Neurosurgery is a surgical specialty concerned with the diagnosis and surgical treatment of disease of, and trauma to, the nervous system (the brain, spinal cord and nerves). As this is a specialty office, we do encourage you to have a primary care physician.



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    Neck (Cervical Spine) Surgery

Anterior Cervical Discectomy and Fusion
Anterior Cervical Discectomy and Fusion (ACDF) is a procedure used to ease neck and arm pain caused by pressure on the spinal nerves in your neck. In this procedure, the surgeon enters the neck from the front and removes a spinal disc to relieve pressure on the spinal cord and nerves. The vertebrae above and below the disc are then held in place with bone graft and sometimes metal hardware.

Posterior Cervical Laminectomy with and without Fusion
Posterior cervical decompression with and without fusion is done to help relieve neck and arm pain caused from pressure on the spinal nerves in your neck. The cause of the pressure on the nerves may be related to a herniated disc, bone spurs, stenosis, or an unstable spine (spondylolisthesis). Our surgeons will remove the pressure on the spinal nerves and may need to lock together (fuse) two or more vertebrae to keep the bones from shifting out of alignment.

Disc Replacement Surgery
Disc replacement surgery is recommended for patients who have a degenerative disc causing pressure on the spinal cord or nerve. An artificial cervical disc is inserted between two cervical vertebrae after the disc has been surgically removed to decompress the spinal cord or a nerve root. The disc replacement allows for retaining as much normal motion as possible while keeping the motion segment stable.

Posterior Cervical Laminoplasty
Posterior cervical Laminoplasty is a procedure intended to relieve pressure on the spinal cord and nerves at multiple levels of the cervical spine. The laminoplasty procedure involves "hinging’ one side of the bones (vertebrae) of the spine and cutting the other side to form a "door" The door is then opened and held in place with wedges of bone to relieve the pressure on the spinal cord and nerves.

Occipital Cervical Fusion
The goal of occipital cervical fusion surgery is to stabilize the junction where the base of the skull attaches to the neck. A procedure that usually involves fusing the bony anatomy of the craniovertebral junction using titanium plates and screws and bone grafts.

Minimally Invasive Procedures
Minimally invasive surgery uses a much smaller incision, generally about an inch in length. This type of surgery creates a small tunnel through the muscles in the neck down to the area where the herniated disc or nerve compression is located.

Spine Tumors
A spinal tumor is a growth of cells (mass) in or surrounding the spinal cord and nerves. The goal of treatment is to reduce or prevent nerve damage from pressure or (compression of) the spinal cord and nerves, and reduce pain.



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    Mid-Back (Thoracic Spine) Surgery

Thoracic Sympathectomy
Thoracic sympathectomy is done most commonly for excessive sweating in the face, palms of the hands, and axilla (underarms. The condition is known as hyperhydrosis. During surgery, tiny clips are placed on the sympathetic nerves to relieve these symptoms.

Dorsal Column Stimulator
Spinal Cord stimulation, also known as dorsal column stimulation, uses a device that is surgically implanted to send mild electric signals to your spinal cord. A small wire called a lead carries the shocks from a battery implanted into your abdomen to the nerve fibers of the spinal cord. Stimulation does not eliminate the source of pain, it simply interferes with the signal, and thus the amount of pain relief varies for each person. Trial stimulation takes place by pain management specialists or a physiatrist (Doctor who specializes in physical medicine), prior to a referral to our office.

Spine Tumors
A spinal tumor is a growth of cells (mass) in or surrounding the spinal cord and nerves. The goal of treatment is to reduce or prevent nerve damage from pressure or (compression of) the spinal cord and nerves, and reduce pain.



Neck Surgery  |   Thoracic Surgery  |   Low-Back Surgery |   Brain Surgery  |   Peripheral / Cranial Nerve Procedures



    Low-Back (Lumbar Spine) Surgery

Laminectomy with Discectomy
Laminectomy and discectomy is a surgical procedure most often performed to treat leg pain related to a herniated disc that is pressing on a nerve. It is designed
to take the pressure off the nerve by removing the portion of the disc that is pressing on the nerve, leaving the nerve with a better healing environment.

