Brain Health
As one of the most important organs in the human body, the brain plays a vital role in regulating every aspect of our daily lives. From controlling basic motor functions to managing complex cognitive processes, the brain is responsible for a wide range of critical functions that help us thrive as human beings. However, like any other part of the body, the brain is also susceptible to various forms of damage and disease, which can significantly impact its function and overall health.
At the Dr. Ilyas Munshi, M. D. neurological surgery clinic, the importance of brain health cannot be overstated. As specialists in the diagnosis and treatment of neurological disorders, our medical professionals are acutely aware of the devastating effects that brain damage or disease can have on an individual’s quality of life. By promoting brain health and raising awareness about the various factors that contribute to brain health, our neurological surgery clinics can help patients take an active role in maintaining the health and function of their brain, potentially reducing the risk of developing serious neurological conditions later in life.
Aneurysm
Overview
An aneurysm is a balloon-like bulge, or weakening, in an artery wall. Eventually, the aneurysm size, or pressure of blood inside the aneurysm will cause it to rupture– which can be life-threatening.
Anatomy
Arteries located throughout the body are tube-like vessels that function to transfer oxygen and nutrients to the body’s tissue, muscle, and organs. An artery is made out of three layers: the inner intima layer, the middle media layer, and the elastic external layer. An aneurysm can develop when the artery’s layers begin to thin. When the protective layers begin to thin and weaken, the aneurysm will develop.
Over time, the aneurysm may not cause any symptoms, however, when a cerebral aneurysm ruptures it releases blood into the subarachnoid space. The subarachnoid space is normally where cerebrospinal fluid flows. In the case of a ruptured aneurysm, the subarachnoid space increases intracranial pressure, irritates the lining of the brain, and deprives oxygen to the brain.
Causes
- Genetics
- Smoking
- Hypertension
Symptoms
Most aneurysms are asymptomatic unlike they rupture
Symptoms of an unruptured aneurysm:
- Double vision
- Pain above and behind the eye
- New, unexplained headache
Symptoms of a ruptured aneurysm:
- Sudden onset of severe headache
- Nausea, vomiting
- Stiff neck
- Transient loss of vision or consciousness
Diagnosis
Initially, your healthcare provider will perform a thorough history and physical exam. In addition to clinical findings, your healthcare provider may wish to order additional diagnostic tests to determine the cause including: CT scans, angiogram, or MRA scans.
Treatment
Based on the patient’s presentation, imaging, and severity of disease initial treatment may vary. Conservative treatments include observation, smoking cessation, and blood pressure control. In some cases, surgery may be necessary.
Meningioma
Overview
A meningioma is typically a slow-growing, benign tumor that grows within the protective membranes of the brain and spinal cord.
Anatomy
There are three layers, known as the meninges, that surround and protect the brain and spinal cord. From the outer layer inwards, there is the dura, arachnoid, and pia mater. Meningiomas grow from the middle, arachnoid layer and tend to grow inwards. As the tumors grow inward, they can cause pressure on the brain and spinal cord. These tumors are typically benign and very slow growing.
Causes
There is no clear cause as to which factors can cause meningiomas to develop.
Symptoms
- Many patients may be asymptomatic
- Headaches
- Weakness in extremities
- Seizures
- Neurological deficits
Diagnosis
Initially, your healthcare provider will perform a thorough history and physical exam. In addition to clinical findings, your healthcare provider may wish to order additional diagnostic tests to determine the cause including: CT, MRI imaging, or angiograms.
Treatment
Based on the patient’s presentation, imaging, and severity of disease initial treatment may vary. Conservative treatments include observation, serial imaging, and/ or medications. In some cases, surgery may be necessary.
Trigeminal Neuralgia
Overview
Trigeminal neuralgia occurs when the trigeminal nerve becomes irritated. This irritation causes extreme, shock-like facial pains.
Anatomy
The trigeminal nerve is the fifth (V) cranial nerve which arises from the brainstem and innervates multiple areas of the face. The nerve has three branches (V1, V2, and V3) that supply feeling and movement to the face.
- Ophthalmic division (V1): provides sensation to the forehead and eye
- Maxillary division (V2): provides sensation to cheek, upper lip, and roof of mouth
- Mandibular division (V3): provides sensation to the jaw and lower lip; and movement to the muscles involved in chewing and swallowing
When the trigeminal nerve becomes irritated or the nerve sheath begins to deteriorate, painful attacks can occur, which is known as trigeminal neuralgia.
