Neuro Surgery

Craniotomy is the surgical removal of part of the skull to expose the brain.

A craniotomy is the most commonly performed surgery for brain tumor removal. It may also be done to remove a blood clot and control hemorrhage, inspect the brain, perform a biopsy, or relieve pressure inside the skull.

Before the operation, the patient will have undergone diagnostic procedures such as computed tomography scans (CT) or magnetic resonance imaging (MRI) scans to determine the underlying problem that required the craniotomy and to get a better look at the brain's structure. Cerebral angiography may be used to study the blood supply to the tumor, aneurysm, or other brain lesion.

There are two basic ways to open the skull:
• a curving incision from behind the hairline, in front of the ear, arching above the eye
• at the nape of the neck around the occipital lobe.

The surgeon marks with a felt tip pen a large square flap on the scalp that covers the surgical area. Following this mark, the surgeon makes an incision into the skin as far as the thin membrane covering the skull bone. Because the scalp is well supplied with blood, the surgeon will have to seal many small arteries. The surgeon then folds back a skin flap to expose the bone.

Using a high speed hand drill or an automatic craniotome, the surgeon makes a circle of holes in the skull, and pushes a soft metal guide under the bone from one hole to the next. A fine wire saw is then moved along the guide channel under the bone between adjacent holes. The surgeon saws through the bone until the bone flap can be removed to expose the brain.

After the surgery for the underlying cause is completed, the piece of skull is replaced and secured with pieces of fine, soft wire. Finally, the surgeon sutures the membrane, muscle, and skin of the scalp.

Some spinal tumors, benign or malignant, require surgical intervention before or after non-operative treatments. When pain is unresponsive to non-operative treatment, neurologic deficit progresses, a specimen is needed, neural elements (e.g. nerves) are compressed, vertebral destruction exists, or when spinal stabilization is necessary - surgery is considered.

The primary goals in surgery are to reduce pain caused by the spinal tumor, restore or preserve neurologic function, and provide spinal stability. The spinal tumor may be approached surgically from the front (anterior) or back (posterior) of the body.

Surgery may include tumor resection (partial removal) or excision (complete removal). When the tumor is removed (partially or completed) pain and neurologic problems may clear up.

Spinal instrumentation and Fusion are procedures used to reconstruct and stabilize the spine. These procedures join and solidify the level (or levels) where a spinal element (e.g. vertebral body) has been damaged or removed.

Instrumentation uses medically designed hardware such as rods, bars, wires, and screws. These devices hold the spine straight during fusion. Fusion is the adhesive process joining bony spinal elements.

The number of days spent the patient will spend in the hospital after surgery is partially dependent on the procedure(s) performed. Thereafter, the patient's care is monitored by periodical office visits and re-evaluation by the treating physician..