Decompressive Laminectomy with and without Fusion
Lumbar decompression with and without fusion is done to help relieve back and leg pain caused from pressure on the spinal nerves in your lower back. The cause of the pressure on the nerves may be related to a herniated disc, bone spurs, stenosis, or an unstable spine (spondylolisthesis). Our surgeons will remove the pressure on the spinal nerves and may need to lock together (fuse) two or more vertebrae to keep the bones from shifting and pressing on nerves.

Interspinous Process Decompression (X-STOP)
Interspinous Process Decompression (X-STOP) is done to relieve back and leg
pain caused from stenosis or narrowing around the spinal nerves. The surgeon
places a spacer between two bones called spinous process in the back of your spine. This can be done as an outpatient procedure.

Tethered Cord
A tethered cord occurs when the spinal cord becomes attached, or tethered to the surround tissue, usually at the base of the back. It this happens, the cord itself will become tight and stretched, leading to symptoms of nerve damage such as weakness or numbness in the legs, back pain, and trouble controlling the bladder or bowels. Surgery may be recommended to prevent further neurological deterioration.

Myelomeningocele / Spina Bifida Repair
Myelomeningocele is a birth defect in which the backbone and spinal canal do not close before birth. The condition is a type of spina bifida. the unfused portion of the spinal column allows the spinal cord to protrude through an opening. To prevent further damage of the nervous tissue and to prevent infection, the surgeons will operate to close the opening on the back.

Minimally Invasive Procedures
Minimally invasive procedures use a much smaller incision, generally about an inch in length. This type of surgery creates a small tunnel through the muscles in the back down to the area where the herniated disc or nerve compression is located.

Pain / Baclofen Pumps
A baclofen/pain pump is used to treat moderate to severe spasticity/pain in patients. Spasms/pain may occur in a patient’s torso, arms, and/or legs. A patient is normally screened through Mary Free Bed or a pain clinic, where they undergo baclofen/pain medication trials. If they are a candidate then surgery is required to insert the pump. It is inserted under the abdominal muscles and then a small catheter is tunneled under the skin. This catheter runs from pump to a specific level in the patient’s spine. The pump is then programmed by computer to continuously release a specified dose of medication that is determined by the physician.

Spine Tumors
A spinal tumor is a growth of cells (mass) in or surrounding the spinal cord and nerves. The goal of treatment is to reduce or prevent nerve damage from pressure or (compression of) the spinal cord and nerves, and reduce pain.



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    Brain Surgery

Tumors
A brain tumor or neoplasm refers to a "new growth" of cells in the brain. These often cause headaches, seizures, or other neurological deficits. Brain tumors can occur in various areas of the brain (skull based, frontal, etc). Tumors can be either benign or malignant. Malignant tumors are referred to as cancerous and benign are not cancerous. Treatments can consist of surgical resection or removal, biopsy, radiation or chemotherapy. Other tumors can be treated with modification of the body's own immune system (immunotherapy). This all depends on the pathology of the tissue sample taken from the tumor.

A craniotomy is an operation of the skull in which the bone covering the brain is removed so the surgeon can gain access to the brain. This maybe done to either remove/repair abnormal structures in the brain or to reduce pressure beneath the skull. The skull bone after surgery is then placed back.

Craniectomy is an operation in which the skull is entered by removing small pieces of bone. This is used for tumors of the posterior fossa (back of the head). Unlike a craniotomy, the removed pieces of bone are not reinserted into the skull. Following surgery, a soft spot may be felt in the area of the scar.

Cerebrovascular (AVM and Aneurysms)
An aneurysm is a blood filled bulge (balloon-like) that comes off an artery wall. The bulge is caused by a weakening of an artery wall. Some factors that may cause this are uncontrolled high blood pressure, smoking, family history of an aneurysm, etc. An aneurysm can rupture or leak, causing a hemorrhagic stroke. Options depending on the size and location of an aneurysm are either coiling or clipping.

An arteriovenous malformation (AVM) is a congenital disorder of blood vessels. It is a tangled bed of arteries and veins. These can cause bleeding, seizures, headaches, and other neurological problems. An AVM can occur in a variety of locations in the brain and also may vary in size/shapes. Treatment may consist of observation, surgical resection, embolization, radiosurgery, or a combination of options

Skull Base Surgery
Skull-based tumors lie deep within the skull/brain tissue making them more difficult to remove. These masses may be found tangled in tissue or twisted around neural end vascular structures. There are many different kinds of skull based tumors. The treatment option depends on the size and location of the tumor. Surgery may be coordinated with other specialists such as an ENT (ear, nose, and throat) doctor or a neuro-otologist, etc. Our practice offers all available approaches to skull base tumors including endoscopic, endonasal and transpetrosal as indicated by the type and location of the tumor. Based on the pathology of the tumor a patient may need to have periodic imaging done or to follow with an oncologist for further treatment options.

