ANATOMY OF THE BRAIN
Anatomy of the Brain
The human brain is a mysterious three-pound organ that controls all functions of the body, interprets information from the outside world, and embodies the mind and soul. Intelligence, creativity, emotion, and memories are a few of the many things governed by the brain. The cerebrum is the largest part of the brain and is divided into right and left hemispheres. Each hemisphere has four lobes: frontal, temporal, parietal, and occipital. The cerebellum is located under the cerebrum. The brainstem acts as a relay center connecting the cerebrum and cerebellum to the spinal cord.
TRAUMATIC BRAIN INJURY
Traumatic Brain Injury
Traumatic brain injury (TBI) is sudden damage to the brain caused by a blow or jolt to the head. Common causes include car or motorcycle crashes, falls, sports injuries, and assaults. Injuries can range from mild concussions to severe permanent brain damage. The consequences of a brain injury can affect all aspects of a person’s life, including physical and mental abilities as well as emotions and personality. While treatment for mild TBI may include rest and medication, severe TBI may require intensive care and life-saving emergency surgery.
An acoustic neuroma is a tumor that grows from the nerves responsible for balance and hearing. More accurately called vestibular schwannoma, these tumors grow from the sheath covering the vestibulocochlear nerve. Acoustic neuromas are benign (not cancerous) and usually grow slowly. Over time the tumor can cause gradual hearing loss, ringing in the ear, and dizziness. Because of their slow growth, not all acoustic neuromas need to be treated. Treatment options include observation, surgery, and radiation.
ACOUSTIC NEUROMA SURGERY: SUBOCCIPITAL CRANIOTOMY
Acoustic Neuroma Surgery: Suboccipital Craniotomy
A suboccipital craniotomy is a surgical procedure performed to remove an acoustic neuroma growing from the nerve responsible for balance and hearing (vestibulocochlear). During surgery, a section of the skull is removed behind the ear to access the tumor and nerves. The goals of surgery are: first, the maintenance of facial nerve function; second, the preservation of socially useful hearing in the affected ear; and third, tumor removal.
Clipping is a surgical procedure performed to treat a balloon-like bulge or weakening of an artery wall known as an aneurysm. As an aneurysm grows it becomes thinner and weaker. It can become so thin that it leaks or ruptures, releasing blood into the spaces around the brain – called a subarachnoid hemorrhage (SAH). A neurosurgeon places a tiny clip across the neck of the aneurysm to stop or prevent an aneurysm from bleeding.
Coiling is a minimally invasive endovascular procedure performed to treat an aneurysm – a balloon-like bulge or weakening of an artery wall. As an aneurysm grows, it thins and weakens. It can become so thin that it leaks or ruptures, releasing blood into the space around the brain. This bleeding is called a subarachnoid hemorrhage (SAH) and is life threatening. During coiling, tiny coils are packed into the aneurysm to promote blood clotting and close off the aneurysm.
An aneurysm is a balloon-like bulge or weakening of an artery wall. As an aneurysm enlarges it puts pressure on surrounding structures, causing headache or vision problems, and may eventually rupture. A ruptured aneurysm releases blood into the spaces around the brain, called a subarachnoid hemorrhage (SAH) – a life-threatening type of stroke. Treatment focuses on stopping the bleeding and repairing the aneurysm with surgical clipping, coiling, or bypass.
An aneurysm is a balloon-like bulge or weakening of an artery wall. As an aneurysm enlarges it puts pressure on surrounding structures, causing headache or vision problems, and may eventually rupture. A ruptured aneurysm releases blood into the spaces around the brain, called a subarachnoid hemorrhage (SAH) – a life-threatening type of stroke. Treatment options for aneurysms include observation, surgical clipping, coiling, and bypass.
ARTERIOVENOUS MALFORMATION (AVM)
Arteriovenous malformation (AVM)
An arteriovenous malformation (AVM) is an abnormal tangle of blood vessels in the brain or spine. Some AVMs have no specific symptoms and little or no risk to a one’s life or health, while others cause severe and devastating effects when they bleed. Treatment options range from conservative watching to aggressive surgery, depending on the type, symptoms, and location of the AVM.
