Brain Surgery Archives - Desert Spine and Neurosurgical Institute

Primary Brain Tumors

support — Thu, 24 Jun 2021 12:48:57 +0000

Tumors that begin in brain tissue are known as primary tumors of the brain. (Information about secondary brain tumors appears in the following section.) Primary brain tumors are named according to the type of cells or the part of the brain in which they begin.

The most common primary brain tumors are gliomas. They begin in glial cells. There are many types of gliomas:

Astrocytoma: The tumor arises from star-shaped glial cells called astrocytes. In adults, astrocytomas most often arise in the cerebrum. In children, they occur in the brain stem, the cerebrum, and the cerebellum. A grade III astrocytoma is sometimes called an Anaplastic Astrocytoma. A grade IV astrocytoma is usually called aGlioblastoma Multiforme or GBM (see below).

Brain stem glioma: The tumor occurs in the lowest part of the brain. Brain stem gliomas most often are diagnosed in young children and middle-aged adults.

Ependymoma: The tumor arises from cells that line the ventricles or the central canal of the spinal cord. They are most commonly found in children and young adults.

Ologodendroglioma: This rare tumor arises from cells that make the fatty substance that covers and protects nerves. These tumors usually occur in the cerebrum. They grow slowly and usually do not spread into surrounding brain tissue. They are most common in middle-aged adults.

Some types of brain tumors do not begin in glial cells. The most common of these are:

Medulloblastoma: This tumor usually arises in the cerebellum. It is the most common brain tumor in children. It is sometimes called a primitive neuro-ectodermal tumor (PNET).

Meningioma: This tumor arises in the meninges. It usually grows slowly.

Schwannoma: A tumor that arises from a schwan cell. These cells line the nerve that controls balance and hearing. This nerve is in the inner ear. The tumor is also called an acoustic neuroma. It occurs most often in adults.

Cranipharyngioma: The tumor grows at the base of the brain, near the pituitary gland. This type of tumor most often occurs in children.

Germ cell tumor of the brain: The tumor arises from a germ cell. Most germ cell tumors that arise in the brain occur in people younger than 30. The most common type of germ cell tumor of the brain is a germinoma.

Pineal Region tumor: This rare brain tumor arises in or near the pineal gland. The pineal gland is located between the cerebrum and the cerebellum.

Glioblastoma Multiforme (GBM):

Glioblastoma Multiforme (GBM) is the most common primary brain tumor.

GBM has a male predominance and is mostly located in deep frontal and temporal region of the brain.
Treatment modalities include surgical resection are used in selected cases biopsy only, radiation therapy, and chemotherapy.

Gross total resection of this tumor has been shown in some studies to increase both life expectancy and quality of life, although, complete resection at microscopic level is considered impossible.

GBM Case Presentation:

Fifty-five year-old lady presented with new onset seizure.

An MRI of her brain disclosed a right occipital tumor.
She underwent frameless stereotactic craniotomy with gross total resection of the tumor which was later found to be glioblastoma multiforme (GBM).

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Metastatic Brain Tumors

support — Thu, 24 Jun 2021 12:47:49 +0000

Overall the most common brain tumors are metastatic brain tumors which arise from a primary tumor elsewhere in the body.
The distribution of metastatic tumor types in the brain reflects the distribution of systemic tumors in the general population
Therefore, most brain metastases arise from lung cancer, breast cancer, or melanoma, which represent the three most common sites of primary tumors.
The number and location of metastases guides the determination of the proper treatment approach, especially the decision for surgical resection.
A major predictor of survival is the number of cranial lesions that occur in patients who present with metastatic brain disease.

Metastatic Tumor Case Presentation:

65-year-old right handed lady with the history of metastatic ovarian cancer who presented with dysarthria and difficulty with bringing the right word out (anomia).
Her condition rapidly evolved into inablility in moving her right arm and leg, and speak (aphasia, and right hemiparesis) and she was brought to the emergency room.
Although patient could understand spoken language, she was unable to express herself (expressive aphasia).

