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   Read More:    Neurosurgery Overview       Spine Surgery       Cranial Surgery       Other Surgery       Deep Brain Stimulation (DBS)       Gamma Knife       Neurosurgical Links      

Brain Tumors

Brain tumors include benign and more aggressive tumors, both of which often need surgical treatment or biopsy for diagnosis. Surgery for brain tumors ranges from minimally invasive biopsies or nearly non-invasive radiosurgery, to more aggressive surgical approaches. Some tumors require more than one modality for diagnosis and treatment.

Surgery

Open surgery for brain tumors is often done for resection or removal of accessible lesions. Modern techniques such as image-guided surgery, contact lasers and endoscopes have made the treatment of these tumors easier on the patient. Many types of brain tumors can be addressed surgically, including meningiomas, schwannomas, gliomas, metastatic tumors, pituitary adenomas, and others.

Open surgery also allows the use of other treatment during surgery. Chemotherapy and radiation can be delivered directly to the tumor during an open operation. This allows for higher concentrations of drug or radiation to be delivered to the site without exposing the rest of the body. Tumors at the base of the skull often require more extensive procedures and more lengthy operations. These tumors often involve the nerves and vessels that exit and enter the skull. Special procedures and monitoring are used during the surgery to increase the safety of the patient.

Radiosurgery

Radiosurgery is a technique used to treat tumors or vascular malformations of the brain without cutting the skin. Carefully designed radiation beams are delivered to the site, minimizing damage to surrounding structures. This is ideal for patients with multiple tumors of the brain. Radiosurgery is also used when conventional surgery might be too dangerous. Radiosurgery is not useful for every situation but plays a very important role in the surgical treatment of brain tumors.

Biopsy

Occasionally, only a small sample of issue is needed to start therapy for tumors or brain infections. Using sophisticated computer aided targeting, a small sample of tissue can be obtained with very small incisions. Usually the patient is awake for the surgery and leaves the hospital the next morning.

Vascular Disorders

These include strokes, aneurysms, arteriovenous malformations (AVMs) and other disorders of the vessels that deliver blood to the brain and spinal cord. Often people with these problems come to our attention in the emergency room. Severe headaches and changes in consciousness are associated with bleeding in the brain or stroke. Aneurysms and AVMs can present with bleeding. Strokes can either be associated with bleeding or with the lack of blood flow to the brain.

Surgery

Surgery for vascular problems of the brain often requires a "craniotomy", or opening the skull, for treatment. Aneurysms are small blisters found on blood vessels in the brain. When these blisters break, blood leaks out and irritates the brain. Patients with aneurysms often complain of headaches, nausea or vomiting, and frequently have loss of consciousness prior to arriving at the hospital. Emergent care, both medical and possibly surgical, is needed for treatment. During surgery, clips are placed on aneurysms to prevent rupture or to stop bleeding. An AVM is a tangle of blood vessels in the brain, in which there are abnormal connections between the arteries and veins. These abnormal vessels are prone to break open and bleed, which irritates the brain. This irritation is similar to that seen with aneurysms. AVMs must be removed to prevent re-bleeding, however unlike aneurysms, surgery for an AVM is rarely emergent. Surgery for AVMs can be either stereotactic radiosurgery (see Gamma Knife) or endovascular therapy.

Endovascular Treatment

Treatment of vascular disorders does not always require open surgery. Some aneurysms can be treated from inside the vessels. Neurosurgeons work in concert with neuroradiologists to place platinum coils inside of aneurysms to prevent further bleeding. Similarly, AVMs can be treated with glue. From inside the vessels glue is placed into the AVM to shrink it and prevent further bleeding. After gluing the malformation, subsequent treatment is usually needed; either radiosurgery or open surgery.

Trauma

Head trauma can vary from a mild bump on the head to severe injury from motor vehicle accidents or falls. Surgery is not always needed for head injuries. Severe head injury that results in blood clots in or on the brain will often require surgery. Our Surgeons cover two major trauma centers in the metropolitan area and are accustomed to dealing with all forms of head injury.

Movement Disorders

Parkinson's disease, Essential tremor, Dystonia, Huntington's chorea and others are considered movement disorders. These are disorders in which the patient is unable to control movement of the body. Surgery for these disorders is highly specialized. Stimulation of various brain structures can decrease the symptoms of these disorders. This involves the placement of electrodes into the brain that are connected to "pacemakers" placed under the skin next to the collarbone. Please see our section on Deep Brain Stimulation

Endoscopic Surgery

Endoscopes can be used to assist in some open operations or replace the microscope in minimally invasive operations. Endoscopes can be used for surgery inside the fluid filled spaces of the brain, to biopsy masses or treat certain forms of hydrocephalus (increased fluid pressure in the brain). We have a movie to demonstrate endoscopic ventricular surgery.

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