Causes
- Age
- Abnormalities in surrounding arteries or veins
- Multiple sclerosis
- Tumors
Symptoms
- Facial pain worsened with chewing food, touching face, or brushing teeth
- Pain described as “burning,” “shocking,” or “jabbing”
- Episodes of pain may last seconds to days
Diagnosis
Trigeminal neuralgia may be able to be diagnosed following a thorough history and physical exam. In addition to clinical findings, your healthcare provider may wish to order additional diagnostic tests to determine the cause, usually an MRI image.
Treatment
Based on the patient’s presentation, imaging, and severity of disease initial treatment may vary. Conservative treatments include medications or injections. In some cases, radiosurgery or microvascular decompression surgery may be necessary.
Pituitary Adenoma
Overview
Pituitary adenoma are typically slow-growing, benign tumors that originate from the pituitary gland which can interfere with normal hormone levels.
Anatomy
The pituitary gland is a small, bean-shaped organ that sits at the base of the brain behind the bridge of the nose. The pituitary gland can be thought of as the “master gland.” The pituitary gland secretes multiple hormones which are responsible for controlling all of the endocrine glands within the body.
Some of hormones made by the pituitary gland include:
- Prolactin hormone: responsible for making a woman’s milk after childbirth
- Growth hormone: responsible for controlling body growth and metabolism
- Adrenocorticotropic hormone: responsible for creating cortisol, which helps control the body’s sugar, protein, and fat
- Thyroid-stimulating hormone: regulates the thyroid’s function and ability to regular growth, temperature, and heart rate
- Antidiuretic hormone: regulates the body’s water balance
- Luteinizing hormone and follicle-stimulating hormone: controls menstrual cycle in women and sperm production in men
Symptoms
- Many patients may be asymptomatic
- Double vision
- Headaches
- Hormonal symptoms (amenorrhea, gynecomastia, infertility)
Causes
- Unknown
Diagnosis
Pituitary adenoma may be able to be diagnosed following a thorough history and physical exam. In addition to clinical findings, your healthcare provider may wish to order additional diagnostic tests to determine the cause, including: endocrine lab tests, vision assessments, or MRI
Treatment
Based on the patient’s presentation, imaging, and severity of disease initial treatment may vary. Conservative treatments include observation, serial imaging, or medications. In some cases, radiation or transsphenoidal resection surgery may be necessary.
Intracerebral Hemorrhage
Overview
Intracerebral hemorrhage (ICH) is caused by bleeding within the brain tissue which can be a life-threatening type of stroke. This is a medical emergency that can cause irreversible damage if not assessed and treated promptly.
Anatomy
Within the brain, there are tiny arteries which supply blood to the tissue. In the case of high blood pressure, or trauma, these tiny, thin-walled arteries will rupture. This leads to blood being released within the brain. Enclosed within the rigid skull, this blood will lead to increased pressure and lead the brain to compress within the skull. As blood continues to spill into the brain, the brain tissue becomes deprived of oxygen, which is known as a stroke. The excess blood can also release toxins that can further damage the brain.
Symptoms
- Headache
- Nausea and vomiting
- Sudden weakness or numbness of face, arm or leg
- Loss of consciousness
- Sudden vision changes
Causes
- Hypertension
- Bleeding disorders or blood thinners
- Arteriovenous malformations
- Head trauma
Diagnosis
Intracerebral hemorrhages may be able to be diagnosed following a thorough history and physical exam. In addition to clinical findings, your healthcare provider will order additional diagnostic tests to determine the diagnosis including: CT, angiograms, or MRI
Treatment
Intracerebral hemorrhage is a medical emergency and must be treated promptly to prevent irreversible damage. Generally, patients with small hemorrhages on imaging will be treated medically, including: blood pressure control, intracranial pressure (ICP) management, and reversal of blood thinners. Patients with large hemorrhages, will most likely require surgical treatment to remove the hematoma and decompress the brain.
Microvascular Decompression
Overview
Microvascular decompression (MVD) is a surgery done to relieve compression of the fifth cranial nerve, the trigeminal nerve.
Who is a Candidate?
This surgery may be performed for individuals with trigeminal neuralgia that is not well controlled with medications, or facial pain that was not relieved with prior procedures.
What Happens During surgery?
- First, the patient’s head is placed in a 3-pin fixation device which keeps the head in position during the procedure.
- Once positioned correctly, approximately a 3-inch incision is made behind the ear. This allows the surgeon to visualize and drill a small opening into the occipital bone of the skull.