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Brainstem Tumors

support — Thu, 24 Jun 2021 12:46:19 +0000

Brainstem gliomas are one of the most common tumors in this region.
They account for about twenty-percent of intracranial tumors in children.
Symptoms typically begin with cranial nerve palsy and hydrocephalus (resulting for example in double vision, headache, nausea and vomiting etc.).
Treatment for them typically includes radiation and cerebrospinal fluid diversion (third ventriculostomy vs. shunt placement).

Brainstem tumor case presentation:

A 36-year old woman with one year history of headache and hypertension presented with diplopia, progressive headache, nausea and vomiting and loss of consciousness. MRI scan of her brain showed a tectal tumor obstructing the cerebral aqueduct and hydrocephalus. The Patient underwent stereotactic endoscopic third ventriculostomy followed by gross total resection of the tectal tumor which was found to be anaplastic astrocytoma. She was discharged from the hospital neurologically intact and shunt independent.

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Pituitary Tumors

support — Thu, 24 Jun 2021 11:57:51 +0000

They account for about %10-%25 of brain tumors
Mean age of patients with pituitary tumors is 20-50 years.
Although symptoms largely depends on the type of the pituitary tumor, however, most patients present with headache.
Female patients are typically afflicted with Prolactin or ACTH secreting tumors and males with Growth hormone secreting tumors.
Depending on the different studies cited, they can be classified into 3 groups: benign, invasive adenoma, and carcinoma.
Adenomas form the largest portion of pituitary tumors with an overall estimated prevalence of about 17%, but only a minority are symptomatic.
Tumors less than 1 cm are classified as microadenoma and tumors equal or greater than 1 cm in size are called macroadenoma. – Macroadenoma have a higher probability of causing visual field defects due to pressing on optic chiasm.
Prolactin secreting tumors are the most common pituitary tumors and respond well to non-surgical/medical treatment.

Surgical Treament of Pituitary Tumors

Pituitary Tumors are approached by a team of surgeons composed of a Skull Based trained ENT surgeon and a Neurosurgeon.

After patients are seen and evaluated by each member of the Pituitary Tumor Team, patients’ case is presented to the Eisenhower Brain Tumor Board and discussed.

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Colloid Cysts

support — Thu, 24 Jun 2021 11:51:04 +0000

Colloid cysts are non-neoplastic intracranial cysts and really not a classical brain “tumor”.
Mean age of patients presenting with colloid cyst is 20 to 40 years with no sex predominance.
They are usually found at the foramen of Monro, in the anterior roof of the third ventricle.
This cyst is filled with a gelatinous, viscous material.
The colloid cyst usually becomes symptomatic in adults when it obstructs, the foramina of Monro and results in hydrocephalus. Rare but well-documented cases have been associated with severe headache followed by sudden death
Macroscopically, the smooth wall of the lesion is filled with a viscous fluid that can result in a severe ventriculitis if spilled. The lesion grows slowly, and malignant change has not been reported.

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Meningioma

support — Sat, 12 Jun 2021 22:36:57 +0000

Meningiomas are the most common extrinsic brain tumors and follow glioblastoma multiforme (GBMs) as one of the most common intracranial brain tumors.
Are a type of slow-growing tumor that forms in the meninges (thin layers of tissue that cover and protect the brain and spinal cord). Meningiomas usually occur in adults.
The incidence among females is about twice as many as males.
These are typically slow growing tumors and symptoms depends on the location.
About %70 of meningiomas have monosomy 22.
These tumors have hormone receptors for estrogen.
Meningioma incidence is increased by radiation.
%90 of meningiomas are located intra-cranially and the remaining are found in the spine.

Meningioma Case presentation:

77 year old man with new onset seizure
MRI scan of his brain showed a large left sphenoid wing tumor radigraphically consistent with meningioma.
He underwent frameless stereotactic orbitozygomatic craniotomy and gross total resection of this tumor.

