizures start, called the seizure focus, can be clearly identified, and if the area to be removed is not responsible for any critical functions, such as language, sensation and movement. Extensive evaluation and testing are necessary to determine if surgery is appropriate.