BRAIN PROBLEMS

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Brain Tumour Surgery

Surgery is the primary treatment for brain tumors that can be removed without causing severe damage. Many benign (non-cancerous) tumors are treated only by surgery. Most malignant (cancerous) tumors, however, require treatment in addition to the surgery, such as radiation therapy and/or chemotherapy.

The most common types are:

Astrocytoma: The tumor arises from star-shaped glial cells called astrocytes. It can be any grade. In adults, an astrocytoma most often arises in the cerebrum.

Grade I or II astrocytoma: It may be called a low-grade glioma.

Grade III astrocytoma: It's sometimes called a high-grade or an anaplastic astrocytoma.

Grade IV astrocytoma: It may be called a glioblastomaor malignant astrocytic glioma.

Meningioma: The tumor arises in the meninges. It can be grade I, II, or III. It's usually benign (grade I) and grows slowly.

Oligodendroglioma: The tumor arises from cells that make the fatty substance that covers and protects nerves. It usually occurs in the cerebrum. It's most common in middle-aged adults. It can be grade II or III.

Brain Tumor Symptoms

Symptoms (signs) of benign brain tumors often are not specific. The following is a list of symptoms that, alone or combined, can be caused by benign brain tumors; unfortunately, these symptoms can occur in many other diseases:

Vision problems

Hearing problems

Balance problems

Changes in mental ability (for example, concentration, memory, speech)

Seizures, muscle jerking

Change in sense of smell

Nausea/vomiting

Facial paralysis

Headaches

Numbness in extremities

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Skull Base Surgery

Skull base surgery is a highly specialized, minimally invasive surgical technique for evaluating, diagnosing and treating benign or cancerous growths located on the underside of the brain, the base of the skull and the upper vertebrae of the spinal column. It can also be advantageous in repairing congenital anomalies and malformations.

Skull base surgeons use special instruments inserted through the skull’s natural openings (e.g., nose, mouth and above the eyes) to operate rather than accessing the brain through a craniotomy (surgical opening of the skull). Prior to the development of skull base surgery it was necessary to remove relatively large portions of the skull and/or facial musculature in order to gain entry into these areas. The benefits of skull base surgery include less risk of infection and damage to cerebral structures and nerves, less risk of disfigurement and a shorter recovery time.

A partial list of conditions that may be treated using skull base surgery includes:

Pituitary tumors

Meningiomas

Chordomas

Trigeminal neuralgia

Vestibulocochlear nerve disorders

Craniopharyngiomas

Hemifacial spasms

Craniostenosis

Cerebro-spinal fluid fistulas

Cerebral aneurysms

Arteriovenous Malformations (AVMs)

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Aneurysm & Arterio-Vnous Macformation (AVM) Surgery

What is a brain aneurysm? An aneurysm forms when an artery in the brain develops a bulge. This is caused by a weak area in the blood vessel's wall. The aneurysm can break open and bleed. This is a medical emergency and requires treatment right away. Aneurysms that bleed are very serious: half of patients die before reaching a hospital or within the first few days. Of the patients who survive a ruptured aneurysm, half develop a serious disability. A ruptured brain aneurysm requires treatment because it is likely to bleed again. Each time a brain aneurysm bleeds, the risk of death or disability is high.

What is an arteriovenous malformations (AVM)? Vascular malformations are abnormal connections between the arteries and veins in the brain. They are also called arteriovenous malformations (AVMs). These usually form before birth. AVMs are located within the brain. Without the normal channels of vessels to handle blood under high pressure, AVMs can bleed. The bleeding causes a blood clot in the brain, which can lead to death or disability. Although not as dangerous or common as brain aneurysms, AVMs have significant risks.

Symptoms of spinal AVMs

Spinal AVMs often don’t cause any symptoms. When they do, they're usually minor and hard to notice. In a few people, however, the symptoms can be severe enough to affect their ability to function.

Muscles that feel weak or become paralyzed

Problems with balance and coordination (ataxia)

Pain or unusual sensations throughout your body, such as tingling or numbness

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Intraventricular Tumour Surgery

Intraventricular Tumor: Ventricles are hollow areas within the brain that are filled with cerebrospinal fluid, a clear liquid that surrounds and cushions the brain and spinal cord. Intraventricular tumors (also known as ventricular tumors) are generally benign tumors or lesions found within the ventricles of the brain. These tumors may arise from a variety of cells in the region and often obstruct the flow of cerebrospinal fluid and cause a buildup of pressure in the skull.

Symptoms: Intraventricular tumors are especially significant because they often obstruct the flow of cerebrospinal fluid. When the flow of cerebrospinal fluid is blocked, it is a condition known as obstructive hydrocephalus. In people with hydrocephalus, the volume of fluid in the ventricle increases, placing pressure on surrounding brain tissue and leading to headache, nausea, mental status deterioration, visual disturbances and death. Intraventricular tumors can cause other symptoms depending on location, including seizures, weakness or numbness in the limbs, impairments in language function, gradual changes in mood or personality, and memory loss.

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Pituitary Tumour Surgery

This is the most common way to remove pituitary tumors. Transsphenoidal means that the surgery is done through the sphenoid sinus, a hollow space in the skull behind the nasal passages and below the brain. The back wall of the sinus covers the pituitary gland.

Surgical removal of a pituitary tumor usually is necessary if the tumor is pressing on the optic nerves or if the tumor is overproducing certain hormones. The success of surgery depends on the tumor type, its location, its size and whether the tumor has invaded surrounding tissues. The two main surgical techniques for treating pituitary tumors are:

Endoscopic transnasal transsphenoidal approach: This usually enables your doctor to remove the tumor through your nose and sinuses without an external incision. No other part of your brain is affected, and there's no visible scar. Large tumors may be difficult to remove this way, especially if a tumor has invaded nearby nerves or brain tissue.

Transcranial approach (craniotomy): The tumor is removed through the upper part of your skull via an incision in your scalp. It's easier to reach large or more complicated tumors using this procedure.

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Endoscopic Brain Surgery

Endoscopic brain surgery is a procedure used primarily to treat brain tumors. It is considered a minimally invasive brain surgery that allows neurosurgeons to identify and treat conditions that are deep within the brain.

The Endoscopic Endonasal Approach is a minimally invasive surgical approach to the skull base that was refined and is performed at UPMC by a multidisciplinary surgical team to remove skull base brain tumors and lesions through the nose. EEA is performed using a narrow telescope called an endoscope.