brain services

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Aneurysm clipping is a surgical treatment for a brain aneurysm, a balloon-like bulge on a blood vessel wall that can enlarge over time and ultimately rupture, causing a life-threatening stroke. If the aneurysm has a narrow neck, neurosurgeons can clip it at its base, thereby isolating the aneurysm from the normal blood flow. Clipping an aneurysm requires a craniotomy, the surgical opening of the skull.

Coiling is a minimally invasive, endovascular procedure used to neutralize a brain aneurysm, a balloon-like bulge on a blood vessel wall that can enlarge over time and ultimately rupture, causing a life-threatening stroke. A benefit of coiling is that it does not require invasive surgery or the opening of the skull (a craniotomy). During a coiling procedure, a surgeon threads a flexible catheter from the large femoral artery near the groin up to one of four arteries in the neck that lead to the brain. The surgeon then inserts platinum coils through small tubing into the aneurysm. The compacted coils are designed to block blood flow and prevent the aneurysm from bleeding.

Gluing is a minimally invasive, endovascular procedure that fills a brain aneurysm with a glue-like material known as Onyx HD 500. An aneurysm is a balloon-like bulge on a blood vessel wall that can enlarge over time and ultimately rupture, causing a life-threatening stroke. While aneurysms that have a narrow neck can be surgically clipped at their base or filled with coils, aneurysms with wide necks are problematic because they cannot be clipped and because coils may not remain inside. During embolization with Onyx®, a flexible balloon catheter is threaded up from the large femoral artery in the upper leg (groin area) and advanced to an artery that leads to the brain The balloon catheter is placed over the aneurysm neck and inflated; a second flexible catheter then dispenses Onyx® into the aneurysm. After the glue has solidified, the balloon is deflated and removed. With the aneurysm now filled with solidified glue, blood can no longer enter the arterial bulge and pose a risk of stroke.

Angioplasty and stenting is a treatment for a narrowed or blocked artery in the brain (intracranial artery stenosis) or neck (carotid artery disease). The blockage is often caused by a buildup of plaque inside the artery wall that reduces blood flow to the brain. If left untreated, it could lead to stroke. During angioplasty, the physician inserts a catheter or tube into an artery in the groin and then threads the catheter through the arteries to the location of the plaque. A small balloon is slowly inflated within the narrowed artery to dilate it and compress the plaque against the wall. A self-expanding mesh-like tube called a stent is placed over the plaque, holding open the artery.

Treatment of an arteriovenous malformation (AVM), an abnormal tangle of blood vessels in the brain, can be accomplished in a variety of ways. Treatment options range from conservative watching to aggressive surgery, depending on the type, symptoms, and location of the AVM. Specialists treat some AVM’s with radiosurgery, aiming focused beams of radiation at the lesion and causing the blood vessels to gradually close off. Other AVM’s are treated with endovascular embolization, a minimally invasive procedure in which glue or another material is delivered into the AVM through a tiny catheter. After embolization, blood is no longer able to flow through the malformation. Still other AVM’s are treated surgically. A surgical opening, or craniotomy, is made in the skull, and the brain is gently retracted so that the AVM may be located. Using a variety of techniques such as laser and electrocautery, the AVM is shrunk and dissected from normal brain tissue.

Brachytherapy involves delivering radiation from inside the brain to help eradicate a tumor or reduce its size. A neurosurgeon places radioactive material that is sealed in seeds, about the size of grains of rice, directly into the tumor cavity during surgery.

Biopsy is a procedure to remove a small amount of tumor to be examined by a pathologist under a microscope. A biopsy can be taken as part of an open surgical procedure to remove the tumor or as a separate diagnostic procedure, known as a needle biopsy via a small hole drilled in the skull . A hollow needle is guided into the tumor and a tissue sample is removed. A stereotactic biopsy is like a needle biopsy but is performed with the use of a stereotactic head frame and a computer to precisely locate the tumor and direct the needle.

A carotid endarterectomy is a treatment for carotid stenosis (a narrowing or blockage of the carotid artery), which is an important risk factor for stroke. The body’s two carotid arteries, one on the right side and one on the left, run through the neck and supply oxygen-rich blood to the brain. During an endarterectomy, a surgeon makes an incision in the neck and physically removes plaque from the inside of the artery.