Intra-operative Image Guidance.

He was neurlogically completely intact and was discharged from the hospital in a few days.in good health. His MRI postoperatively showed complete resection of the tumor.

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Craniotomy for Aneurysms

support — Sat, 12 Jun 2021 22:32:57 +0000

What is it?

The human skull, which is formed by the union of several cranial and facial bones, is anatomically divided into five regions: an upper region or vertex, a lower region or base, two side regions, and a frontal region, the face. The region of the skull through which the surgeon selects to perform a craniotomy is based on the type of condition requiring treatment. A skull base craniotomy is performed, for example, to treat Chiari (kee-ar-ee) malformations – congenital abnormalities of the base of the brain where the spinal column joins the skull. Named after Professor Hans Chiari – the German pathologist who in 1890 first described these abnormalities of the brain, these malformations usually cause a protrusion of the cerebellum through the bottom of the skull into the spinal canal, which results in poor circulation of cerebrospinal fluid from the brain to the spinal cord.

Why is it done?

Patients who suffer from the following cranial conditions are potential candidates for this operation:

Tumors (e.g., brain, pituitary, optic nerve, acoustic neuroma)
Cysts (e.g., arachnoid, colloid)
Bleeding (hemorrhage)
Blood clots (hematomas) from injuries (subdural hematomas or epidural hematomas)
Weaknesses in blood vessels (cerebral aneurysms)
Abnormal blood vessels (AVMs or arteriovenous malformations)
Damage to the tissue covering the brain (dura)
Cerebrospinal fluid (CSF) leaks
Chiari malformations
Premature fusion of the normally separate bones of the skull (craniosynostosis)
Infection in the brain (brain abscesses)
Skull trauma (e.g., fractures)

The Operation

An understanding of what a craniotomy involves will help you to approach your operation and recovery with confidence.

Incision
Part of the scalp is shaved and cleaned. An incision is then made through the scalp to the skull.

Exposure
A small hole, called a burr hole, is drilled through the skull to the brain. In some cases, several burr holes are drilled to allow your surgeon to lift and remove a piece of the bone. The bone between these holes is cut to create a flap in the skull through which the surgeon can access the brain and its surrounding structures. Next, the dura is cut to expose the brain.

Related Procedure
At this point in the operation, depending on the condition for which you are receiving treatment, several different procedures are performed. For example, your surgeon may remove tumors, clip aneurysms, drain cysts or shunt blood clots (a passage created between two natural bodies, such as blood vessels, shunts divert or permit flow from one body to the other).

Closure
The dura is then sutured closed, and the bone that was removed from the skull is put back in place and secured with metal plates and screws. The operation is completed when your surgeon closes and dresses the incision.

Recovery
Your surgeon will have a specific post-operative recovery/exercise plan to help you return to normal life as soon as possible. The amount of time that you have to stay in the hospital will depend on this treatment plan.

As you read this, please keep in mind that all treatment and outcome results are specific to the individual patient. Results may vary. Complications, such as infection and blood loss, are some of the potential adverse risks of cranial surgery. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information.

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What is Craniotomy?

support — Sat, 12 Jun 2021 22:24:00 +0000

What is it?

Craniotomy is an operation that involves removing a piece of bone from the skull (cranium) to provide access to the brain and its surrounding structures. The term craniotomy is derived from the Latin words cranium (head) and -otomy (act of cutting, incision).
The human skull, which is formed by the union of several cranial and facial bones, is anatomically divided into five regions: an upper region or vertex, a lower region or base, two side regions, and a frontal region, the face. The region of the skull through which the surgeon selects to perform a craniotomy is based on the type of condition requiring treatment. A skull base craniotomy is performed, for example, to treat Chiari (kee-ar-ee) malformations – congenital abnormalities of the base of the brain where the spinal column joins the skull. Named after Professor Hans Chiari – the German pathologist who in 1890 first described these abnormalities of the brain, these malformations usually cause a protrusion of the cerebellum through the bottom of the skull into the spinal canal, which results in poor circulation of cerebrospinal fluid from the brain to the spinal cord.

