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cranial-conditions

Cranial Conditions

  • Normal Pressure Hydrocephalus

    Your brain normally contains fluid filled cavities called ventricles. The fluid is called cerebrospinal fluid, or CSF, and it circulates within your brain and down your spine. Normal pressure hydrocephalus (NPH) is an imbalance in the pressure system of the fluid filled ventricles. These ventricles then increase in size, a condition known as hydrocephalus. When ventricles enlarge, or dilate, the pressure within them can rise as well; this can cause certain problems. In NPH however, though the ventricles enlarge in size, the pressure does not significantly rise. This can result in a very specific set of problems, including unsteadiness while walking, problems controlling the bladder, and memory problems or confusion. NPH is usually diagnosed after a brain CT or MRI reveals the enlarged ventricles. Sometimes your physician will then order a spinal tap, to drain some of the excess fluid. If the symptoms improve, even temporarily, then you may be a candidate for a surgery to divert the excess fluid to be absorbed elsewhere within your body. Sometimes this is accomplished with a shunt, or a small thin tube which carries the excess fluid from your brain to your abdomen. Other times a small communication can be made between two of the fluid-filled cavities within the brain. If you are a candidate for surgery, your neurosurgeon will help determine which procedure is best for you.

  • Hydrocephalus

    Your brain normally contains fluid filled cavities called ventricles. The fluid is called cerebrospinal fluid, or CSF, and it circulates within your brain and down your spine. Hydrocephalus is a condition which occurs when these ventricles become enlarged with too much fluid. When this occurs, the pressure within the ventricles may increase, and this elevated pressure can cause certain problems. These can include visual disturbances, headaches, confusion, sleepiness, and nausea and vomiting. Other problems can occur as well, whether or not the pressure rises. Hydrocephalus is usually diagnosed after a brain CT or MRI reveals the enlarged ventricles. The treatment is usually a surgery to divert the excess fluid to be absorbed elsewhere within your body. Sometimes this is accomplished with a shunt, or a small thin tube which carries the excess fluid from your brain to your abdomen. Other times a small communication can be made between two of the fluid-filled cavities within the brain. If you are a candidate for surgery, your neurosurgeon will help determine which procedure is best for you. Your neurosurgeon will discuss the risks, benefits, and long term management of this condition.

  • Arteriovenous Malformation (AVM)

    Vascular malformations are abnormal tangles of blood vessels that can occur in different parts of the body, and also within the brain. They are usually congenital, or present at birth, but some can also develop over time. Many of these vascular malformations are tiny and never cause any problems. An arteriovenous malformation (AVM) is one of the vascular malformations that can occur within the brain. They can be small or large. They can occur on the surface of the brain or deep within. While some cause no problems, others can cause bleeding, or seizures, or both. Not all AVM’s require treatment, but once they are found they are usually imaged every year at least to make sure they are stable. For those AVM’s requiring treatment, different options exist. Surgery to remove the AVM is one option. Others can be treated with radiation, thereby avoiding surgery. Sometimes the blood supply to the AVM can be intentionally blocked, a procedure known as embolization, and this can make the treatment by either surgery or radiation a little safer. Your neurosurgeon will discuss the various management options and help determine which plan is best for you.

  • Cerebral Aneurysms

    A cerebral aneurysm is a bulge on a weakened wall of an artery, usually at the base of the brain. It can resemble a small sac or pocket protruding out of the artery. Cerebral aneurysms are very common; they can be present since birth, and one out of every 15-20 people can have at least one cerebral aneurysm. Very often they are found incidentally, or for reasons unrelated to the aneurysm itself. For example, they are often seen if someone has an MRI for a headache, or dizziness, even though the aneurysm has nothing to do with either symptom. It is very common for neurosurgeons to see patients in the office who have an unruptured cerebral aneursym which was found for an unrelated reason. They often require no treatment, and the patients are reassured. Since they are so common, the real issue is who is at risk for having an aneurysm rupture, or burst. This typically causes a very serious hemorrhage or bleed within the brain, often a life-threatening emergency, known as a subarachnoid hemorrhage. A ruptured aneurysm causes a severe headache, often with vomiting. The known risk factors for rupture include high blood pressure, cigarette smoking, certain types of illicit drug use, and even family history of rupture. Once someone suffers a ruptured aneurysm, the immediate family members should be examined to make sure no other family member has an aneurysm. Once an aneurysm ruptures, it needs to be treated to seal the breach so it cannot bleed again. Sometimes this is accomplished by a brain surgery known as “clipping the aneurysm”, wherein a small clip is placed directly on the aneurysm. Other times the ruptured aneurysm can be secured by a catheter entering the blood supply through the groin area, through which tiny coils are deposited directly into the aneurysm; this is known as “coiling the aneurysm”. The decision as to which treatment is best for a ruptured aneurysm, whether clipping or coiling, is made by the physicians. Once the aneurysm has been treated, the patient still typically has a long course in the hospital recovering from the hemorrhage.

