Neurosurgery is the medical specialty concerned with the diagnosis and treatment of disorders or injuries to the brain, spinal cord and peripheral nerves (such as nerves in the hands or feet).

Spinal Surgery

Microdiscectomy
In general, a herniated lumbar disc is a fragment of disc material that has exuded through a tear in the covering surrounding it. The disc fragment exudes out and presses upon a nearby nerve to create pain and disability. Deciding whether or not to have surgery for the disc herniation depends upon the amount of disability the person is experiencing and the neurological signs an individual might have. With a herniated lumbar disc, patients will many times be given a course of conservative care to include rest at home, physical therapy, chiropractic manipulation, or epidural steroid injections. Should one or more of these measures fail to improve the patient significantly; the patient will then go on for a diagnostic study such as an MRI or an immediate evaluation by a neurosurgeon.

The technique of the laminotomy and microdiscectomy is a commonly performed back operation with over a 90 percent chance of improvement of pain and symptoms in the patients receiving the surgery.
A small incision is made in the back with the patient either asleep or under spinal anesthesia. The muscle immediately underneath is dissected to expose the roof of the bone (lamina). This lamina is over the top of the nerve. Small portions of this bone are then removed to expose the nerve underneath. The nerve is then dissected and held to one side, and the disc fragment that had exuded out and pressed upon the nerve is then removed. At this point, the surgeon can remove some more disc material within the disc space if he or she feels that further disc material might exude out to hurt the patient again. No matter how aggressively the removal of the disc material within the disc space is performed, there will always be some remaining disc material left behind. Most of the patients receiving the microdiscectomy and/or laminotomy go home a day after surgery. Some patients have been able to be discharged the day of surgery.

Fusion/Instrumentation
Surgery for the spine involves a variety of approaches and techniques. First know that a laminectomy is not a discectomy is not a fusion is not an instrumentation.

A laminectomy is a removal of the roof of bone over the surface of the spinal cord and involves an incision on the back or back of the neck. A laminectomy is performed to either decompress the underlying nerve or spinal cord or to gain access to the inside of the spinal column so that the surgeon can remove disc or tumor. A laminectomy can sometimes be combined with a removal of a portion of the facet to further decompress the nerve or to gain further surgical access for the rest of the procedure.

Discectomy can be accomplished in several ways. If there is a herniated fragment, the surgeon can perform a small laminectomy (laminotomy) and remove the fragment. Many times the surgeon can choose to remove more disc material within the disc space in an effort to prevent more material from herniating out later. Not all discectomies require an approach from the back however. The approach that a surgeon chooses for the disc problem is tailored to the anatomical location of the herniation (cervical, thoracic, or lumbar), whether the degeneration or herniation is central or lateral, and the degree that the disc is pressing upon the spinal cord.

A fusion is the placement of bone in a joint space to prevent that joint from moving. This is done when it is felt that the movement is counterproductive or even dangerous for the patient. In these cases the patient can have severe degeneration of the disc and vertebral body such that movement in the particular area constantly elicits pain or neurological deficit. A fusion can also be necessary in the face of major spinal cord trauma. Fusion can also be required when a large amount of bone and joint has been destroyed by infection or tumor.

Instrumentation is a surgical process that many times goes hand in hand with fusion. Instrumentation is a general term indicating that some form of metal was applied to the spine during the surgical procedure. The metal is generally titanium because it is lightweight, very strong, and better able to be visualized in the MRI. The forms that instrumentation takes are diverse and designed to fit any spinal problem that the surgeon faces. It includes metal plates with screws and bolts designed to strut the front of two vertebral bodies, interpedicular screws to bore into the vertebral body and be interconnected with a rod to prevent motion of two segments, and cages that are placed within the disc space and filled with morselized bone to create a fusion. The decision as to what type of instrumentation to use or whether to use it at all rests with the surgeon and his or her experience when confronting a particular complex spine problem.

Tumor
The body is made up of many types of cells. Each type of cell has special functions. Most cells in the body grow and then divide in an orderly way to form new cells as they are needed to keep the body healthy and working properly. When cells lose the ability to control their growth, they divide too often and without any order. The extra cells form a mass of tissue called a tumor. Tumors are benign or malignant.
Benign brain tumors do not contain cancer cells. Usually these tumors can be removed, and they are not likely to recur. Benign brain tumors have clear borders. Although they do not invade nearby tissue, they can press on sensitive areas of the brain and cause symptoms.

Malignant brain tumors contain cancer cells. They interfere with vital functions and are life threatening. Malignant brain tumors are likely to grow rapidly and crowd or invade the tissue around them. Like a plant, these tumors may put out "roots" that grow into healthy brain tissue. If a malignant tumor remains compact and does not have roots, it is said to be encapsulated. When an otherwise benign tumor is located in a vital area of the brain and interferes with vital functions, it may be considered malignant (even though it contains no cancer cells).

Doctors refer to some brain tumors by grade-from low grade (grade I) to high grade (grade IV). The grade of a tumor refers to the way the cells look under a microscope. Cells from higher grade tumors are more abnormal looking and generally grow faster than cells from lower grade tumors; higher grade tumors are more malignant than lower grade tumors.

Vascular Neurosurgery
Aneurysms of blood vessels in the brain are a fairly common problem. In fact, approximately ten percent of people may have aneurysms that do not cause any symptoms at all. However, an aneurysm can rupture and cause bleeding in the brain. Once discovered, an aneurysm usually is treated to prevent further bleeding over time. The aneurysm is a small area on a blood vessel where there has been a weakening that slowly enlarges over time and can rupture.

For some aneurysms, the treatment of choice is surgery to expose the aneurysm and place a small metallic clip across the base of the aneurysm to completely occlude it. This prevents further risk of bleeding. The patient is in the hospital for aggressive postoperative treatment if they have had an aneurysm rupture. This is designed to prevent any further problems such as spasm of blood vessels which can occur after bleeding has taken place.

Stereotactic Radiosurgery
Stereotactic Radiosurgery is a method of treating tumors and vascular abnormalities of the brain without resorting to traditional surgery. There are no incisions because the "surgery" is done with multiple beams of radiation focused onto the abnormal area through the skin.

Gamma Knife
Gamma Knife Radiosurgery is one of the most precise, powerful, and proven treatments for brain disorders. It's a preferred treatment for benign or malignant brain tumors, blood vessel malformations, skull base tumors, and dysfunctions such as trigeminal neuralgia – a painful condition of the facial nerves.

The Gamma Knife is a highly advanced machine that delivers a powerful dose of radiation to a precise target in the brain. Patients experience little or no discomfort during the procedure, usually go home the same day, and are generally able to resume normal activities almost immediately.