Why is it done?

Patients who suffer from the following cranial conditions are potential candidates for this operation:

Tumors (e.g., brain, pituitary, optic nerve, acoustic neuroma)
Cysts (e.g., arachnoid, colloid)
Bleeding (hemorrhage)
Blood clots (hematomas) from injuries (subdural hematomas or epidural hematomas)
Weaknesses in blood vessels (cerebral aneurysms)
Abnormal blood vessels (AVMs or arteriovenous malformations)
Damage to the tissue covering the brain (dura)
Cerebrospinal fluid (CSF) leaks
Chiari malformations
Premature fusion of the normally separate bones of the skull (craniosynostosis)
Infection in the brain (brain abscesses)
Skull trauma (e.g., fractures)
The Operation

An understanding of what a craniotomy involves will help you to approach your operation and recovery with confidence.

Incision
Part of the scalp is shaved and cleaned. An incision is then made through the scalp to the skull.

The post What is Craniotomy? appeared first on Desert Spine and Neurosurgical Institute.

Trigeminal Neuralgia

support — Sat, 12 Jun 2021 17:00:39 +0000

Differential diagnosis of facial pain is fairly extensive and includes common causes such as headache, as well as characteristic cranial neuralgias, such as trigeminal neuralgia.
The trigeminal nerve, because of its distribution, is the location of a wide variety of pain syndromes. Of these, trigeminal neuralgia is a well-known and relatively common disorder.
Classically, trigeminal neuralgia pain is localized to one or more branches of the trigeminal nerve and is characterized by sharp, lancinating, electric-shock-like pain occurring as a brief episode that lasts several seconds, with pain-free intervals between attacks.
These attacks are initiated by stimulation of a so-called trigger zone, or they may start spontaneously without obvious provocation. Early on, the disorder may involve periods of pain remission that can last for years.
The exact nature of the mechanism of trigeminal neuralgia remains unknown; however, it is generally accepted that focal demyelination in the root of the trigeminal nerve is involved in the pathogenesis.
The diagnosis of classic trigeminal neuralgia also assumes preservation of the function of the trigeminal nerve, with mild hypesthesia in a minority of cases.
Perhaps the most important feature of facial pain that labels it as trigeminal neuralgia is its unequivocal improvement with an anticonvulsant such as carbamazepine, gabapentin, or phenytoin. This response to carbamazepine can be helpful in differentiating trigeminal neuralgia from other orofacial pain.
Advanced imaging can in most cases identify the vessel which is pressing on the trigeminal nerve and causes the symptoms of trigeminal neuralgia.
This knowledge becomes prudent in surgical approach to the treatment of trigeminal neuralgia.

Treatment of trigeminal neuralgia is broadly divided into two categories:

1- Destructive treatment:

Radiofrequency Rhizotomies
Balloon Gangliolysis
Stereotactic Radiosurgery (ie Gamma Knife)

The possible complication of destructive treatment is facial numbness, neuroparalytic keratitis, or the sever complication of anesthesia dolorosa which is a more complex facial pain.

2- Non destructive treatment:

Medical treatment (Tegretol, Baclofen, Dilantin, etc.)
Microvascular decompression (with initial success rate of 85 to 95%)

The possible complication of non destructive treatment is side effect of medication and risk of surgery.

Trigeminal Neuralgia Case Presentation:

Here a patient with facial pain was diagnosed with trigeminal neuralgia. Using a special sequence MRI mapping of her trigeminal nerve and adjacent vascular structures, left superior cerebellar artery was found to be impinging on her trigeminal nerve.

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Image Guided Craniotomy

support — Sat, 12 Jun 2021 16:54:01 +0000

Using state of art technology, brain tumors and a variety of spinal pathology can be treated with minimal risk to the surrounding normal tissue.

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