BRAIN TUMORS: AN INTRODUCTION
Brain tumors: an introduction
A tumor is abnormal tissue that grows by uncontrolled cell division. Normal cells grow in a controlled manner as new cells replace old or damaged ones. For reasons not fully understood, tumor cells reproduce uncontrollably. Brain tumors are named after the cell type from which they grow. They may be primary (starting in the brain) or secondary (spreading to the brain from another area). Treatment options vary depending on the tumor type, size and location; whether the tumor has spread; and the age and medical health of the person.
Carotid stenosis is a narrowing of the carotid arteries, the two major arteries that carry oxygen-rich blood from the heart to the brain. Also called carotid artery disease, carotid stenosis is caused by a buildup of plaque inside the artery wall that reduces blood flow to the brain. The process of plaque buildup is called atherosclerosis.
CEREBRAL BYPASS SURGERY
Cerebral bypass surgery
A cerebral bypass is a surgical procedure performed to restore, or “revascularize,” blood flow to the brain. A cerebral bypass is the brain’s equivalent of a coronary bypass in the heart. The surgery involves connecting a blood vessel from outside the brain to a vessel inside the brain to reroute blood flow around an artery that is narrowed, blocked, or damaged. The main goal of bypass surgery is to restore blood supply to the brain and prevent strokes.
CHIARI I MALFORMATION
Chiari I malformation
Chiari type I is a condition in which the bony space enclosing the lower part of the brain is smaller than normal. Crowding causes the cerebellar tonsils to push through the skull and down into the spinal canal. The herniated tonsils block the normal flow of cerebrospinal fluid. Symptoms vary widely, but the most common include severe headache at the back of the skull, neck pain, dizziness, numbness in the hands, and sleep problems. Mild symptoms are treated with monitoring and medication. For severe symptoms, surgery may be needed to remove bone and enlarge the space.
A concussion is a mild traumatic brain injury caused by a blow or “ding” to the head. Common in falls, sports, and car crashes, concussions can temporarily affect the brain causing confusion, memory, speech, vision, or balance problems. The person may appear fine at first, but may show symptoms hours or days later. If left undiagnosed, a concussion may place a person at risk of developing second impact syndrome-a potentially fatal injury that occurs when an athlete sustains a second head injury before a previous head injury has healed. The best treatment is time to allow the brain to heal.
Craniotomy is a cut that opens the cranium. During this surgical procedure, a section of the skull, called a bone flap, is removed to access the brain underneath. The bone flap is usually replaced after the procedure with tiny plates and screws.
ENDOSCOPIC TRANSSPHENOIDAL SURGERY
Endoscopic transsphenoidal surgery
Transsphenoidal surgery is performed to remove tumors from the pituitary gland, sellar region, and sphenoid sinus of the skull. The surgery is performed through the nose with a microscope or more commonly with an endoscope. Pituitary tumors cause a variety of hormone problems and can grow to large size, compressing important nerves and arteries at the base of the brain. When this occurs, surgery is needed to remove the tumor, especially when vision is at risk. Tumor removal often reverses endocrine problems and restores normal hormone balance.
A seizure (often called a fit, spell, convulsion, or attack) is a visible sign of a problem in the electrical system that controls your brain. A single seizure can have many causes. Those who continue to have unproked seizures may have a chronic disorder called epilepsy. The term “seizure disorder” is often used as another way to describe epilepsy.
Epilepsy surgery is performed to treat seizures that are uncontrolled with medication. About 30% of people with epilepsy are not controlled with medication and are considered medically intractable. “Medically intractable seizures” are defined as persistent seizures despite trials of three or more appropriate antiepileptic drugs , alone or in combination. People with medically intractable seizures may be candidates for surgical treatment to achieve better seizure control.
