What is Neurological Surgery ?

It is the medical specialty concerned with the diagnosis and treatment of of patients with injury to, or diseases/disorders of the brain, spinal cord and spinal column, and peripheral nerves within all parts of the body. The specialty of neurosurgical care includes both adult and pediatric patients. Dependent upon the nature of the injury or disease a neurological surgeon may provide surgical and/or non-surgical care.

TYPES OF NEUROLOGICAL SURGERY

Today, there are many forms of treatment for various conditions of the spine, brain, and peripheral nerves. Your physician will usually try to get you well by prescribing such things as physical therapy, nerve blocks, and sometimes medications. When these types of conservative treatment are not effective, or if your physician feels that they would not help your individual condition, surgery may be an option. If this is the case, he will discuss the type of surgery recommended with you, as well as the benefits and associated risks.

Preparing for Surgery

There are several things you can do to prepare for any type of neurological surgery. Your physician will give you exact instructions on how to prepare for your surgery based on your diagnosis, what type of procedure you are having, and any other health factors. Some of these things often includediscontinuing aspirin or other blood thinners several days before your surgery. It is best if you quit smoking, as smoking can lengthen the amount of time it takes to heal from surgery, especially spinal fusions. Be sure to arrange to have someone to take you home from the hospital and to be with you for the first few days after your surgery. You may want to have some meals already prepared so that you will not have to exert yourself cooking. One of our Patient Care Coordinators will also give you instructions such as to not eat or drink anything after midnight, where to go and what other medications to take the morning of your surgery.

Cervical Spine Surgery

Surgery for the Cervical Spine can be done through a small incision on the side of your neck (called an Anterior Cervical Discectomy and Fusion) or an incision down the back of your neck, called a Posterior Cervical Laminectomy. Your physician will determine which approach is best for you, based on your diagnosis and other factors.

During an Anterior Approach, you physician will make a small horizontal incision on the side of your neck somewhere above your collarbone. Special surgical instruments are used to reach the herniated disc and remove it, unpinching the nerve. Then a bone graft is inserted between the vertebrae, where the disc used to be. This is called a fusion. The fusion is to stabilize the vertebrae and try to prevent further problems in the cervical spine. Sutures are placed under the skin and steri-strips outside the skin to hold the incision closed as it heals. The sutures will not need to be removed, and the steri-strips will peel away from the skin in a few days under warm water.

Lumbar Spine Surgery

There are a variety of types of surgery for the low back, or Lumbar Spine. Your physician will decide what is the best type for you based on your diagnosis and other factors.

Two of the most common types of Lumbar surgery are a Lumbar Micro-Discectomy and a MetRX(external link)Both are usually done under general anesthesia. In the Micro-Discectomy, your physician will make a small, vertical incision near your spine. Special surgical instruments and a microscope are used to locate the herniated part of the disc and unpinch the nerve. Staples are placed on the outside of the incision to hold it closed as it heals. The MetRx is a minimally invasive procedure(external link)and requires a smaller incision. The ruptured disc is removed through a small tube and the incision is usually closed using steri-stips instead of sutures or staples. Many patients can go home the same day as their surgery after a Lumbar Microdiscectomy and a MetRx. Your physician will inform you when you need to return to the office to have the staples removed.

In cases of a compression fracture of the lumbar vertebrae, a procedure known as Kyphoplasty may be recommended. Under general anesthesia, your physician will use a type of balloon to elevate the collapsed vertebral body to its correct position. The balloon is removed and the resulting cavity is filled with a special cement that holds the vertebral body in place. It’s like placing an internal cast to help a broken bone heal. Most patients go home the day after the procedure.

Carpal Tunnel Release

A Carpal Tunnel Release is an outpatient surgery, performed under local anesthetic and sedation. You physician will make a small incision at the base of your palm and release the carpal ligament, which covers the carpal tunnel. This frees the median nerve which runs through the carpal tunnel into the hand and fingers and relieves the symptoms of pain, tingling, and numbness you may have been experiencing prior to surgery. (Your hand and fingers may feel numb for several hours after surgery, due to the anesthetic administered in the operating room.) Once the surgery is over, your physician will give you instructions on how to take care of your incision at home, and tell you when to come back to the office to have your bandage changed or sutures removed.

Ulnar Nerve Decompression

An Ulnar Nerve Decompression is an outpatient surgery performed under general anesthetic. Your physician will make a small incision near the elbow and free the ulnar nerve which runs down the forearm and into the hand. An Ulnar Nerve Decompression should relieve the symptoms of pain, tingling, and numbness you may have been experiencing prior to surgery. (Your hand and fingers may feel numb for several hours after surgery, due to the anesthetic administered in the operating room.) Once the surgery is over, your physician will give you instructions on how to take care of your incision at home, and tell you when to come back to the office to have your bandage changed or staples removed.

Craniotomy

A Craniotomy may be necessary for many different reasons. Some of the most common reasons are bleeding and/or swelling of the brain, a brain tumor, or an aneurysm. Craniotomies are usually performed under general anesthesia. In the operating room, your physician will remove a piece of the skull, which is the bony covering around the brain. The size of the incision varies according to the reason for it Once a window is made into the skull, your physician will open the dura, or covering around the brain. The next step depends on your diagnosis. In the case of bleeding, the source of the bleeding is controlled and the excess blood and any damaged tissue are removed. For brain tumors, your physician may take a biopsy or try to remove as much of the tumor as possible. Sometimes, special chemotherapy wafers are placed in the brain where the tumor was to give further treatment to the tumor site. For aneurysms, the artery is clipped at the weakened spot to prevent normal blood flow from rupturing the area.


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