Subdural Hematoma
A subdural hematoma is a collection of blood in the space between the outer layer (dura) and middle layers of the covering of the brain (the meninges). This may be caused by torn, bleeding veins on the inside of the dura as a result of a blow to the head. A person can also get this simply by falling. Small subdural hematomas may not be very serious, and the blood can be slowly absorbed over several weeks. Larger hematomas, however, can gradually enlarge over several weeks, even though the bleeding has stopped. This is why follow up imaging is needed. Surgery might possibly be indicated as well depending on the size of the bleed, location, and a patient’s medical condition.

Chiari Malformation / Syringomyelia
A Chiari malformation occurs when the a portion of the cerebellum ( part of the brain responsible for fine motor control) protrudes thru the foramen magnum ( the opening at the base of the skull ). This can result in cerebrospinal fluid accumulating in the spinal cord, also known as syringomyelia or syrinx. To relieve pressure on the brain, spinal cord and cranial nerves, the surgeon may remove a small portion of bone from the base of the skull and/or remove a portion of the upper cervical vertebrae.

Cranioplasty
Cranioplasty is an operation that will put a patient’s cranial bone back on. However, if there is no bone available, then the skull defect may be repaired with an artificial bone product.

Hydrocephalus
Hydrocephalus is sometimes referred to as "water on the brain." It is an abnormal accumulation of fluid, cerebrospinal fluid (CSF). This fluid cushions the brain and spinal cord from injury. Hydrocephalus is normally treated surgically by placing a shunt. This device diverts the fluid from the ventricles of the brain to another area of the body, most often in the abdomen. One tip of the catheter is placed in the ventricles and the other in the belly.



Neck Surgery  |   Thoracic Surgery  |   Low-Back Surgery  |   Brain Surgery  |   Peripheral / Cranial Nerve Procedures



    Peripheral / Cranial Nerve Procedures

Ulnar Nerve
Ulnar nerve compression presents as numbness on the inside of the hand and in the ring and little fingers. The goal of surgery is to release the pressure on the ulnar nerve where it passes through the cubital tunnel. In this surgery, the surgeon forms a completely new tunnel from the flexor muscles of the forearm. The ulnar nerve is then moved out of the cubital tunnel and placed in the new tunnel.

Carpal Tunnel
Carpal tunnel syndrome is caused by compression of the median nerve in the wrist. Surgical treatment for this condition involves releasing the nerve by cutting the ligament at the bottom of the wrist. This is usually done as an outpatient procedure with local anesthesia or mild sedation.

Vagus Nerve Stimulator
The vagus nerve is a cranial nerve that helps control many involuntary body functions. The vagus nerve stimulator is implanted to help control seizures and depression. Two small wires are placed around the vagus nerve on the left side of the neck and the wires are connected to a small generator implanted in the chest. A neurologist or psychiatrist will make the referral for you to our office. They will program and adjust the settings after the placement of the vagus nerve stimulator.

Cochlear / Vestibular / Acoustic Neuromas
Acoustic Neuroma, also known as vestibular schwannomas are tumors arising from a branch of the 8th cranial nerve (vestibulocochlear). The nerve is responsible for hearing and balance. Our surgeons perform microsurgery often with a neurotologist, to remove the mass.

Trigeminal Neuralgia
Trigeminal neuralgia is a disorder of the fifth cranial trigeminal nerve that causes sudden stabbing or shooting pains across portions of the face. Some cases of trigeminal neuralgia are caused by irritation of the nerve by a vein or artery. Our surgeons perform a microvascular decompression of the nerve. A small opening is made in the skull behind the ear and the blood vessel that is compressing the nerve is moved away from the nerve. A small pad may be placed between the nerve and the vessel.

Our surgeons also assist radiation oncologist with the stereotactic radiosurgery that delivers a single dose of radiation to the nerve to gradually decrease pain.



Neck Surgery  |   Thoracic Surgery  |   Low Back Surgery  |   Brain Surgery  |   Peripheral / Cranial Nerve Procedures



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