A cerebral artery bypass is a surgical procedure performed to restore, or “revascularize,” blood flow to the brain. A cerebral bypass is the brain's equivalent of a coronary bypass in the heart. The surgery involves connecting a blood vessel from outside the brain to a vessel inside the brain to reroute blood flow around an artery that is narrowed, blocked, or damaged. The main goal of bypass surgery is to restore blood supply to the brain and prevent strokes. During the two-step surgical procedure, a vascular surgeon “harvests” an artery from another part of the body. A neurosurgeon then uses that artery to bypass the damaged artery in the neck or brain. The harvested artery is threaded under the skin and into the skull, where it is then attached to another healthy artery. This restores healthy blood flow to the patient’s brain.

A Chiari decompression is a surgical procedure performed to alleviate symptoms of Chiari I malformation, a condition in which the lower part of the brain, called the cerebellar tonsil, herniates down through the skull and into the spinal canal. The herniated tissue presses against the brainstem and blocks the normal flow of cerebrospinal fluid (CSF), often causing headaches and pain at the base of the skull or neck. Surgery involves relieving the progression of symptoms and compression of the brainstem and cranial nerves. During the procedure, the neurosurgeon removes bone at the back of the skull and spine to widen the foramen magnum. The dura overlying the tonsils is opened and a dural patch is sewn to expand the space and restore normal CSF flow.

Chemotherapy is a treatment that uses chemical agents (drugs) to kill cancer cells. The drugs can be taken by pill or intravenous (IV). Wafers soaked in chemotherapy drug can be placed directly into the brain after a tumor has been removed. The wafers are about the size of a nickel and deliver BCNU, a standard form of chemotherapy, directly to the remaining tumor cells and brain.

A cranial reconstruction, or cranioplasty, is an inpatient procedure in which neurosurgeons repair defects in the skull in order to protect the individual’s brain. Skull defects can be caused by physical trauma, a gunshot wound, or surgery. During a cranioplasty, neurosurgeons use a graft to repair a defect in the front of the skull. The graft can be made from the patient’s own bone, either adjacent to the defect or from somewhere else in the body, or from synthetic material. The surgeon affixes the graft, or implant, to the skull with small titanium plates and screws.

A craniotomy is a surgical cut that opens the skull, or cranium, which encases the brain. A craniotomy, which can be small or large, is used in the treatment of several conditions, including brain tumors, blood clots, aneurysms, arteriovenous malformations, or fractures to the skull. A craniotomy also may be performed so that surgeons can remove foreign objects, reduce swelling, or treat infection. During this surgical procedure, a section of the skull, called a bone flap, is removed to access the brain underneath. The bone flap is usually replaced after the procedure with tiny plates and screws.

Deep brain stimulation (DBS) surgery is a treatment for people with Parkinson’s disease, essential tremor, and dystonia. DBS is a minimally invasive procedure in which a neurosurgeon implants a medical device, similar to a pacemaker, into the brain to deliver electrical stimulation to precisely targeted areas. DBS is very effective at reducing dyskinesias, the uncontrolled wiggling movements caused by high doses of levadopa medication. Typically, DBS will help make your symptoms less severe so that lower medication doses may be used.

Epilepsy surgery can be performed to eliminate or reduce seizures in patients who have medication-resistant or “intractable” seizures. Epilepsy surgery can performed in two different ways. In some situations, a neurosurgeon removes an area of the brain that is producing seizures. This is called a “curative” procedure, because the goal is stop the seizures entirely. In a second type of procedure, the neurosurgeon seeks to limit the spread of seizure activity or reduce the frequency of seizures by interrupting the seizure’s pathway. This procedure is considered “palliative,” because it is aimed at reducing physical harm caused by seizures. A candidate for epilepsy surgery undergoes rigorous testing to ensure that surgery can be performed safely and without negatively impacting brain structures responsible for movement, memory and cognition.

Endoscopic transsphenoidal surgery is a minimally invasive surgery performed to remove tumors from the pituitary gland, sellar region, and sphenoid sinus of the skull. The surgeon approaches the pituitary through the nose. A small incision is made at the back of the nasal cavity and causes little disruption of the nasal tissues. The ENT surgeon works through the nostrils with a tiny camera and light called an endoscope. Once the pituitary is exposed, the neurosurgeon removes the tumor.