  • Brain Tumors

    • Benign Brain Tumors

      There are many different types of brain tumors. Some are benign, i.e. not cancer, and others are malignant, i.e. cancer. The most common benign brain tumor is called a meningioma, which grows from the tissue covering the brain. They can be small and not require any treatment or surgery. These small, non-surgical meningiomas will typically be imaged yearly to ensure they are not growing. Meningiomas can also be large and require surgical removal. Some can also be treated with radiation, or with a combination of surgery and radiation. If you have a meningioma, your neurosurgeon will help determine which management plan is best for you.

    • Malignant Brain Tumors

      Most malignant, or cancerous, brain tumors can be categorized as either primary or metastatic. A primary malignant brain tumor is one which originates within the brain tissue. This is different from a metastatic tumor, which is when a cancer from somewhere else in the body spreads to the brain. A metastatic tumor is like a seed which deposits in the brain tissue, a lung cancer for example, and as it grows it pushes the surrounding brain tissue away. Therefore these metastatic tumors can often be removed in their entirety, while primary tumors can almost never be removed in their entirety. This is because with a primary brain tumor the brain tissue itself is turning into a cancer, it is not just being pushed out of the way by a growing tumor. The most common metastatic tumors spreading to the brain start in the lung or breast. The most common primary brain tumors are known as astrocytomas. There are different stages of astrocytomas. While some are considered benign, most are malignant; the most aggressive type is called a glioblastoma multiforme, or a GBM. These almost always require surgery, followed by radiation and chemotherapy. If you or a loved one has a brain tumor, your neurosurgeon will help coordinate the care with multiple other specialists if necessary, such as neurologists, oncologists, and radiation oncologists.

  • Chiari Malformation

    Named for an Austrian pathologist from the 1800’s, this disorder is characterized by a crowding of the contents at the the base of the skull which puts pressure on certain parts of the brain. The posterior, or hind portion of the base of the skull grows a little smaller than it ought to be, and this causes a crowding of the parts of the brain housed by that section of the skull base. These include the cerebellum and the brainstem. In fact, the available space can be so compromised that two small paired structures at the base of the cerebellum known as the tonsils (different from the tonsils in the back of your throat) can eke through the hole in the bottom of the skull where the brainstem normally transitions to become the spinal cord. This can cause pressure on the brainstem, and result in the many varied symptoms of Chiari Malformation. By far the most common symptom is headache at the base of the skull. Other symptoms can include swallowing difficulties, feelings of imbalance, clumsiness or dropping things, bladder or bowel habit changes, coldness in the hands and feet, ringing in the ears, word finding difficulties, difficulty concentrating, and many others. Many patients go undiagnosed for a long time. Many patients are treatable with a surgery designed to relieve the pressure on the brainstem. If you have a Chiari Malformation your neurosurgeon will help determine if you might be helped with surgery.

  • Intracranial Hemorrhage

    There are different types of hemorrhages, or bleeds, which can occur in the brain. They are usually named for the compartment of the brain they affect. For example, a thick covering called the dura surrounds the entire brain. If the hemorrhage or bleed occurs on top of or above the dura, between the dura and the skull, it is known as an epidural hematoma. This type of hemorrhage is almost always from a trauma or head injury, and is usually associated with a skull fracture. If a hemorrhage occurs below the dura, sandwiched in between the dura and the surface of the brain, it is known as a subdural hematoma. Like epidural hematomas, these can also be traumatic, causing significant pressure on the brain and requiring emergency surgery to relieve the pressure. But subdural hematomas can also be chronic and long-standing, slowly accumulating over weeks or months till the building pressure finally causes problems such as weakness or confusion. These chronic subdural hematomas occur most often in the elderly, and are also amenable to drainage to relieve the pressure. Another type of hemorrhage that can occur is an intracerebral hematoma. These occur within the brain tissue itself, often from high blood pressure. Sometime these hypertensive intracerebral hematomas are amenable to surgery. Other times, depending on variables such as size of the clot, location within the brain, or age and health of the patient, it is best to let the blood dissolve over time slowly and not perform surgery. The neurosurgeon and/or neurologist will usually help make that determination.

  • Movement Disorders

    Deep brain stimulation (DBS) is a technology that was first used in medicine in the 1970s, largely for the treatment of chronic pain, but over the past 20 years DBS has reemerged as an effective treatment for movement disorders such as Parkinson’s disease and essential tremor. Patients with Parkinson’s disease who undergo DBS find improvements in motor symptoms including tremor, rigidity, slowed movements, and overall balance and coordination. Under general anesthesia, electrodes are placed in the brain and connected to a type of pacemaker, called an impulse generator (IPG), which is implanted under the skin of the chest. Advantages of DBS include easy adjustment of the IPG with a computer, no permanent destruction of vital brain tissue (such as with a pallidotomy or thalamotomy), low risk of side effects, possibility for reduced dosages of medications, and the ability to turn the device off at any point in time. A high percentage of patients with Parkinson’s disease that undergo DBS report marked improvement of their symptoms. Your physician will be sure to discuss the risks, benefits, and long-term management of this procedure in greater detail.

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