COMMON NEUROSURGERY

.Common cases operated in neurosurgery 

 Tumors of central nervous system

 Brain tumors

The brain is made up of many different types of cells. Brain cancers occur when one type of cell transforms from its normal characteristics and grows and multiplies in an abnormal way. Usually they are named after the part of the brain or the type of brain cell from which they arise.

Astrocytoma: The tumor arises from star-shaped glial cells called astrocytes. In adults, astrocytomas most often arise in the cerebrum. In children, they occur in the brain stem, the cerebrum, and the cerebellum.

Brain stem glioma: The tumor occurs in the lowest part of the brain. Brain stem gliomas most often are diagnosed in young children and middle-aged adults.

Ependymoma: The tumor arises from cells that line the ventricles or the central canal of the spinal cord. They are most commonly found in children and young adults.

Oligodendroglioma: This rare tumor arises from cells that make the fatty substance that covers and protects the nerves. These tumors usually occur in the cerebrum. They grow slowly and usually do not spread into surrounding brain tissue. They are most common in middle-aged adults.

Medulloblastoma or primitive neuroectodermal tumor: This tumor usually arises in the cerebellum. Rarely do these tumors spread outside the brain. It is the most common brain tumor in children.

Meningioma: This tumor arises in the meninges and grows slowly. Meningioma are benign and do not spread from their original site. Malignant meningiomas are very rare.

Schwannoma: This tumor arises from the Schwann cells. These cells line the nerve that controls balance and hearing. This nerve is in the inner ear. The tumor is also called an acoustic neuroma. It occurs most often in adults. They are more common in people who have a genetic disease called neurofibromatosis type 2.

Craniopharyngioma: The tumor grows at the base of the brain, near the pituitary gland. This type of tumor most often occurs in children.

Hemangioblastoma: This is a rare type of tumor that develops from cells that line the blood vessels. They are benign and grow slowly

Pituitary tumors: These types of tumors develop in the pituitary gland. They are benign and are called pituitary adenomas.

Germ cell tumor of the brain: The tumor arises from a germ cell. Most germ cell tumors that arise in the brain occur in people younger than 30 years. The most common type of germ cell tumor of the brain is a germinoma.

Pineal region tumor: This rare brain tumor arises in or near the pineal gland. The pineal gland is located between the cerebrum and the cerebellum. The most common tumors are germinomas, teratomas, pineocytomas and pineoblastomas.

 Spine tumors

Tumors of the spine can be either benign or malignant. Benign tumors include schwannomas, neurofibromas and meningiomas. Malignant tumors are most commonly caused by cancers that spread from other body areas (i.e. lung, breast, kidney or skin cancer.

 Cerebrovascular disorders

Cerebral aneurysm: Is the dilation, bulging, or ballooning-out of part of the wall of an artery in the brain.

Arteriovenous malformation (AVM): An abnormal connection between the arteries and veins in the brain, usually congenital.

Cavernous angioma: Is a blood vessel abnormality characterized by large, adjacent capillaries with little or no intervening brain. The blood flow through these vessels is slow.

Cerebrospinal fluid leak :A CSF leak is an escape of the fluid that surrounds the brain and spinal cord.

Moya-Moya disease: A progressive disease of the distal internal carotid arteries and their major branches that is characterized by occlusion of these vessels.

Subarachnoid hemorrhage: Bleeding in the area between the brain and subarachnoid space.

 Movement disorders

Essential tremor: A disabling movement disorder consisting of shaking of one or both hands when the patient uses the hand to do something.

Parkinson's disease: A Neurodegenerative disorder caused by the loss of cells that produce a chemical called dopamine. The hallmark of Parkinson's disease is a resting tremor, slowness of movement (bradykinesia), and limb rigidity.

 Pain disorders

Trigeminal neuralgia: A sharp shooting lancinating pain found in the forehead, face or jaw region. The pain is usually on only one side of the face.

 Peripheral nerve disorders

Carpal tunnel syndrome: Compression of the median nerve at the wrist. This causes numbness in the hand, thumb, and fingers.

 Epilepsy

Epilepsy caused by tumors or malformations of blood vessels

Temporal and extra temporal lobe lesions

 Adult hydrocephalus

Normal pressure hydrocephalus: Dilation of the ventricles of the brain caused by an obstruction of the normal spinal fluid passage from one ventricle to other. 

