Brain and Spine Surgery

Stereotactic Craniotomy for Brain Tumor

Administrator — Fri, 30 Oct 2009 22:37:04 +0000

Brain tumors and other abnormalities of the brain can be targeted and located in the brain by using computer guidance (stereotaxy) and then removed through small openings in the head with microsurgical technique. One such operation in demonstrated here. You can learn more about stereotaxy and microsurgical technique at www.pakzaban.com/educational.html (under the “Modern Techniques and Technology” tab).

Brain Cavernous Malformation

Administrator — Fri, 30 Oct 2009 22:16:39 +0000

Vascular malformations of the brain are divided into 3 categories: arteriovenous malformations (AVMs), cavernous malformations, and venous malformations. The first two have the potential to bleed, whereas venous malformations (which represent developmental variations of the brain’s normal venous anatomy) do not generally bleed.

AVMs are high-flow lesions in which arteries of the brain communicate with the veins of the brain through fragile low-resistance AVM vessels. AVMs carry a significant risk of bleeding, and the bleeding can be quite significant because of the high blood flow through these lesions.

Cavernous malformations are low-flow lesions which usually hemorrhage into their own cavity rather than into the adjacent brain. As such they cause less brain destruction when they hemorrhage and are less dangerous and easier to remove than AVMs.

Thoracic Spinal Tumor

Administrator — Fri, 30 Oct 2009 21:59:34 +0000

Tumors of the spine are categorized into three classes: 1) intramedullary tumors, 2) intradural extramedullary tumors and 3) extramedullary tumors. Intramedullary tumors are located inside the spinal cord itself. They destroy and/or expand the spinal cord. Extramedullary intradural tumors are outside the spinal cord but inside the dura (the tough fibrous sheath that surrounds the spinal cord). They compress the spinal cord. Extradural tumors are outside the dura, usually associated with the bones (vertebrae) of the spine. They may compress the dura and spinal cord or may destroy the vertebrae, producing spinal instability.

Tumors in each of the three categories may be benign or malignant. The most common intradural extramedullay tumors (meningiomas and schwanommas) are benign, whereas the most common extradural tumors are malignant.

The featured video demonstrates surgical resection of a meningioma. Meningiomas are benign tumors arising from the dura. As they grow and reach a certain size, they compress the spinal cord, producing such symptoms as weakness, paralysis, numbness, incontinence, or pain. The surgical steps shown in this video consist of removing bone (laminectomy) to expose the dura (not shown in video), opening the dura, opening the arachnoid (filmy membrane inside the dura), detaching the tumor from the dura to devascularize and debulk it, dissecting the tumor from the spinal cord and nerve rootlets, removing the tumor, and closing the dura.

Schwanommas are the other common type of intradural extramedullary tumors of the spine. They arise from the covering of the nerves emerging from the spinal cord. They may traverse the dura through the nerve root sleeve and become both intra- and extradural. The following MRI image shows an intradural/extradural schwannoma:

Axial Post-Contrast MRI of Cervical Spine

Lumbar Microsurgical Discectomy

Administrator — Tue, 22 Sep 2009 12:59:21 +0000

A lumbar disc herniation occurs when the disc capsule tears (ruptures) and a fragment of the disc nucleus (disc cartilage) comes out of the disc space into the spinal canal to compress a nerve root. In this video, removal of the herniated disc fragment from under the nerve root is demonstrated during a lumbar microsurgical discectomy.

Anterior Cervical Discectomy and Fusion with Allograft

Administrator — Mon, 29 Jun 2009 03:04:19 +0000

This is a detailed video demonstration of the steps involved in a one-level anterior cervical discectomy and fusion operation. The steps include discectomy (disc removal), osteophyte (bone spur) removal, decompression of dura (the covering of spinal cord), allograft (cadaver bone graft) preparation, allograft insertion, and plating.

Pituitary Tumor Resection

Administrator — Tue, 12 May 2009 04:46:37 +0000

This video demonstrates trans-sphenoidal resection of a pituitary tumor. The operation is performed through the nose. In this video, exposure of the sella (the boney compartment which houses the pituitary gland at the base of the skull) has been obtained through the nose. The steps involved in opening the sella, removing the tumor, and closing the sella and sphenoid sinus are shown.

Lumbar Discectomy (Microsurgical)

Administrator — Tue, 17 Feb 2009 03:55:28 +0000

Discs are soft cartilage cushions between the vertebrae of the spine. When a disc herniates (ruptures), a fragment of the disc enters the spinal canal and put pressure on the spinal nerve roots or the spinal cord. Disc herniations in the lumbar spine can cause back pain, sciatica (i.e. pain radiating down a leg), and numbness and weakness in one or both legs. In severe cases, bowel and bladder function may be affected.

Lumbar miscrodiscectomy is an operation performed through a small incision in the lower back. The goal of the operation is to remove the herniated fragment of disc in order to decompress the affected nerve structures and to relieve the neurological symptoms.

Resection of Metastatic Brain Tumor

Administrator — Wed, 07 Jan 2009 03:10:05 +0000

Metastatic brain tumors are cancerous tumors that travel to the brain from other sites in the body. They are generally well-encapsulated (i.e. do not send fingers into the brain) and can be effectively resected during surgery. Surgery followed by radiation therapy has been found to significantly improve survival in patients with single metastatic brain tumors. Modern stereotactic and microsurgical techniques allow for rapid recovery from these operations. Radiosurgery is another option for treatment of these tumors.

Anterior Cervical Fusion

Administrator — Wed, 07 Jan 2009 02:09:35 +0000

This video shows the steps involved in an anterior cervical fusion operation. This is one of the more common and successful operations currently performed for treatment of cervical spine disorders. The video starts after two abnormal cervical discs have been removed and shows the steps involved in the fusion process. For more informtion about this and other neurosurgical procedures, visit www.pakzaban.com or visit my eMedicine article entitled “Spinal Instability and Spinal Fusion Surgery.”

Steps in Anterior Cervical Discectomy and Fusion

A) Disc has been removed. B) Bone graft being harvested. C) Bone Graft. D) Graft inserted into disc space. E) Plate placed.

42-year-old man with a suprasellar mass

Administrator — Thu, 01 Jan 2009 22:44:44 +0000

A 42-year-old man presents with a suprasellar mass, shown on the post-contrast T1-weighted MRI shown here. Several years ago, he had an operation through his nose at another country. No records are available and he can not provide any additional history.

His neurological exam is remarkable for a patchy bitemporal hemianopia. Neuroendocrine testing is normal except for low testosterone.

The lesion was removed by craniotomy and the diagnosis was confirmed. Provide a differential diagnosis for this lesion.

Post-contrast MRI after surgical resection of the tumor