Surgery in Neurological Diseases - An Overview

Introduction

Neurosurgery or brain surgery is done for patients with any disorder affecting the brain and nerves in the body. The brain is the most important organ weighing about three pounds and makes up only about two percent of the total body weight. Being a critical organ, it is protected by a hard skull and cushioned by the cerebrospinal fluid. It regulates all the activities in the body. Hence, any disorder in the brain can cause abnormal activity and needs immediate treatment. The surgery on the brain is complicated and performed only by a specialist, namely the neurosurgeon.

What Are the Reasons for Brain Surgery?

Brain surgery is done when there is any damage or disease of the brain. The damage to the brain can be traumatic or acquired.

• Traumatic brain injury is caused due to an external force (accidents, violence, etc.) that damages the skull, affecting the brain.

• Acquired brain injury is due to infection, tumor, stroke, or any neurological illness that increases the pressure on the brain.

Both traumatic and acquired brain injury occur after birth. During or before birth, the damage caused to the brain by trauma during delivery or genetic mutations is referred to as congenital brain injury.

A few other reasons for the surgery are:

• Hemorrhage (bleeding) in the brain.

• Brain aneurysm (a condition causing a bulge in the wall of blood vessels).

• Brain abscess.

• Diseases causing facial pain like trigeminal neuralgia.

• Diseases affecting the nervous system, such as Parkinson's disease.

• Hydrocephalus (swelling within the brain due to fluid build-up).

What Are the Symptoms of Brain Damage?

Since the brain, nerves, and spinal cord are involved in almost all functional activities, numerous changes can be noticed with its damage. They can be categorized into cognitive, perceptual, physical, and emotional symptoms. The cognitive symptoms include:

• Memory loss.

• Difficulty in paying attention, understanding, and processing information and thoughts.

• The ability to make decisions becomes poor.

The perceptual symptoms include:

• The balance of the body is affected.

• Disorientation.

• Altered sensation to touch, vision, hearing, smell, and taste.

The physical symptoms include:

• Headache.

• Fatigue.

• Altered consciousness.

• Sleep disorders.

• Seizures (sudden uncontrolled body shaking due to abnormal electrical activity in the brain).

• Weakness.

• Speech impairment.

The emotional symptoms include:

• Fluctuations in emotional reactions.

• Irritability.

• Aggression.

• Cannot tolerate stress.

What Are the Investigations Done to Detect a Neurological Disease?

The neurosurgeon makes the patient undergo various tests for the proper diagnosis and treatment plan. Some investigations include

• Electroencephalogram (EEG) measures brain activity.

• Electromyography (EMG) measures nerve and muscle activity.

• Evoked potential (EP) measures electrical activity in the brain and spinal cord.

• Computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound produce images of the hard and soft structures of the brain.

• A myelogram is an imaging technique using contrast dye and a CT scan to detect nerves and spinal cord abnormalities.

• A sleep study is done to evaluate the sleep-wake cycle and brain activity.

• A lumbar puncture (a thin needle inserted between the bones in the lower spine region) is performed to diagnose problems in the cerebrospinal fluid.

• Neuroendocrine studies are done to know the hormone levels of endocrine glands such as pituitary in case of pituitary tumor.

What Are the Types of Neurological Surgeries Performed?

There are many different types of neurological surgeries. All of them are done under general anesthesia or sedation. Some of the most common types of neurosurgery include:

1. Craniotomy - Craniotomy refers to removing a part of the skull to visualize the brain for surgeries involving the removal of blood clots, tumors, and aneurysms. It also treats skull fractures and relieves pressure after injuries or strokes.

2. Biopsy - Biopsy refers to removing a small portion of brain cells or tissue to confirm any abnormalities detected by imaging studies. The tissue sample drawn is then sent to the pathologist for examination.

3. Deep Brain Stimulation - This procedure is used in conditions like Parkinson’s disease (a disease affecting the nerves) and seizures. It uses a battery-operated device wherein the electrode leads are placed in specific brain regions. The electrodes generate electrical impulses to stimulate the brain in specific areas. A pacemaker-like device is placed on the upper chest to control the amount of stimulation.

4. Neuroendoscopy - Neuroendoscope is a long tube with a camera attached to one end. It can be introduced through the mouth, nose, or an incision made on the skull. This procedure helps remove skull lesions or tumors of the pituitary gland, which is located near the bridge of the nose.

5. Posterior Fossa Decompression - The surgery is helpful in conditions like Chiari malformation (a structural defect in the cerebellum due to inadequate space and pressure build-up). An incision is made on the back of the skull, and a small portion of the skull bone is removed. The removal helps provide adequate space to the cerebellum and relieves pressure.

6. Cerebral Aneurysm Repair - This is done by removing a portion of the skull bone, locating it, and placing a metal clip on the aneurysm to restrict blood flow.

7. Thrombectomy - Thrombus refers to any blood clot. Thrombectomy is the removal of the clot. Here, a thin wire with a contrast dye is introduced through the groin to the blood vessels of the head. The affected blood vessel is identified, and the clot is removed.

What Is Awake Brain Surgery?

In this type of brain surgery, the patient is sedated, and local anesthesia is given to the scalp. The patient remains slightly conscious during the surgery to answer or make movements that the surgeon commands. This helps the surgeon ensure normal vision, hearing, memory, and speech functioning. Brain tumors near critical areas are treated by this method.

What Are the Risks Involved With Neurosurgery?

Brain surgery is a complex procedure, and several risks can be involved that must be resolved as soon as possible.

• Impairment in speech, vision, balance, and coordination.

• Memory loss.

• Blood clot.

• Hemorrhage (bleeding) in the brain.

• Stroke (due to the poor blood supply to the brain).

• Brain swelling.

• Coma (brain death causing prolonged unconsciousness).

• Seizures.

• Infection at the site of the wound.

What Are the Advancements in Neurosurgery?

1. Stereotactic Radiosurgery - It is not a surgery involving any cuts or incisions on the body. The procedure is a type of radiotherapy used to treat brain tumors and other functional abnormalities.

2. Laser Interstitial Thermal Therapy - Laser therapy is used for lesions that are difficult to access through standard surgical procedures. The laser generates heat that removes the tumor without damaging the adjacent tissues.

The techniques mentioned above are some of the advancements used for the precise treatment of neurological conditions.

Conclusion

Surgery for neurological diseases is a complex procedure, and a precise treatment performed by an experienced neurosurgeon is essential for improving the patient’s quality of life after surgery. Any symptoms related to brain damage or disease must be consulted with the physician to prevent further complications. With the advancements in the field of neurosurgery, the outcome has improved substantially.