 Brain injuries

Subdural hematoma: Blood clot that occurs on the surface of the brain and just below the dura (outermost covering of the brain). A subdural hematoma usually occurs from the tear of one of the veins that drain the brain of blood. 

Epidural hematoma; Blood above dural space

Post-traumatic seizures

Spinal disorders

Degenerative spine (spondylosis and spondylolisthesis): Protrusion of one of the disc. This protrusion can cause pain or neurological symptoms.

Post-traumatic cervical instability.

Spinal arteriovenous malformation (AVM): An abnormal tangle of blood vessels on, in or near the spinal cord.

Spinal cord injuries and fractures.

Chiari Malformation: The malformation consists of a protrusion of the bottom portion of the cerebellum into the upper portion of the spinal canal. This malformation can lead to headaches, arm or leg symptoms, or problems with the nerves that supply the head and neck.

Operative procedures

1. Shunt procedures

Ventriculo Peritoneal Shunt: Ventriculoperitoneal shunt is a surgery performed to relieve intracranial pressure caused by hydrocephalus. The fluid is shunted from the ventricles of the brain into the abdominal cavity

Lumbar-peritoneal Shunt: Lumbar peritoneal (LP) shunt is a technique of cerebrospinal fluid (CSF) diversion from the lumbar thecal sac to the peritoneal cavity.

2.Endoscopic procedures

Third Ventriculostomy: Endoscopic third ventriculostomy is a surgical procedure in which an opening is created in the floor of the third ventricle using an endoscope placed within the ventricular system through a burr hole. This allows the cerebrospinal fluid to flow directly to the basal cisterns, thereby shortcutting any obstruction. It is used to treat certain forms of obstructive hydrocephalus.

Ventricular lesion Excision

Pineal region tumor Biopsies

3.Skull base surgeries

Foramen Magnum Decompression for Chiari malformation by the removal of the outer layer of the dura mater.

Pituitary adenoma resection

Excision of skull base meningiomas, Schwannomas, Chordomas

4.Stereotaxy and image guidance

Neuronavigation

Biopsies

Tumor removal

5.Movement disorder surgeries

Deep Brain Stimulation for Parkinson’s disease and essential tremors.

Thalamotomy: A stereotactic surgical technique for the discrete destruction of specific groups of cells within the thalamus primarily effective for tremors such as those associated with Parkinson's Disease.

Pallidotomy: a procedure where a tiny electrical probe is placed in the globus pallidus (one of the basal ganglia of the brain), which is then heated to 80 degrees celsius for 60 s, to destroy a small area of brain cells. Pallidotomy is used to treat dyskinesias in patients with Parkinson's disease.

6.Epilepsy surgeries

Amygdalohippocampectomy: a surgical procedure for the treatment of epilepsy which consists of the removal of the hippocampus, which has a role in memory, spatial awareness, and navigation, and the amygdalae, which have a role in the processing and memory of emotional reactions, both structures forming part of the limbic system of the brain.

Corpus callossotomy: Corpus callosotomy is an operation that severs (cuts) the corpus callosum, a band of nerve fibers located deep in the brain that connects the two hemispheres of the brain. Thus interrupting the spread of seizures from one  hemisphere to the other.

Vagal Nerve Stimulation: Vagus nerve stimulation (VNS) is an adjunctive treatment for certain types of intractable epilepsy and treatment-resistant depression It involves the implantation of a generator that stimulates the vagus nerve and thus reduces seizure activity.

Hemispherectomy: a surgical procedurewhere one cerebral hemisphere is removed or disabled. This procedure is used to treat a variety of seizure disorders where the source of the epilepsy is localized to a broad area of a single hemisphere of the brain.

Grid Placement: The grids are surgically placed, by way of an open craniotomy, over and around areas suspected to be linked to a patient’s seizures. The exact number of grids used and specific location of placement depends on the individual needs of the patient.

Selective Resection

7.Vascular procedures

Clipping of Aneurysm

STA – MCA bypass

Radial Artery bypass

AVM excision

Cavernous Angiomas

8.Spine

Excision of tumor of Spinal Cord

Spinal Instrumentation

Cranio–Vertebral Junction Instrumentation

Spinal Inter Vertebral Disc Surgeries

9.Pediatric procedures

Posterior Fossa Tumors

Primitive Neuroectodermal Tumors

Craniosynostosis

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