Brain Conditions

Pituitary Tumors –Endoscopic Approach

Pituitary tumor is a malformed cellular growth in the pituitary gland sited in the brain. The pituitary gland releases hormones that act directly on the body tissues and also control the production of hormones from supplementary glands such as thyroid and adrenal glands. Thus pituitary tumors contribute to overproduction of one or more hormones triggering conditions such as hyperthyroidism, gigantism, Cushing’s syndrome and abnormal secretion from the breasts. As they grow these tumors may exert pressure on the optic nerve causing visual disturbances. The diagnosis is accordingly made on the basis of endocrine function tests for cortisol, follicle stimulating hormone, insulin growth factor-1, luteinizing hormone, serum prolactin, testosterone and thyroid hormone levels. The diagnosis is supplementary endorsed by MRI of the head.

Skull Base Tumors

Skull base tumors are tumors located at the base of the skull. They may be malignant or benign. The treatment comprises surgery, radiation therapy, chemotherapy either alone or in combination.

Hydrocephalus

Hydrocephalus implies water on the brain. It is illustrated by an excess accumulation of cerebrospinal fluid (CSF) around the brain within the skull. This extreme collection of fluid within the inadequate space of the bony skull conveys pressure on the brain and brings about impairment to the brain tissue. It particularly appears in children however may also arise in adults and older people. It can occur due to birth defect, genetic defect, infection of the central nervous system, injury or tumors of the brain or spine. The diagnosis can be verified by CT scan of the head. Additional imaging tests such as skull X-rays, brain scan, ultrasound and arteriography may likewise be exercised. Occasionally lumbar puncture and assessment of the cerebrospinal fluid is also performed.

Epilepsy Surgery

Surgery is recommended for an epilepsy patient when medications do not manage the seizures. The surgery goal is either to end the seizures (curative) or decrease their incidence and severity (palliative).

Burr Holes for Haematoma

A burr hole for haematoma is performed to remove a blood clot from around the surface of the brain. The location of the blood clot is usually beneath the firm covering of the brain.

A small cut is made in the skin over the site of the blood clot. A small hole is drilled into the skull beneath the cut and the firm covering of the brain is opened. The fluid within the blood clot is allowed to drain. Any blood clot debris is washed away from the brain to ensure it is all removed.

A small plastic tube (drain) may be inserted to allow any residual fluid to be drained away. This is usually removed within 24 – 48 hours. The cut is then closed, usually with stitches or staples.

Craniotomy & Repair of Anterior Cranial Fossa Floor

This brain operation is performed to repair the cranial fossa floor and stop the leaking brain fluid.

A cut is usually made on the head through the hairline from ear to ear. A segment of skull bone is removed to allow access to the cranial fossa floor. The area of the leaking brain fluid is identified.

Another cut is made in your upper thigh. This will allow tissue to be taken which is to be used as donor tissue to repair the leaking area of the cranial fossa floor.

Tissue glue may also be used to assist with the repair of the leaking brain fluid. The skull bone is put back and closed with metal plates and screws.

The cuts are closed with stitches or staples.

Craniotomy for Evacuation of Intracranial Haematoma

A Craniotomy for evacuation of intracranial haematoma is performed to remove a blood clot from around the surface of the brain.

A cut is made in the skin over the site of the blood clot. A segment of skull bone is removed to allow the surgeon to view the brain. The firm outside lining of the brain will be opened.

The blood clot is identified and removed. The surface of the brain is rinsed to help remove the clot.

The skull is closed with plates and screws and the cut closed with stitches or staples.

Craniotomy & Clipping of Anterior Cerebral Aneurysm

A cerebral aneurysm is an abnormality and weakness in the wall of a blood vessel in the brain. This operation is performed to enable a titanium clip to be placed on the neck of the aneurysm to prevent it from bleeding.

A cut is made over the area where the brain needs to be opened. A segment of skull bone will be removed. A titanium clip is placed across the neck of the Aneurysm.

The skull bone is put back and is closed with metal plates and screws.

The cut closed with stitches or staples.