GLIOMA BRAIN TUMORS
Glioma Brain Tumors
A glioma is a type of brain tumor that grows from glial cells. Glial cells support nerve cells with energy and nutrients and help maintain the blood-brain barrier. Glioma is an umbrella term used to describe the different types of gliomas: astrocytoma, oligodendroglioma, and glioblastoma.
Hemifacial spasm (HFS) is an involuntary twitching or contraction of the facial muscles on one side of the face. Medication, surgery, and Botox injections are treatment options to stop the spasms and relieve the discomfort. Each treatment offers benefits, but each has limitations. You and your doctor should determine which treatment is best.
INTRACEREBRAL HEMORRHAGE ICH
Intracerebral hemorrhage ICH
Intracerebral hemorrhage (ICH) is a type of stroke caused by bleeding within the brain tissue itself – a very life-threatening situation. A stroke occurs when the brain is deprived of oxygen due to an interruption of its blood supply. ICH is most commonly caused by hypertension, arteriovenous malformations, or head trauma. Treatment focuses on stopping the bleeding, removing the blood clot (hematoma), and relieving the pressure on the brain.
INTRACRANIAL ARTERY STENOSIS
Intracranial artery stenosis
Intracranial stenosis is a narrowing of an artery inside the brain that can lead to stroke. Stenosis is caused by a buildup of plaque inside the artery wall that reduces blood flow to the brain. The process of plaque buildup is called atherosclerosis. Atherosclerosis that is severe enough to cause symptoms carries a high risk of stroke and can lead to brain damage and death. Treatments aim to reduce the risk of stroke by controlling or removing plaque buildup and by preventing blood clots.
A meningioma is a type of tumor that grows from the protective membranes, called meninges, which surround the brain and spinal cord. Most meningiomas are benign (not cancerous) and slow growing; however, some can be malignant. Symptoms typically appear gradually and vary depending on the location and brain area affected. Because these are slow growing tumors, not all meningiomas need to be treated immediately.
METASTATIC BRAIN TUMORS
Metastatic brain tumors
Metastatic brain tumors begin as cancer in another part of the body and spread to the brain via blood or nearby tissue. There can be one (metastasis) or multiple (metastases) tumors.
MICROVASCULAR DECOMPRESSION MVD
Microvascular decompression MVD
Microvascular decompression (MVD) is a surgical procedure that relieves abnormal compression of a cranial nerve. It is performed to treat trigeminal neuralgia, vagoglossopharyngeal neuralgia, and hemifacial spasm. These conditions are often caused by an artery or vein compressing the nerve root as it leaves the brainstem. When compressed, normal nerve impulses can recruit nearby nerve fibers and send faulty messages. Medications often provide relief to patients with these conditions, but when medications become ineffective or cause serious side effects, one treatment option is MVD.
Moyamoya disease is a disorder caused by blocked arteries at the base of the brain. The name “moyamoya” means “puff of smoke” in Japanese and describes the appearance of the tangle of tiny vessels that form to compensate for the blockage. As the normal blood vessels narrow and become blocked, a person may suffer a stroke – a life-threatening situation. No medication can stop or reverse the progression of moyamoya disease. Treatment focuses on reducing the risk of stroke and restoring blood flow to the brain.
PARKINSON’S DISEASE (PD)
Parkinson’s Disease (PD)
Parkinson’s Disease (PD) is a chronic, progressive disorder that affects nerve cells deep in the brain responsible for planning and controlling body movement. Dopamine is a chemical used in body movement. When the dopamine-producing nerve cells die, symptoms such as tremor, slowness, stiffness, and balance problems begin to occur. The cause of Parkinson’s is largely unknown and the disease cannot be cured at this time. Treatments focus on reducing symptoms to enable a more active lifestyle.
COPING WITH PARKINSON’S DISEASE
Coping with Parkinson’s Disease
Parkinson’s Disease (PD) is a degenerative, progressive neurologic disorder that affects the way you move. Treatment focuses on reducing the symptoms to enable a normal, active lifestyle. While medication is necessary, you can do your part to maintain a healthy lifestyle by eating a balanced diet and staying physically active in order to contribute to your overall health and well-being.
