Brain
Brain Tumors
Facial Pain Syndromes
Trigeminal neuralgia, also known as tic douloureux, is a neurological disorder affecting the trigeminal nerve, the nerve that carries sensory information from the face to the brain. This chronic condition causes severe, shooting pain in the face, sometimes as fleeting, momentary twinges, other times as frequent bouts of excruciating pain. Because the trigeminal nerve is responsible for sensation all around the face, including the eyes, mouth and sinus cavities, trigeminal neuralgia can result in pain on one side of the jaw, cheek or mouth, or, less frequently, near the forehead or one of the eyes.
The pain usually comes on suddenly and, although it lasts from a few seconds to a few minutes, may be physically and mentally incapacitating. When the pain occurs along the cheek or jaw, it is sometimes mistaken for a severe toothache.
Episodes may be triggered by activities that cause a vibration in the cheek, such as shaving, brushing the teeth, applying makeup, eating, drinking or talking, or even encountering a slight breeze. As the condition progresses, the episodes of pain may become longer and more frequent.
Meningiomas
Metastases
Metastasis, or metastatic cancer, refers to cancer that spreads to a different part of the body than where it originally started. This diagnosis typically grows when cancer cells break from the main tumor and enter the lymphatic system (bloodstream), which carry fluids around the body. As a result, cancer cells travel far from the original tumor, settle and grow new tumors in different parts of the body. Metastases may also develop when cancer cells from the main tumor, generally in the stomach or abdominal cavity, break off and grow in nearby areas such as the liver, lungs or bones.
Treatment for metastases may include chemotherapy, hormone therapy, surgery and radiations. Many factors that help decide on treatment options include:
- The original cancer and where it started
- How much the cancer has spread and where it is located
- Age and health
Subdural Hematoma
Chiari Malformation
Gliomas
Intracranial Hemorrhage
Intracranial Hemorrhage (ICH), often referred to as brain bleeds, refers to critical bleeding inside the skull or brain. There are four types of ICH which include the following:
- Epidural hematoma: This is a collection of blood, either in a clot or ball, outside of a blood vessel. An epidural hematoma occurs when the blood between your skull and covering of the brain accumulates.
- Subdural hematoma: This is the collection of blood on the surface of the brain. Typically, this injury occurs due to rapid forward and stopping movements such as a car accident.
- Subarachnoid hemorrhage: This occurs when there is bleeding between the thin tissue covering the brain (meninges) and the brain. Common causes include trauma, however; it can also be caused by rupture of a major blood vessel in the brain.
- Intracerebral hemorrhage: This injury occurs when there is bleeding outside of the brain. One of the most common causes of an intracerebral hemorrhage occurs with a stroke.
An Intracranial hemorrhage is severe and can be life-threatening. Diagnosis and treatment vary and depend on the individual case. Your physician will suggest starting off with a CT scan of your head to identify abnormalities in the brain such as swelling or clots. Treatment may include surgery to relieve pressure on the skull and remove any blood clots.
Skull Fractures
A skull fracture occurs when there is an impact or injury to the head that is strong enough to result in any break in the cranial bone (skull). Although fractures are difficult to see, there are a few symptoms that indicate a fracture, including swelling or tenderness around the area of impact, facial bruising, or bleeding from the nostrils or ears. Skull fractures come in many different types and depend on the force, location and shape of the object making impact with the head.
- Closed fracture: Also known as a simple fracture occurs when the skin covering the impacted area is not broken or cut.
- Open fracture: Also known as a compound fracture occurs when the skin is broken, and the bone protrudes.
- Decompressed fracture: This refers to a fracture that forces the skull to indent or extend into the brain cavity.
- Basal fracture: This fracture occurs in the areas around the eyes, ears, nose or at the top of the neck, near the spine.
A skull fracture may be diagnosed using a simple physical examination of the head, however; to identify the extent and severity of the injury, x-rays, CT scans and MRIs are commonly conducted for precise imaging and optimal treatment. For most cases, treatment may only include pain medication and the bone will heal on its own over time. The only case in which surgery is necessary is when a decompressed fracture occurs where the bone has a more difficult time healing on its own.
