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What Is Neurosurgery?
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  • What is neurosurgery?

    Neurosurgery is the operative therapy of the central and peripheral nervous system. For brain tumors, neurosurgery is brain surgery and is the operative removal of brain tumors. Neurosurgery or brain surgery for brain tumors is a very diverse field. The determinants of neurosurgery for brain tumors include the type of brain tumor, size of the brain tumor, location of the brain tumor in the brain, the symptoms caused by the brain tumor, and the neurological deficit caused by the brain tumor.

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  • How is Neurosurgery different from other surgery?

    Neurosurgery is the operative surgery on the brain or peripheral nerves. For neurosurgery (brain surgery) the neurological capacities of the patient (thought, memory, personality, reading, writing, walking) are the primary concerns for preservation. The neurological status of the patient is the basis for determining when to perform neurosurgery and for evaluation of the patient after neurosurgery.

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  • During Neurosurgery how is the brain opened for removal of a tumor?

    For Neurosurgery, the brain tumor is approached in sequential steps starting from the outside and working inwards. First, the patient is given general anesthesia. The scalp is then shaved and the skin is prepared using special soap. The scalp is "infiltrated" with local anesthetic containing epinephrine to reduce bleeding. The scalp is cut with a scalpel above the location of the path to the tumor. The scalp is retracted. The skull is opened using a special high speed, air-driven saw. The "bone flap" is removed and kept in sterile saline until time to replace it during closing. Once the portion of the skull is removed, the "dura" is visible. The "dura" or fibrous covering of the brain, is opened using a small, narrow scalpel. The opening of the dura usually corresponds to the outline of the opening formed by removal of the skull. The opening of the dura allows exposure of the underlying brain. This exposes the surface of the brain. The brain is either "retracted" (lifted out of the way) or incised (cut) to make a path to the brain tumor.

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  • During Neurosurgery how does the surgeon remove only the tumor and not hurt the brain?

    The path to the tumor is chosen long before Neurosurgery. The positioning of the patient allows the correct trajectory to the tumor during Neurosurgery. The path that will result in least damage is chosen. The path may involve retraction or lifting of brain rather than cutting the brain. For transcortical openings, a small portion of the cortex (gyrus) is coagulated using the bipolar coagulator. A #14 blade scalpel allows opening the cortex. The brain is gently entered using gentle suction and retraction by flat, smooth retractors. Once the tumor is visualized, its removal can begin. The initial approach to the brain tumor can take several hours, depending on the location (less for superficial brain tumors near surface, more for "deep" brain tumors near center of the brain). The neurosurgeon often uses the operative microscope to carefully view the brain tumor and the surrounding normal brain at this stage. Using visual magnification, the brain tumor is first "biopsied" (small piece taken for "frozen section") if no biopsy was taken before. This tells the neurosurgeon, in the operating room, the type of brain tumor with which he is dealing, and guides the aggressiveness of the resection.

    The brain is gently retracted away from the brain tumor during removal. To minimize retraction and pressure on the brain, the central portion of the brain tumor is removed, allowing the remainder of the brain tumor to fold in on the cavity, thereby reducing pressure on the normal brain. This prevents pressure on the brain.

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  • During Neurosurgery how can the brain tolerate surgery inside it?

    The brain can tolerate Neurosurgery inside it. The goal of Neurosurgery for brain tumor is preservation of the normal brain and removal of the brain tumor. The normal brain is only gently retracted away from the brain tumor during Neurosurgery, thus preventing injury to the normal brain tissue. In cases where the normal brain tissue is cut in order to reach the brain tumor, a path to the brain tumor is selected that involves "silent" regions of the normal brain (regions that can be traversed or even sometimes removed without subsequent neurological deficit).

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  • Why is Neurosurgery sometimes the best treatment for brain tumors?


    Neurosurgery, or brain surgery, is immediate. Neurosurgery can often remove the entire tumor with low or acceptable risk.

    Rapid Resolution

    When symptoms (weakness, numbness, diminished consciousness) are rapidly progressing, an immediate therapy is necessary. Neurosurgery can remove the source of the neurological deficit relatively rapidly.

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  • Which tumors can Neurosurgery treat?

    Neurosurgery can successfully treat many different tumors, both benign and malignant. The malignant tumors treated most often are the "brain metastases" or tumors that have spread to the brain. When the brain metastases are solitary or single, neurosurgical resection is particularly attractive.

    The malignant gliomas are frequently treated with neurosurgery both initially and at the time of recurrence. Because the gliomas (fibrillary, anaplastic and glioblastomas) can infiltrate (spread via "fingers" into surrounding normal brain) complete resection is often difficult. For the pilocytic astrocytomas, the neurosurgery can often result in complete removal.

    Many "benign" tumors can be successfully treated with neurosurgery. These include the acoustic neuromas, meningiomas and pituitary adenomas. For the acoustic neuromas, neurosurgery offers immediacy of treatment but may have higher risk to the facial motor and sensory nerves when compared to radiosurgery. For the meningiomas neurosurgery is often employed for total or subtotal removal. If the meningioma is "deep" or is in the cavernous sinus, radiosurgery is often a useful treatment. For the pituitary adenomas, neurosurgery can rapidly decrease hormonal production. If the resection is complete, no further treatment may be required.

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  • What are the different types of specialties in brain tumor Neurosurgery?

    • The skull base Neurosurgery treats meningiomas of the cavernous sinus, medial sphenoid wing, parasellar and olfactory groove. The skull base Neurosurgery also treats acoustic neuromas, chordomas of the clivus, and pituitary adenomas.

    • The malignant brain tumor Neurosurgery treats the malignant intrinsic brain tumors including the glioblastoma multiforme, anaplastic astrocytoma, anaplastic oligodendrogliomas, brain metastases, pineal tumors including pinealomas and pineoblastomas. The malignant brain tumor Neurosurgery also treats lymphomas of the brain, medulloblastomas, germinomas, embryonal cell carcinomas and teratomas.

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