A craniotomy is a procedure in which a piece of bone is carefully removed from the skull to give access to the brain and the structures around it. This may be done to remove a tumor, a blood clot, or sometimes to treat vascular disorders.
Awake craniotomy is a specialized procedure in which a patient is kept sedated and locally anesthetized while performing essential functions like speaking and moving during mapping of the brain and removal of a brain tumor. The patient is kept comfortable throughout the procedure. This approach is the gold standard for removal of many types of tumors that present in functional brain areas.
Minimally invasive port surgery is a technique for brain tumor, colloid cyst, or hematoma removal that involves a very small craniotomy and access to a deep area of the brain using a cylinder-shaped access tube. This procedure allows surgeons to get deep access into the brain while minimizing any effect on surrounding brain tissue.
Neuroendoscopy involves the use of a precise, miniature camera at the end of a long tube to visualize the brain in a minimally-invasive technique. This technique can be used to visualize the fluid system of the brain or to look around corners of the brain in complex cases.
– “Keyhole” Surgery involves the use of an endoscope through a tiny opening in the skull to visualize, manipulate and/or remove a lesion within the space around the brain.
Generally performed for Chiari malformation, foramen magnum decompression is a surgical procedure in which the bone from the base of the skull and the top of the bone from the spine is removed, allowing the surgeon to sew in a patch graft and decompress the brain and the top of the spinal cord.
Most often performed to re-route fluid into the abdominal cavity, ventricular shunting is the careful placement of a catheter into the fluid spaces of the brain which then passes under the skin into another body cavity. This procedure is used to relieve pressure within the brain in patients with hydrocephalus, which is caused by an excess of fluid on the brain.
The least invasive form of brain surgery is stereotactic radiosurgery, which directs focused radiation to a pinpointed mass in the brain. Because this technique is so precise, it is a safe way to target the brain mass without affecting surrounding tissue. This procedure does not require anesthesia or any incision and is usually performed in the outpatient setting. Radiosurgery with TrueBeamTM technology is an innovative and painless way to eliminate or control the growth of both benign and malignant brain tumors.
Our surgeons have expertise in the diagnosis and surgical management of all types of brain and spinal tumors, including the following:
A glioma is a type of brain tumor that arises from the glial cells of the brain or spine. Symptoms of gliomas can include headaches, vomiting, seizures, and cranial nerve disorders due to the increase in pressure in the skull. Pain, weakness or numbness in the extremities can also be caused by a glioma.
One of the most common types of tumor found in the skull cavity, a meningioma is a tumor that starts in the membranes that surround and invest the brain and spinal cord. Many meningiomas compress the brain, which can damage brain tissue, nerves, or vessels causing disability.
Brain metastases are considered secondary brain tumors and occur when cancer cells spread from their original site to the brain. As these grow, they create pressure on the surrounding brain tissue causing symptoms such as headache, mental changes such as memory loss, seizures, and dizziness.
Schwannomas are benign tumors that grow from the lining of nerves exiting the brain or the spinal cord.
Colloid cysts are developmental, slow-growing masses that can cause headaches, visual problems, and even death from obstruction of fluid flow in the brain. They are typically located in a part of the brain called the foramen of Monro, which connects the largest chambers of the brain’s fluid system.
Other tumors that commonly occur in the part of the brain called the ventricle include subependymomas, meningiomas, neurocytomas, choroid plexus tumors, and subependymal giant cell astrocytomas. Although these tumors can be dangerous and even life-threatening, most of these tumors are not malignant.
Lymphoma of the brain is a form of cancer that is usually treated with medications rather than surgery. However, it is just as important to diagnose lymphomas correctly to determine the appropriate treatment. Intrathecal chemotherapy, which involves an infusion of medicine into the spinal fluid, is a common treatment for lymphoma.
A number of masses, or lesions, can occur within the brain and cause neurologic dysfunction without being tumors. Many of these lesions can require removal or corrective surgery. Some of these conditions include:
There are many kinds of spinal tumors. These can be located in the spinal cord, such as gliomas and ependymomas. There can also be tumors outside the spinal cord but inside the spinal lining, such as meningiomas, schwannomas, and neurofibromas. Lastly, spinal tumors can also grow within the bone and lining of the spinal cord, such as spinal metastases. Surgery is typically required to remove these tumors as well as to stabilize the spine.
Commonly referred to as “water on the brain,” hydrocephalus encompasses the group of disorders that involve impairment of the production, circulation, and/or resorption of cerebrospinal fluid, which can lead to buildup of fluid within the brain and subsequent neurologic dysfunction.
Hemorrhage can occur inside the brain (intraparenchymal hemorrhage), or outside the brain, either inside or outside the brain lining (subdural hematoma, epidural hematoma). Evacuation of hemorrhage via craniotomy is required in selected cases.
The Lexington Medical Center Brain Tumor Program is led by Johnathan A. Engh, MD, FAANS.
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