Craniotomy & Resection of Intrinsic Lesion

A Craniotomy and resection of Intrinsic Lesion is performed to remove a lesion from within the brain.

A cut is made over the area of the lesion. A segment of bone will be removed. The firm outside lining of the brain will be opened.

If the lesion is not seen on the surface of the brain, a cut is made into the brain to expose the lesion. A computerised guidance system is used to locate the exact location of the lesion.

The lesion is removed either from the inside by removing it piece by piece or by going around the outside of the lesion to separate it from the brain.

As much of the lesion will be removed as is safe to do so. The skull bone is put back and is closed with plates and screws and the cut closed with stitches or staples.

Elevation of Depressed Skull Fracture

A Depressed Skull Fracture is a break in one or more of the bones in the skull caused by a head injury. Broken fragments of skull can lacerate or bruise the brain or damage blood vessels.

A cut is made in the skin so they can access the skull fracture. Part of the skull bone may need to be removed to access the bone fragments. The operation requires the reassembling of the broken bone fragments with metallic plates and screws.

Metallic mesh or bone cement may be required to improve a cosmetic result for shaping the skull. The skin will be closed with stitches or staples.

Endoscopic Procedure & +/- Endoscopic Third Ventriculostomy

The endoscopic procedure is a minimally invasive procedure which gives access to the deepest part of the brain using an instrument called an endoscope.

The procedure can be performed to:

• Inspect the brain
• Biopsy/remove small tumours
• Drain/remove cysts and
• Create bypass channels for circulation of cerebrospinal fluid (CSF).

A small cut is made in the scalp over the site of the underlying problem. A small hole is drilled into the skull beneath the cut and the firm covering of the brain is opened.

The endoscope is passed through the small hole into the brain. Sometimes, it is necessary to create a small pathway through the brain with the endoscope to reach the problem. Using this technique, access to parts of the brain can be achieved with relative ease.

When completed the endoscope is removed.

Endoscopic third ventriculostomy is performed as an adjunct to the endoscopic procedure in order to create an opening into one of the fluid filled cavities of the brain called the third ventricle.

This procedure is performed to bypass any obstruction to the flow of cerebrospinal fluid. To achieve this the endoscope is passed into fluid filled cavities (ventricles) within the centre of the brain. The endoscope is navigated into the third ventricle and a small opening is made in the floor of the third ventricle.

This allows the excess cerebrospinal fluid to drain away from the brain, relieving any pressure.

The cut is closed with stitches or staples.

Insertion of External Ventricular Drain

External Ventricular Drains are inserted for the management of too much fluid or increased pressure on the brain.

The procedure involves a small cut being made about 10cm above the eyebrow usually on the top right hand side of the head. A small hole is drilled into the skull beneath the cut and the firm covering of the brain is opened.

A small plastic tube (drain) is passed into the fluid spaces of the brain and stitched in place. The drain is connected to a drainage collection bag to collect the fluid from the brain. The drain will stay in place until the excess fluid is managed or other treatment options are discussed.

The cut is closed with sutures or clips.

Insertion of Ventricular Shunt

• Peritoneal Shunt
• Pleural Shunt
• Atrial Shunt

This procedure is performed to relieve pressure inside the skull caused by fluid on the brain. This fluid is drained from the ventricles of the brain into the abdominal/pleural cavity or atrium by the means of a shunt. A shunt usually consists of two catheters and a one-way valve.

A small cut is made in the scalp and a small hole is drilled into the skull beneath the cut. A small tube (catheter) is placed into the brain to drain the fluid.

Another cut is made either in the abdomen or chest. A second catheter is tunnelled under the skin, from behind the ear, down the neck and chest, and ending a cavity.

The catheter from the abdomen and the catheter in the brain are then connected by a valve. This valve controls the flow of fluid from the brain.

The valve will be sutured to stop it from moving. The wounds will be closed with sutures.

Insertion of Ventriculoperitoneal Shunt

This procedure is performed to relieve pressure inside the skull caused by fluid on the brain. This fluid is drained from the ventricles of the brain into the abdominal cavity by the means of a shunt. A shunt usually consists of two catheters and a one-way valve.

