Brain Surgery

The brain controls and coordinates conscious and unconscious body functions, as well as higher functions such as memory, learning and thinking. Like any other part of the body, it is susceptible to bleeding, infection, trauma and other forms of damage. This damage or alteration in brain function sometimes requires brain surgery (neurosurgery) to diagnose or treat these problems. Brain surgery treats problems in the brain and the structures around it through an opening (called a craniotomy) in the skull

Dr. Kuether has also received additional training above and beyond his Neurosurgical fellowship in Endovascular treatments.

Brain surgery may be needed to treat or remove:

• Brain tumors
• Bleeding (hemorrhage) or blood clots (hematomas) from injuries (subdural hematoma or epidural hematomas)
• Weaknesses in blood vessels (cerebral aneurysms) See also: Brain aneurysm repair
• Abnormal blood vessels (arteriovenous malformations; AVM)
• Damage to tissues covering the brain (dura)
• Infections in the brain (brain abscesses)
• Severe nerve or facial pain (such as trigeminal neuralgia or tic douloureux)
• Skull fractures
• Pressure in the brain after an injury or stroke
• Some forms of seizure disorders (epilepsy)
• Certain brain diseases (such as Parkinson’s disease) that may be helped with an implanted electronic device

Symptoms
The symptoms of conditions requiring brain surgery may vary, depend on the type and severity of the condition. General symptoms include:

• Headache
• Nausea
• Vomiting
• Drowsiness
• Seizures

Brain conditions may require brain surgery
The main types of brain conditions that may require brain surgery include:

• Alterations of the brain tissue – such as brain cancer, infections and swelling (edema).
• Alterations in brain blood flow – such as subdural hematoma, subarachnoid hemorrhage, and intraventricular bleed.
• Alteration in cerebrospinal fluid – such as infection or hydrocephalus.

Brain cancer
Some of the different types of brain cancer that may require brain surgery include:

• Gliomas – glial cells make up the supportive tissue of the brain, and don’t conduct electrical impulses. Glioma is a broad term used to describe brain tumors associated with the three types of glial cell, which include the astrocyte, oligodendrocyte, and the ependymal cell.
• Pituitary tumor – cancer of the pituitary gland, such as craniopharyngioma.
• Acoustic neuroma or schwannoma – a type of benign tumor that grows in the canal connecting the brain to the inner ear.
• Medulloblastoma – a type of cancer that originates in the brain and can migrate down the spinal cord.
• Dysembryoplastic neuroepithelial tumor (DNET) – an abnormal tissue growth in the brain that may or may not is cancerous.
• Primitive neuroectodermal tumor (PNET) – a general term referring to abnormal tissue growths of the brain.
• Lymphomas – cancers of the lymphatic system.
• Chordomas – tumors that originate in particular parts of the skeleton including the skull.
• Metastases or secondary tumors – metastasis means cells (usually cancer), which have moved from one part of the body to another.

Alterations in brain blood flow
Some of the causes of altered blood flow in the brain include:

• Subdural hematoma – the build-up of blood beneath the thickest membrane (meninges) that covers the brain, called the dura mater. A subdural hematoma can be classified as acute, acute on chronic or chronic. The most common cause is a head injury.
• Stroke – occurs when a blood vessel supplying the brain either blocks or bursts. A stroke produces sudden and unexpected brain injury and can sometimes be fatal.
• Subarachnoid hemorrhage – bleeding between the arachnoid membrane and the delicate membrane that covers the brain (pia mater). Common causes include head injury and aneurysms.
• Intraventricular bleed – an increase in blood flow may cause the small blood vessels of the brain (periventricular capillary network) to burst. Premature babies are at increased risk.

Alteration in cerebrospinal fluid
Some of the causes of alteration in cerebrospinal fluid include:

• Hydrocephalus – the abnormal build-up of cerebrospinal fluid within the skull. In babies, this can cause the head to enlarge.
• Infection – various infections of the brain can cause alterations to cerebrospinal fluid.

Urgent medical treatment is vital
If left untreated, any condition requiring brain surgery can cause further damage to the brain. Pressure on the brain can be harmful as it forces the brain against the skull, causing damage to the brain and hampering the brain’s ability to function properly. This drop in function can lead to long-lasting brain damage and, if left untreated, death.

Diagnosis methods
The range of diagnostic tests can include:

• Physical examination
• Medical history
• CT scan
• MRI scan.

Craniotomy explained
A craniotomy is an operation to open the skull in order to access the brain for surgical repair. The patient is put under general anesthesia. The hair on the scalp is shaved. A neurosurgeon performs the craniotomy by first cutting through the scalp over the area where the brain injury is thought to lie. A hole is then cut into the skull in order to access the brain. This is needed to repair any ruptured blood vessels and to remove the blood clot or growth.

After the operation is finished, the piece of bone that was removed is replaced, the muscle and skin are stitched up and a drain is placed inside the brain to remove any excess blood left from the surgery. Some of the possible complications following craniotomy include allergic reaction to the anesthetic, bleeding, infection, brain damage, brain swelling, stroke, and seizures.

Things to remember

• Conditions that require brain surgery include brain cancer, stroke, and hydrocephalus.
• If left untreated, any condition requiring brain surgery can cause further damage to the brain.
• A craniotomy is an operation to open the skull in order to access the brain for surgical repair

Some good resources to find more about brain surgery are listed below:

Wikipedia Wikipedia Human Brain Link

American Association of Neurological Surgeons educational links AANS Educational Links