Neurosurgery is surgery of the nervous system.
Neurosurgery is the surgical specialization that treats diseases and disorders of the brain and spinal cord. Back pain can sometimes produce neurological symptoms such as numbness, muscle weakness, and loss of bowel and bladder control due to dysfunction at the nerve root.
These symptoms are indicators that neurosurgery is required to treat the underlying cause of back pain as opposed to conservative treatments. Procedures to treat back pain under the realm of neurosurgery include discectomy, laminectomy, and spinal fusion surgery.
A neurosurgeon is a Medical Doctor or Doctor of Osteopathic Medicine who has completed a five or six-year residency that focuses on the surgical treatment of patients with neurological conditions.
A neurosurgeon is trained in the diagnosis and treatment of disorders of the brain, spine, spinal cord, nerves, intracranial, and intraspinal vasculature. A neurosurgeon may complete additional training with a Spine Fellowship and specialize in spine surgery.
A ventriculoperitoneal (VP) shunt is a medical device that relieves pressure on the brain caused by fluid accumulation.
VP shunting is a surgical procedure that primarily treats a condition called hydrocephalus. This condition occurs when excess cerebrospinal fluid (CSF) collects in the brain’s ventricles. CSF cushions your brain and protects it from injury inside your skull. The fluid acts as a delivery system for nutrients that your brain needs, and it also takes away waste products. Normally, CSF flows through these ventricles to the base of the brain. The fluid then bathes the brain and spinal cord before it’s reabsorbed into the blood.
When this normal flow is disrupted, the buildup of fluid can create harmful pressure on the brain’s tissues, which can damage the brain. Doctors surgically place VP shunts inside one of the brain’s ventricles to divert fluid away from the brain and restore normal flow and absorption of CSF.
People of any age can develop hydrocephalus and therefore require a VP shunt. However, according to the Mayo Clinic, hydrocephalus is more likely to occur in babies and older adults. The National Institute for Neurological Disorders and Stroke (NINDS) estimates that 1 to 2 of every 1,000 babies are born with hydrocephalus.
Excess fluid can build up around the brain for a number of reasons, including:
- overproduction of CSF
- poor absorption of CSF by the blood vessels
- blockages preventing fluid from flowing throughout the brain
Blockages are the most common cause of hydrocephalus. Cysts, tumors, or inflammation in the brain can impede the normal flow of CSF and create an unsafe accumulation. Symptoms of hydrocephalus can include:
- large head size
- excessive sleepiness
- poor appetite
- cognitive delays or regression
- memory loss
- poor coordination
- impaired vision
Imaging tests can confirm the diagnosis of hydrocephalus. Ultrasound, CT scans, and MRI scans allow doctors to view the cavities and tissues within the brain. Testing will show if areas of the brain contain more fluid than normal.
A tumor is an abnormal growth of cells that serves no purpose. A benign tumor is not a malignant tumor, which is cancer. It does not invade nearby tissue or spread to other parts of the body the way cancer can. In most cases, the outlook with benign tumors is very good. But benign tumors can be serious if they press on vital structures such as blood vessels or nerves. Therefore, sometimes they require treatment and other times they do not.
What causes a benign tumor to form? Often the cause is unknown. But the growth of a benign tumor might be linked to:
- Environmental toxins, such as exposure to radiation
- Local trauma or injury
- Inflammation or infection
In many cases, benign tumors need no treatment. Doctors may simply use “watchful waiting” to make sure they cause no problems. But treatment may be needed if symptoms are a problem. Surgery is a common type of treatment for benign tumors. The goal is to remove the tumor without damaging surrounding tissues. Other types of treatment may include medication or radiation.
A brain tumor, known as an intracranial tumor, is an abnormal mass of tissue in which cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. More than 150 different brain tumors have been documented, but the two main groups of brain tumors are termed primary and metastatic.
Primary brain tumors include tumors that originate from the tissues of the brain or the brain’s immediate surroundings. Primary tumors are categorized as glial (composed of glial cells) or non-glial (developed on or in the structures of the brain, including nerves, blood vessels and glands) and benign or malignant.
Metastatic brain tumors include tumors that arise elsewhere in the body (such as the breast or lungs) and migrate to the brain, usually through the bloodstream. Metastatic tumors are considered cancer and are malignant.
Metastatic tumors to the brain affect nearly one in four patients with cancer, or an estimated 150,000 people a year. Up to 40 percent of people with lung cancer will develop metastatic brain tumors. In the past, the outcome for patients diagnosed with these tumors was very poor, with typical survival rates of just several weeks. More sophisticated diagnostic tools, in addition to innovative surgical and radiation approaches, have helped survival rates expand up to years; and also allowed for an improved quality of life for patients following diagnosis.
Surgical Treatment of Brain & Spine
Intracranial Surgery: In intracranial surgery, endoscopes are introduced into the brain through very small skull openings, following which tiny instruments may be placed through the same opening for the purpose of performing endoscopic tumor biopsy, colloid cyst resection, and endoscopic cyst fenestration, as well as to treat hydrocephalus. Operations can last from about 15 minutes to an hour, and patients are typically discharged the next day from the hospital.
Spinal Surgery: Spinal surgery may also be performed endoscopically for a range of conditions affecting the spinal column, including lumbar and thoracic hernias, chronic back pain, and compression fractures, among others. Procedures for correction of these conditions include video-assisted transthoracic surgery, computer-assisted lumbar fusion, and lumbar discectomy. These may be performed under local or general anesthesia and patients often go home in as little as one day after the procedure.