Hematoma aspiration is a minimally invasive procedure used to remove large blood clots (hematomas) caused by an intracerebral hemorrhage (a type of bleeding stroke) or trauma to the head. During the procedure, a stereotactic frame is attached to the head with four pins, or screws. A CT scan of the head helps the neurosurgeon pinpoint the exact coordinates of the hematoma. In the operating room, the neurosurgeon then drills a small hole about the size of quarter in the skull. With the aid of the stereotactic frame, a hollow needle is passed through the hole, through the brain tissue, and directly into the clot. The hollow needle is attached to a large syringe, which the surgeon uses to suction out the contents of the blood clot.

Microvascular decompression (MVD) surgery relieves abnormal compression of a cranial nerve. It is performed to treat trigeminal neuralgia, vagoglossopharyngeal neuralgia, and hemifacial spasm. These conditions can occur when an artery or vein compresses the nerve root as it leaves the brainstem. When compressed, normal nerve impulses can recruit nearby nerve fibers and send faulty messages, causing symptoms that include pain and muscle twitching. During an MVD, the neurosurgeon opens the skull (craniotomy), exposes the nerve, and inserts a tiny sponge between the compressing vessel and the nerve. This sponge isolates the nerve from the pulsating effect and pressure of the blood vessel, and painful symptoms are relieved.

A stereotactic needle biopsy is a diagnostic test used to determine whether a brain tumor is benign or malignant. During the procedure, the neurosurgeon inserts a hollow cannula into the tumor. Small biting instruments remove bits of tumor. A pathologist will examine these samples and determine the exact tumor cell type. Peer-reviewed research conducted by Mayfield Clinic neurosurgeons has found that performing a stereotactic needle biopsy in an area of the brain associated with language or other important functions carries no greater risk than a similar biopsy in a less critical area of the brain.

Percutaneous stereotactic radiofrequency rhizotomy (PSR) is a minimally invasive procedure performed to relieve pain caused by trigeminal neuralgia, glossopharyngeal neuralgia, or cluster headaches. The treatment is an option when medications become ineffective in controlling pain or when they are causing serious side effects. During a PSR, a neurosurgeon destroys the part of the nerve that is causing pain by suppressing the pain signal to the brain. The surgeon passes a hollow needle through the cheek and into the selected nerve at the base of the skull. A heating current, which is passed through the electrode, destroys some of the nerve fibers, but not the entire nerve. A PSR is a one- to two-hour outpatient procedure that is performed in a radiology department or an operating room.

A shunt is hollow catheter inserted into the brain to drain or divert cerebrospinal fluid from inside the ventricles into another body cavity such as the abdomen. It is a treatment to relieve hydrocephalus - an abnormal build-up of cerebrospinal fluid usually caused by a blockage of the ventricular system of the brain. Increased intracranial pressure can compress and damage brain tissue. Also called “water on the brain.”

Radiation seeds can be placed in a brain cavity after a tumor has been removed. Radiation seeds, about the size of grains of rice, consist of titanium casings containing low-radioactivity iodine 125. After a tumor’s removal, about 50 to 100 seeds are placed in the surgical cavity, where they remain permanently. By emitting radiation over a period of six months, they destroy microscopic tumor cells that may persist in the brain following surgery.

Stereotactic therapy, often referred to as “surgery without the knife,” involves the destruction of a lesion with multiple, precisely targeted doses of radiation. A lesion is an abnormality that can appear as a tumor or malformation. During radiotherapy, the head is immobilized with a special frame or mask, which also provides a frame of reference for targeting the lesion. Brain scans are taken while the patient is wearing the frame or mask and before each treatment, and special reflectors are placed on the mask to help align the patient. Radiation is delivered by a computerized machine known as a linear accelerator.

Vagus nerve stimulation (VNS) is a procedure used to treat epileptic seizures and depression. It is considered as a treatment option for seizures or depression that are “intractable,” or resistant to being treated effectively with medication. The human body’s two vagus nerves, one on each side, transmit signals into and out of the brain. During a VNS procedure, a neurosurgeon implants a pulse generator (which resembles a pacemaker) in the chest. An electrode from the generator is then threaded, under the skin, to the left vagus nerve in the neck. Electrical impulses generated by the stimulator have been shown to significantly reduce seizures and may be capable of reducing depression in some people.