Neurosurgery

Neurosurgery [NOO-roh-SUR-jur-ee] is a branch of medicine that specializes in surgical treatment of injuries, diseases, and conditions of the brain, nervous system, and associated blood vessels. A neurosurgeon is someone with specialized training to diagnose and surgically treat:

• Back and neck problems, such as scoliosis or a herniated disk
• Brain conditions, such as Cushing’s disease or hydrocephalus [hahy-druh-SEF-uh-luh s]
• Brain or spine injuries, such as traumatic brain injury or concussion
• Seizure, tremor, and movement disorders, such as epilepsy or Parkinson’s disease
• Tumors of the brain and spine
• Chronic or acute nerve pain, such as with carpal tunnel syndrome or trigeminal neuralgia
• Stroke and other disorders that impact blood flow to the brain

A neurosurgeon often works with a neurologist, a doctor who specializes in studying and diagnosing problems, injuries, diseases, and conditions in the brain.

Different kinds of neurosurgery can be used to treat many different conditions, diseases, and injuries. Some surgeries are used for:

• Stopping blood flow to an aneurysm [ANN-yer-iz-uhm], a serious condition where a weak area of a blood vessel wall can bulge and burst
• Removing abnormal or diseased brain tissue
• Draining blood or fluid from an infection in your brain
• Freeing a vein that is caught or snagged

Common neurosurgeries include:

• Gamma knife surgery. This procedure is not an invasive surgery. Instead, gamma rays (high-energy waves like x-rays) are aimed at a tumor in your brain to help remove it or reduce its size.
• Laminectomy (or spinal stenosis [steh-NO-sis] surgery). Sometimes, your spine can narrow, which puts more pressure on your nerves and can cause pain and other problems. A laminectomy, sometimes referred to as spinal stenosis surgery, can can create space between the vertebrae to relieve pressure on spinal nerves.
• Spinal fusion surgery. This surgery involves using a bone graft from another area of the body to fuse spinal vertebrae together. This fusion can stop painful movement between 2 discs. This might be done at the same time as a laminectomy.
• Craniotomy. This is a surgery to open up access to the brain for diagnosing and treating various problems. It involves cutting a “flap” out of the skull that is replaced as soon as the doctor has completed the diagnosis (such as a biopsy) or treatment (such as treating an aneurism).
• Endovascular Neurosurgery. This is a subspecialty within neurosurgery that uses a small catheter placed in a large vein or artery and radiology to diagnose and treat conditions of the brain and spine.

All surgery has risks, and you should talk to your doctor about deciding if the benefits of surgery outweigh the chance that something could go wrong. Common surgery risks include:

• Bad reactions to medicines used during surgery, especially to anesthesia [ann-ess-THEE-see-uh], the medicine that surgeons used to put you to sleep for your surgery
• Problems with breathing during surgery, either because of the surgery itself or the anesthesia used to put you to sleep
• Bleeding, blood clots, and infection

Because your brain impacts the rest of your body, neurosurgeries that target the brain carry additional risks. Some of the most common risks of brain surgery are:

• Seizures
• Stroke
• Coma
• Infections in your brain or skull
• Brain swelling
• Problems with speech, memory, balance, coordination, or vision (depending on where the surgeon is operating)

Neurosurgery can be used to cure or help diagnose and treat many conditions, injuries, diseases, and other problems with the brain, nervous system, and associated blood vessels. For example, neurosurgery can remove a brain tumor, stop bleeding in the brain or remove dangerous blood clots, place a device in the brain to help treat the symptoms of Parkinson’s disease, reduce swelling in the brain, help relieve neck or back pain, or repair a skull fracture.

Your doctor will give you a physical exam, and might use imaging tests like a CT scan, MRI, or x-ray to look at your brain before the surgery. During this exam, you should tell your doctor if you:

• Might be pregnant
• Take any medicines including over-the-counter medicines, supplements, inhalers, liquid medicines, and patches
• Drink more than two alcoholic drinks a day
• Have any allergies or reactions to certain medicines

A few days before surgery

In the days leading up to your surgery, your doctor might ask you to:

• Try to stop smoking. Smoking can make it harder to heal after surgery, and might increase your risk of problems during the operation.
• Stop taking medications like aspirin, ibuprofen, warfarin, and blood thinners.
• Wash your hair with special shampoo the day before the surgery. This can help prevent bacteria from getting into the brain and causing a serious infection.

On the day of surgery

To help prepare for your surgery, follow your surgeon’s instructions for when to stop eating and drinking either the night before or the day of your surgery. Not following these instructions could be very dangerous.

The specific way that neurosurgery is done will depend on the reason for the surgery. For brain surgery, here’s what you can typically expect:

• Your surgeon will shave your scalp in the area where they will operate.
• The surgeon will cut a hole in your skull and remove a flap of bone (a craniotomy). Sometimes, the surgeon can make a smaller hole and use a tube with a camera on the end to work on your brain. The smaller hole means that your recovery from the surgery will be easier.
• An MRI or CT scan can help the doctor find the right place to put the camera.
• Your surgeon will operate on your brain based on the type of surgery you are having. After the surgery, the surgeon will replace the bone flap using metal plates, sutures, and wires. If your brain was swollen or a tumor was removed, the doctor might need to do a second procedure to close the bone flap after the swelling gets better.

Knowing the results from a neurosurgery or seeing an improvement or cure depends on the condition you are being treated for. Talk to your doctors about how long it will take you to know the results.

Depending on the kind of neurosurgery you have, you might not need any follow-up, but it is likely that your doctor and surgeon will want you to come in for more tests and evaluations after the procedure.

Talk to your doctors about how long it will take you to recover and what follow-up tests you might need.