Neurosurgery

Minimally Invasive Surgery (MIS) is surgery performed through one or more small incisions rather than a large opening. Guided by advanced imaging technology, the surgeon inserts small instruments and devices through these incisions to perform the procedure. Over the last 15 years, MIS has grown exponentially as new devices, instruments, techniques and medications have developed. In the case of neurosurgery, most MIS procedures are performed on the spinal cord, though some are done on the brain.

MIS offers several benefits over traditional open surgical procedures. Rather than cut through muscle fibers attached to the spine, the surgeon can gently separate them temporarily. At the same time, tendons and ligaments attached to the spine can remain intact with less damage to muscles and joints. There is less scar tissue and blood loss with MIS, along with shorter recovery time and less pain for the patient.

Some of the most common neurological MIS procedures include:

• Extra-Foraminal Decompression (EFD) to remove a bone fragment that has been forced outside the spinal column by compression and rests under a nerve.
  
• Microendoscopic Discectomy (MED) to repair a ruptured (herniated) disc.
  
• Microendoscopic Lumbar Decompression (MELD) to repair a narrowed section of the spinal column (lumbar stenosis).
  
• Minimally Invasive Surgical Extreme Lateral Interbody Fusion (MIS XLIF) to remove a damaged disc and fuse the remaining discs from a side approach. This technique reduces the chance of nerve damage and scar tissue.
  
• Minimally Invasive Surgical Posterior Lumbar Interbody Fusion (MIS PLIF) to fuse discs by making incisions on both sides of the spine. This technique uses stabilizing rods, screws and implants and is often performed when there is nerve damage or spinal narrowing.
  
• Minimally Invasive Surgical Transforaminal Lumbar Interbody Fusion (MIS TLIF) to fuse two ruptured discs with stabilizing screws by approaching from one side of the spine.

Craniotomy (brain surgery) is surgery performed to remove or repair abnormalities within the brain. In some cases, thanks to recent technological advances, surgeons and patients can choose among two or even three surgical alternatives to achieve the same result.

One alternative is traditional surgery in which a piece of skull is removed, allowing access to the problem area, and then replaced after the procedure is complete. A less invasive alternative is Gamma Knife radiosurgery, which focuses a tiny beam of highly concentrated radioactive material at the problem area. Generally, less invasive procedures are preferred because they are less disruptive and heal more quickly than traditional techniques.

Some common brain surgery procedures include:

• Acoustic Neuroma Tumor Surgery to remove a tumor on the nerve that carries sounds from the ears to the brain. This procedure can usually be performed with an open craniotomy or with radiosurgical techniques.
  
• Aneurysm Surgery to repair a weak spot where an artery in the brain is bulging outward and could burst. The surgery can be performed by open craniotomy, placing a tiny clip on the aneurysm itself or, in some cases, by a new technique called endovascular embolization. This technique uses tiny platinum coils, inserted through a catheter in the leg. The coils are placed at the site of the aneurysm by maneuvering them through the catheter inside the artery. When they are inserted, they strengthen the weak spot in the artery wall and prevent the blood vessel from bursting open.
  
• Arteriovenous Malformation (AVM) Surgery to remove abnormal blood vessels in the brain that could cause blood clots or seizures if left untreated. In many cases, depending on specific circumstances, this procedure can be performed by open craniotomy, endovascular embolization or radiosurgery.
  
• Brain Tumor Surgery to remove tumors found in many areas of the brain, including the pituitary gland, brain stem, central nervous system and other locations. This procedure can often be performed either by open craniotomy or radiosurgery.
  
• Pituitary Tumors (Transsphenoidal procedure) to remove tumors in the pituitary gland. In most cases, because of the location of the gland, the surgeon approaches the tumor by making an incision in the nasal cavity or upper gum line. This procedure is considered less invasive than open craniotomy, with faster recovery time and fewer side effects.
  
• Epilepsy Surgery to sever the nerves that connect the brain's right and left lobes. This procedure protects one half of the brain from some epileptic seizures by confining the focal point to the other half.
  
• Vagus Nerve Stimulation (VNS) to reduce seizures in some Epilepsy patients whose condition doesn't respond to medication. The surgeon connects tiny lead wires to a small battery implanted in the chest. The wires are attached to the Vagus Nerve, which controls movement in many parts of the body. The electric stimulation to the nerve can have the effect of controlling seizures.
  
• Deep Brain Stimulation (DBS) to treat tremors, rigidity and other debilitating symptoms of Parkinson's disease and other neurological movement disorders. With this procedure, the surgeon implants a neurostimulator that sends electrical signals to specific areas deep inside the brain where muscle movement is controlled. The signals can prevent tremors and other symptoms.

Much of neurosurgery involves the spinal cord. The spine is made up of separate bones (discs) that are stacked and connected to muscles, ligaments and other soft tissue. As an integral part of the skeleton, the spinal column literally holds the body upright. At the same time, nerves that carry information to and from the brain run along the inside of the spinal column. These nerves control the muscles that enable movement throughout the body.

Because it performs these dual critical functions (skeletal support and a conduit for nerve fibers), the spine is sometimes susceptible to injury from overuse or degeneration. For example, sometimes small bony parts of the the individual discs of the spine break off, or nerve cells inside the column might get pinched between the disks. Or discs break down because of disease.

Surgeries to correct these and other spine and neck problems include:

• Decompressive laminectomy to remove bone tissue that causes the spinal column to become narrow. This narrowing is usually the result of a herniated disc, tumor or injury.
  
• Discectomy to remove a disc in the cervical spine (neck) or elsewhere in the spinal column. This procedure relieves pressure on the nerve, along with symptoms such as weakness, tingling, numbness and pain.
  
• Laminectomy to take the pressure off a pinched nerve that is caught between two pieces of disc material. Neurologists perform this procedure on patients with spinal stenosis.
  
• Laminotomy to remove a small part of the lamina (small plates that protect each spinal disc) and the ligaments attached to it.
  
• Spinal fusion to stabilize the spinal column by grafting some of the discs together. This procedure treats patients with scoliosis, degenerative disc disease, spondylolisthesis or a spinal fracture. The rods and screws sometimes used in spinal fusion were developed by neurosurgeons at Baptist Health.
  
• Stereotactic Radiosurgery to zap a tumor in the spine using radiation that is highly focused on the site. This procedure, similar to radiosurgery for brain tumors, is less invasive than traditional open surgery with a scalpel.