DEEP BRAIN STIMULATION FOR MOVEMENT DISORDERS
Deep Brain Stimulation for Movement Disorders
Deep brain stimulation (DBS) is a surgical procedure to implant a pacemaker-like device that sends electrical signals to brain areas responsible for body movement. Electrodes are placed deep in the brain and are connected to a stimulator/battery device. Similar to a heart pacemaker, a neurostimulator uses electric pulses to help regulate brain activity. DBS can help reduce the symptoms of tremor, slowness of movement, stiffness, and walking problems caused by movement disorders such as Parkinson’s disease, dystonia, or essential tremor.
PERCUTANEOUS STEREOTACTIC RADIOFREQUENCY RHIZOTOMY PSR
Percutaneous stereotactic radiofrequency rhizotomy PSR
Percutaneous stereotactic radiofrequency rhizotomy (PSR) is a minimally invasive procedure performed to relieve pain caused by: trigeminal neuralgia, glossopharyngeal neuralgia and cluster headaches. Medications often provide pain relief to patients with these conditions, but when medications become ineffective in pain control or cause serious side effects, one treatment option is PSR.
Pituitary tumors grow from the pituitary gland, the master gland of the body, located deep in the skull. These tumors can affect the whole body by interfering with normal hormone production. As the tumor grows, it can cause a variety of symptoms including compression of nearby nerves, resulting in vision problems. There are various kinds of pituitary tumors: adenomas, craniopharyngiomas, and Rathke’s cleft cysts. Most are benign (not cancerous) and are often curable. Treatment options aim to remove the tumor or control its growth and restore normal hormone function.
RADIOSURGERY AND RADIOTHERAPY OF THE BRAIN
Radiosurgery and radiotherapy of the brain
Radiation therapy uses high-energy rays to treat tumors and other diseases. Radiation works by damaging the DNA inside cells and making them unable to divide and reproduce. The benefits of radiation are not immediate but occur over time. Aggressive tumors, whose cells divide rapidly, typically respond more quickly to radiation. Over time, the abnormal cells die and the tumor may shrink. Normal cells can also be damaged by radiation, but they can repair themselves more effectively than abnormal cells. The goal of radiation treatment is to maximize the dose to abnormal cells and minimize the exposure to normal cells.
A seizure (also called a fit, spell, convulsion, or attack) is the visible sign of a problem in the electrical system that controls your brain. A single seizure can have many causes, such as a high fever, lack of oxygen, poisoning, trauma, a tumor, infection, or after brain surgery. Most seizures are controlled with medication. If your seizures occur repeatedly, then you may have the chronic disorder called epilepsy.
Subarachnoid hemorrhage (SAH) is a serious, life-threatening type of stroke caused by bleeding into the space surrounding the brain. A stroke occurs when the brain is deprived of oxygen because of an interruption of its blood supply. SAH can be caused by a ruptured aneurysm. One-third of patients who suffer an SAH will survive with good recovery; one-third will survive with a disability; and one-third will die. Treatment focuses on stopping the bleeding, restoring normal blood flow, relieving the pressure on the brain, and preventing vasospasm.
Think of a stroke as a “brain attack” – it is an emergency! Because a stroke can damage brain tissue, every minute counts. When symptoms appear call 911 immediately. A stroke occurs when the brain is deprived of the oxygen it needs due to an interruption of its blood supply. Without oxygen brain cells die. The oxygen deprived area of brain tissue is called an infarct. Depending on what area of the brain has been affected, a stroke can cause problems with speech, behavior, thought patterns and memory, and may result in permanent brain damage, disability or death.
Trigeminal neuralgia is an inflammation of the trigeminal nerve causing extreme pain and muscle spasms in the face. Attacks of intense, electric shock-like facial pain can occur without warning or be triggered by touching specific areas of the face. Although the exact cause of trigeminal neuralgia is not fully understood, a blood vessel is often found compressing the nerve. Several treatments can relieve the pain. Each treatment offers benefits, but each has limitations. You and your doctor should determine which treatment is best for you.