One of the most common reasons why burr holes are needed is to treat a subdural hematoma. This occurs when blood builds up under the dura layer as a result of a mild head injury. This buildup of blood is dangerous as it pushes up against the skull with nowhere to go causing headaches, changes in behavior, seizures and one-sided muscle weakness. If the blood continues to build-up, it may cause more severe outcomes that lead to coma and brain damage.
After the surgery, individuals will remain in the hospital for a few days so that they may be monitored. It is common to experience some pain at the site of the incision that is typically treated with over-the-counter medications. It is important to follow care instructions and let your healthcare provider know if you experience any seizures, muscle weakness, confusion, fever, stiff neck or swelling, redness or opening of your scalp incision.
Surgery is often the most effective way to treat many brain tumors, whether they are benign or malignant. Craniotomies, which are performed by neurosurgeons, are designated in different ways. A frontotemporal, parietal, temporal or suboccipital craniotomy is named after the bone that is removed.
In order to accurately access the tumor and reduce the risk of damage to healthy brain tissue, imaging devices may be used to help guide the surgeon. Known as a stereotactic craniotomy, scans are taken that create a three-dimensional image of the brain. A computer provides a navigation system to safely route the surgeon to the precise location of the tumor.
Chiari decompression surgery is a specific type of craniotomy designed to treat a rare condition called Arnold Chiari Malformation, where the brain tissue extends into the spinal canal at the back of the skull. This condition may be present at birth, or it may develop as the skull and brain grow.
The back portion of the brain, called the cerebellum, is pushed into the upper spinal canal and obstructs the normal flow of fluid protecting the brain and spinal cord. This can later lead to blocked signals from the brain to the body, or cause a buildup of fluid in the brain or spinal cord causing:
- Headaches
- Neck pain
- Numbness or tingling of the hands and feet
- Vision and speech problems
- Dizziness
Chiari decompression surgery is used to stop the progression of changes in the brain and spinal canal and to also ease or stabilize symptoms.
Trigeminal Neuralgia is one of the most common conditions MVD is used to treat. It occurs when a pulsating vessel behind the ear compresses again the trigeminal nerve, causing painful impulses from the face.
After surgery, individuals will remain in the hospital for a few days for close observation. Nausea and headache are common after surgery and medication can help control these symptoms. MVD is highly successful in treating trigeminal neuralgia and the largest benefit is that it causes little or no facial numbness when compared to alternative methods.
The implant itself is constructed of two parts. The first part is a small, dome shaped container placed beneath the scalp. The container is then connected to a catheter that is placed in the ventricle, an open space within the brain. Cerebrospinal fluid (CSF) is then able to circulate within the space and provide the brain with nutrients and a cushion.
Common side effects after an ommaya reservoir placement include headaches, pain where the incision was made, nausea and vomiting. This procedure is efficient and effective in administering chemotherapy medication directly into the cerebrospinal fluid.
Stereotactic brain biopsy is a regularly performed procedure that allows neurosurgeons to locate a brain lesion (damage to any part of the brain) or tumor and select the coordinate for guiding the biopsy needle. During the procedure, neurosurgeons use MRI or CT imaging to precisely locate the tumor or lesion inside the brain with precise accuracy.
A benefit to using this surgical method is that neurosurgeons are able to reach into the deepest recesses of the brain. This allows them to obtain the specimen to make a proper diagnosis in a relatively safe manner. In most cases, individuals may return home the next day and some are treated on an outpatient basis.
This neuronavigation technology improves the accuracy of the surgery, reduces the size of the incision and increases safety by avoiding essential structures of the brain.
The goal of performing this procedure is to provide more space for the brain within the skull to control the progression of symptoms, relieve compression and restore the normal flow of cerebrospinal fluid (CSF).
Recovery differs for every case and can last from 4 to 6 weeks, depending on general health. After surgery, headaches and neck pain from the incision are to be expected and may last several weeks. Returning to normal activities is gradual and individuals should slowly increase activity but avoid heavy lifting and listen to instructions given by their doctor.