A small cut is made in the scalp and a small hole is drilled into the skull beneath the cut. A small tube (catheter) is placed into the brain to drain the fluid.

Another cut is made in the abdomen. A second catheter is tunnelled under the skin, from behind the ear, down the neck and chest, and ending in the abdominal cavity.

The catheter from the abdomen and the catheter in the brain are then connected by a valve. This valve controls the flow of fluid from the brain to the abdominal cavity.

The valve will be sutured to stop it from moving. The wounds will be closed with sutures.

Intracranial Pressure Monitoring

Intracranial Pressure Monitoring is a procedure which is used for the management of patients whose pressure inside their brain is too high. A special probe which monitors pressure is inserted through a small hole in the skull.

To allow the insertion of the probe a small cut is made in the scalp usually on the top right hand side of the head. A small hole is drilled into the skull beneath the cut and the firm covering of the brain is opened.

The probe is placed a few centimetres into the brain. The probe is connected to a electronic measuring device which monitors the brain pressure.

The probe will stay in place for a few days or until the pressure has stabilised.

The cut will be closed with sutures or staples.

Posterior Fossa Decompression

A Posterior Fossa Decompression is done to relieve the constriction and create more space at the base of the brain.
The procedure involves a cut being made into the tissues at the back of the head and the neck bones covering the base of the brain.

A small section of bone is removed from the base of the skull and at times from the upper back. In many cases the above procedure is enough to relieve the constriction and nothing further is required.

However, in some cases there is a tight band of tissue or scar tissue around the base of the brain which constricts the lining of the brain.

For this reason the lining of the brain is opened to allow further relief. Through a separate cut, a tissue graft is taken from the patient’s thigh and placed in the opening of the brain. It is stitched into position to widen the opening and create more space for the base of the brain.

The bone will be left out and the cut is closed with sutures or clips.

Stereotactic Biopsy of Cerebral Space Occupying Lesion

This procedure is performed to take a small sample of the lesion inside your brain. It is taken to identify the lesion which then determines the appropriate treatment for you.

A small cut is made in the skin which allows a small hole to be drilled into the skull beneath the cut. The firm lining of the brain will be opened.

Using computer guidance a thin biopsy needle is passed into the lesion within the brain. Small samples of the lesion are taken and sent to pathology for examination.

The cut is closed with stitches and staples.

Transsphenoidal Removal for Pituitary Tumour

This procedure is performed to remove a pituitary tumour in the pituitary gland. The tumour is reached by working through the nose.

To accurately localise your tumour a computerised guidance system and a microscope is used to assist with the surgery.

By working through one nostril, a hole is made at the back of the nose into the sphenoid sinus, through a layer of bone between the sphenoid sinus and the pituitary gland to gain access to the tumour.

To help fill the hole from where the tumour was removed, it may be necessary to remove small pieces of fat and other tissue through a small cut in your thigh.

Tissue glue may be used to secure the tissue fat and other tissue in place. This helps to prevent leakage of brain (cerebrospinal) fluid.

The cut in your leg will be closed with sutures and the nose packed with a spongy material.

Brain Tumors

A brain tumor is the growth of abnormal cells in the brain. When most normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body doesn’t need them, and old or damaged cells don’t die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.

Facial Pain

Facial pain is a painful condition that may affect one or both sides of the face or forehead. Facial pain may arise due to injury, infection in facial structures, nerve disorders or from unknown reasons.

Gamma Knife Surgery

Gamma Knife surgery, also referred as stereotactic radiosurgery, is a highly advanced non-invasive neurosurgical procedure for treating various brain conditions and tumors. The gamma knife surgery does not involve anything related with a knife, but actually employs radiation for treatment. Gamma knife contains radiation sources that are placed in a circular set in a heavily shielded unit. The unit directs precise gamma radiation to the selected target area in the brain. These beams are very safe and do not affect the functioning of the brain tissues through which they pass and that of the surrounding tissues.

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