Brain Surgery
Brain Surgery | Types of Brain Surgery | Ventriculoperitoneal Shunt | Brain Aneurysms
Brain Surgery
Definition
Brain surgery is used to treat lesions of the brain and its surrounding structures through an opening (craniotomy) in the skull (cranium). Brain surgery may be necessary to treat brain tumors, bleeding or bloods clots from injuries, weakening of the blood vessels, damage to the brain tissue, infections in the brain, repair fractures of the skull, arteriovenous malformations and for severe nerve or facial pain.
Procedure
The procedure is performed thru an incision in the scalp. The hair on that part of the scalp is shaved. The scalp is cleansed and prepared for the surgery. An incision is made through the scalp and a hole is drill through the skull. A piece of the skull is removed, (usually temporarily) and the surgery is performed. Before your procedure, the neurosurgeon will talk with you about the type of surgery planned.
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Types of Brain Surgery
Biopsy
A biopsy procedure is to remove a sample of tissue. The tissue is then microscopically analyzed. This procedure may be done to only collect at tissue sample or it may also be done as part of the surgery to remove a tumor.
Craniotomy
A craniotomy, as mentioned above, is the making of an opening into the skull. A craniotomy is the most common type of brain surgery to remove a brain tumor. The procedure involves using specialized high-speed medical tools to remove a portion of the skull in order for the neurosurgeon to find the tumor and remove it as much as possible. After the tumor has been removed, the portion of the skull that was cut out is usually replaced and the scalp is sutured closed.
Craniectomy
A craniectomy differs from a craniotomy in that 'ectomy' means removal. In this type of procedure, the bone is removed for access to the brain and is not replaced before closing the incision. The neurosurgeon may decide to do this if he suspects swelling to occur following the surgery or if the skull bone is not reusable. If the bone is reusable, it can be replaced at a later date when it will not cause additional pressure. You will be instructed on how to protect the soft spot in your head created by the missing bone.
Other terms used when describing brain surgery for tumor removal:
- Debulking- means the tumor is surgically reduced in size by removing as much as possible.
- Partial removal- means that the neurosurgeon only removed part of the tumor due to risk of neurological damage. The remaining part of the tumor usually requires additional treatment such as radiation and/or chemotherapy. Unfortunately, partially removed tumors may re-grow. The growth rate depends on the type of tumor and the amount of the tumor remaining.
- Complete removal-is also termed 'gross total resection'. This means the entire tumor was removed. However, it is still possible that tumor cells might remain after this procedure depending on the type of tumor. Because of the possibility of re-growth, the neurosurgeon may recommend additional therapy to treat the remaining cells.
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Ventriculoperitoneal Shunt
Definition
When there is excess fluid in the brain, or the fluid pathway is blocked due to a tumor or swelling, there may be a build up of pressure inside the skull. Ventriculoperitoneal shunt is a surgery performed to relieve the pressure inside the skull (intracranial) caused by the fluid on the brain (hydrocephalus). A shunt is a narrow, flexible tube used to move fluid from the brain to another part of the body. One end of the shunt is placed into one of the 4 cavities (ventricles) in the brain where the cerebrospinal fluid (CSF) circulates. A shunt can be either temporary or permanent. Sometimes a tube is placed into one of the four cavities (ventricles) in the brain and connected to a collecting bag outside of the body. This procedure is called a ventriculostomy and is temporary way of draining the fluid.
Procedure
The surgical procedure to implant a ventriculoperitoneal shunt (VP shunt) usually requires less than an hour in the operating room. The patient is placed under general anesthesia. The scalp is shaved and the patient is scrubbed with an antiseptic from the scalp to the abdominal area. A flap is cut in the scalp and a small hole is drilled in the skull. One end of the shunt is placed into one of 4 cavities (ventricles) in the brain where cerebrospinal fluid (CSF) circulates. A small valve attached to tubing is placed under the scalp. The tubing is then threaded under the skin, down the neck, and into the abdomen. The fluid can then drain out of the shunt and is absorbed by the body. The shunt has a valve that only allows the flow away from the brain. Small incisions are made in both the neck and abdominal area to attach the tubing securely. The incisions are then closed and sterile bandages are applied.
After Surgery
After the surgery, the patient will go to the recovery area and then transferred to either the intensive care unit or an intermediate care area under careful neurological observation. IV fluids and antibiotic are given. The patient is closely monitored to ensure that the shunt is functioning properly. The patient will generally need to stay in the hospital at least 3 days or more depending on how quickly the patient progresses. Imaging studies such as CT scans are done after the surgery to confirm good positioning of the shunt and resolution of the fluid on the brain. Physical therapy is a very important part of the patient's recovery to regain previous levels of motor skills. Therapy is started in the hospital and continued as an outpatient or may be transferred to an acute inpatient rehabilitation care center. In-patient acute rehabilitation helps the patient achieve independence to return home.
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Craniotomy for Brain Aneurysms
Definition of a Brain Aneurysm
A cerebral aneurysm, (also known as an intracranial or intracerebral aneurysm) is an abnormality of the blood vessel causing it to balloon. When the vessel balloons, the inner layer becomes weakened and thinned. The bulging aneurysm can put pressure on a nerve or surrounding brain tissue. It may also leak or rupture, spilling blood into the surrounding tissue. When the vessel ruptures, bleeding occurs into the space around the brain called a subarachnoid hemorrahage (SAH). Although, there may be other treatment options, it is always preferable to treat aneurysms surgically if possible.
Procedure
Surgical treatment for a cerebral aneurysm is a craniotomy in which the blood vessels are accessed through an opening in the skull. The head is shaved and the scalp cleansed before the incision is made. Holes are made in the skull and a piece of bone is taken out in order to enter the brain covering. The aneurysm is then identified and carefully separated from the surrounding brain tissue. A small metal clip is applied to the neck or bottom of the aneurysm. The clip isolates the aneurysm from the blood stream allowing it to deflate. This prevents further bleeds and also takes the pressure off the surrounding brain. These clips come in many shapes and sizes, and the neurosurgeon chooses a size and shape based on the size and location of the aneurysm. At the end of the surgery, the piece of skull is placed back and the skin is closed. The surgery is not meant to reverse the effect of any bleeding that may have already occurred. It is meant to prevent any further bleeding. There may be some blood clots that can be removed during this procedure.
After Surgery
After the surgery, the patient will probably spend a day or two in the intensive care unit where close neurological observation can be done. Physical and Occupational Therapy will be started shortly after surgery while recovering in the hospital. Therapy is important for the patient to re-gain motor skills, strength and independence. Additional therapy may be required once medically stable and discharged from the hospital, this can either be continued on an outpatient schedule or transferred to an acute-inpatient rehabilitation center.
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