General Neurosurgery
Brain Tumours:
A brain tumour is an abnormal growth of cells within the brain. Some tumours are not-cancerous (benign) and others are cancerous (malignant). Due to the closed space of the skull both types can cause problems and need treatment.
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Symptoms of brain tumours vary depending on the location and the size of the tumour and can include:
Headaches
Fits or seizures
Nausea or vomiting
Weakness, numbness or difficulty with movement
Vision changes
Abnormal speech
Difficulties with balance
Memory or personality change
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Brain tumours are usually diagnosed using CT or MRI scans and may require contrast
A biopsy is usually required for a confirmed diagnosis
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Observation with regular scans for follow-up
Supportive treatments to control and reduce symptoms
Surgery – to remove as much of the brain tumour safely and minimising damage to the patient
Radiotherapy – using focused radiation therapy to kill tumour cells and reduce progression
Chemotherapy – using medical therapies to destroy tumour cells and reduce progression
Treatment response is variable and depends on the tumour type and location
Spinal Disease:
Spinal diseases include problems with the spine, spinal cord and nerves that may require surgery. These diseases include disc prolapses or bulges, spinal stenosis (narrowing of the spinal canal), spinal tumours, spinal instability or trauma to the spine.
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Back pain
Nerve pain e.g. sciatica or arm pain
Numbness in the arms or legs
Difficulty walking
Difficulty passing urine or faeces with incontinence
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Diagnosis of spinal diseases usually need CT and MRI scans
Dynamic x-rays or MRI may be required to demonstrate spinal instability
Bone density scans may be required to examine bone quality
Nuclear medicine bone scans (CT SPECT) may be needed to show areas of high bone turnover
Nerve conduction studies may be required to localise the specific level of nerve involvement
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Conservative management is usually first-line treatment with pain medications and spinal physiotherapy
X-ray guided nerve injections of a combination of steroid and local anaesthetic may be useful in symptom management and diagnosis
Surgery may be needed in cases that have failed conservative management
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Discectomy – removing part of a prolapsed disc that is pressing on a nerve
Laminectomy/decompression – surgery to remove the pressure on the spinal cord or nerves
Spinal fusion – stabilization of the spine with metal implants and bone graft
Tumour removal – removing part or all of an abnormal growth that is causing pressure on spinal cord or nerves
Peripheral Nerve Disorders:
Peripheral nerves are those nerves that take signals between the brain and spinal cord and the rest of the body. These nerves can be injured, compressed or affected by abnormal growths or tumours.
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Symptoms depend on the specific nerve affected and the location of the problem, may include:
Pain, or burning sensations in the arms, legs, feet or hands
Numbness, tingling or “pins and needles” sensations
Weakness or wasting of associated muscles
A tenderness or swelling along the nerve (in cases of tumours)
Loss of coordination or difficult using the affected limb
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Primarily history and neurological examination – to localize the nerve problem and the strength, sensation and reflexes
Nerve conduction studies – assess how well the nerves and muscles
MRI or ultrasound – imaging to look for nerve compression or evidence of tumours
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Treatment depends on the cause and the severity of the symptoms, options include:
Non-surgical conservative management with pain medications, physiotherapy, splints and in some cases injections of local anaesthetic and steroids
Decompressive nerve procedures – e.g. carpal tunnel syndrome, ulnar nerve entrapment – releases the pressure on the nerve
Nerve tumour procedures – removal of benign or malignant tumours affecting the nerve
Nerve reconstruction – in cases of injury to nerve may require repair or nerve grafting
Hydrocephalus:
Hydrocephalus is a condition where there is fluid build up in the brain. Too much of this fluid (Cerebrospinal fluid – CSF) can cause increased pressure on the brain which may require treatment.
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Symptoms varies depending on the age of the patient:
In babies and children
Increasing head size with bulging of the soft spots on the skull (fontanelles)
Poor sleep and feeding
Irritability
Cognitive and developmental delay
Vomiting
Seizures
In adults
Headaches
Nausea and vomiting
Blurred vision, double vision or blindness
Difficulty walking and problems with balance
Memory and cognitive difficulties
Loss of balder control
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CT and MRI scans – can show evidence of the fluid build-up and potentially the cause
Special tests such as a lumbar puncture or pressure monitoring may be required to measure CSF pressure and flow
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Aim of treatments is to reduce the fluid build-up and relieve the increasing pressure
Shunt surgery – A tube is placed in the fluid spaces in the brain (ventricles) and connected to a valve and catheter that drains the fluid elsewhere in the body such as the abdomen
Endoscopic third ventriculostomy – Using a small camera an opening in the venrtricles is made to allow fluid to flow more normally
Trigeminal Neuralgia
Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensory information from the face. It is characterised by severe episodes of facial pain. Although not life-threatening, it can be very distressing and affect daily activities such as eating, talking or brushing teeth.
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Sudden, severe, stabbing or electric shock-like facial pain
Pain usually confined to one side of the face
Attacks last a period of seconds to minutes but can be repeated
Pain is often triggered by everyday activities such as talking, eating, shaving, or touching the face
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Usually made based on description of symptoms
MRI is used to look for other possible causes of facial pain (multiple sclerosis or a brain tumour) and to look at compression of the trigeminal nerve by a blood vessel
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Medical therapy is first line with treatment with anti-seizure medications such as carbamazepine or oxcarbazepine to control the nerve pain – other medications may be trialled if pain remains uncontrolled
A number of procedures can be used to treat cases where medication is ineffective or poorly tolerated
A microvascular decompression is a surgical procedure performed under a general anaesthetic, where a small opening is made in the skull behind the ear, and the blood vessel is moved away from the nerve, and a tiny cushion is placed to prevent further irritation of the blood vessel to the nerve
This procedure can provide long-lasting pain relief but has some risks, such as infection, cerebrospinal fluid leak, hearing loss, facial weakness, stroke or pain recurrence
Other ablative procedures may be used to damage part of the nerve to reduce the pain signals transmitted by the nerve. These include:
Radiofrequency ablation: where heat is used to selectively destroy part of the nerve
Balloon compression: a small balloon is inflated near the nerve to damage pain fibres
Glycerol injection: a chemical irritant is injected to injure the nerve fibres
Ablative procedures are shorter and less invasive than surgery and can give good relief, but cause facial numbness or tingling and pain has a greater chance to recur
For Referring Doctors
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