- Retractors are then used to gently move the brain tissue out of the way to visualize the trigeminal nerve’s origin at the brain stem.
- Typically, the nerve is compressed by an abnormal vessel. The vessel and nerve are often surrounded by thickened connective tissue which must be dissected.
- The surgeon will then cut a small teflon sponge and insert it between the abnormal vessel and trigeminal nerve.
- Once the sponge is appropriately placed, the retractor is removed so the brain can return to its original position.
- A small titanium plate is then placed to cover the hold created in the occipital bone of the skull. The plate is secured with tiny screws.
- The muscle and skin is then closed with sutures and a gauze dressing is placed on the skin.
Recovery
- Most patient typically stay 1-2 nights in the hospital following the surgery.
- Within a day of surgery, you may begin gentle movements following surgery including: sitting in a chair, standing, and walking.
- Immediately following surgery, the patient will be unable to lift anything over 5 pounds, perform strenuous activities, or drive until they follow-up in clinic, approximately 2-3 weeks after surgery
- Microvascular decompression is typically highly successful in treating trigeminal neuralgia.
Potential Complications
- Stroke
- Seizure
- CSF leak
- No surgery is risk free, other complications include, but are not limited to, bleeding, infection, injury, or even death.
Disclaimer: This information is strictly informational and not intended for medical advice. If you have any questions about surgical procedures, symptoms, or restrictions following surgery please contact your physician.
Transsphenoidal Hypophysectomy
Overview
A transsphenoidal hypophysectomy is an effective, endoscopic surgery used to remove pituitary adenomas and other skull base tumors.
Who is a Candidate?
This surgery is commonly performed for those with pituitary adenomas, however, patients with other tumors (i.e. benign tumors, meningiomas, or malignant tumors) that are located near the skull base may be candidates for this procedure.
What Happens During surgery?
- A ENT surgeon will begin the surgery by inserting an endoscope in one nostril into the nasal cavity. The scope is guided to the back of the nasal cavity using specialized image-guided navigation.
- Once the ENT has navigated throughout the nasal cavity, a small portion of the nasal septum will be removed to visualize the bony wall of the sphenoid sinus, which is located anterior to the pituitary gland.
- Then, the ENT will cut through the bony wall of the sphenoid sinus, also known as the sella. Once removed, the ENT and neurosurgeon will be able to visualize the pituitary gland and tumor.
- Through the opening in the sella, the neurosurgeon will then be able to remove the tumor using long grasping instruments.
- Once the tumor is removed, the ENT will close the sella opening and septal opening with fat and bone grafts, respectively. These closures prevent cerebrospinal fluid (CSF) leakage and other complications following surgery.
Recovery
- Following surgery, the patient will be admitted to the hospital in a regular room, or in some cases, the ICU for monitoring.
- Immediately following surgery, some patients may experience nasal congestion, nausea, or headaches.
- An endocrinologist may see the patient following surgery to ensure that the patient’s pituitary gland is functioning normally with appropriate hormone levels.
- Once discharged from the hospital, the patient will see the neurosurgeon about 2-3 weeks following surgery for follow up.
Potential Complications
- Damage to the pituitary gland
- Cerebrospinal fluid (CSF) leak
- Vision loss
- No surgery is risk free, other complications include, but are not limited to, bleeding, infection, injury, or even death.
Disclaimer: This information is strictly informational and not intended for medical advice. If you have any questions about surgical procedures, symptoms, or restrictions following surgery please contact your physician.
Brain Biopsy
Overview
A brain biopsy is a procedure to remove a sample of abnormal tissue for evaluation. The tissue and cells taken during a biopsy are then sent to a pathologist to determine the type of tissue and/or if the tissue is benign or cancerous. Biopsies are performed following abnormal imaging results, typically on a CT or MRI.
Procedure
There are 2 types of brain biopsies: open biopsies and needle biopsies. In an open biopsy, a craniotomy (partial removal of the skull) is typically performed prior to removing a sample of tissue to determine the type of disease present. In a needle biopsy, a small hole is made in the skull and a needle is used to access tumors or lesions that are deeper in the brain. In both cases, typically specialized navigation equipment is used to precisely locate the lesion and take biopsies.
Results
After the procedure, the patient will be observed in the ICU for monitoring. In the ICU, frequent neurologic exams will be performed to monitor for any signs or symptoms. In many cases, the patient will be discharged the following day. Biopsy results may take days to weeks to be completed. Once the results are available, your doctor will reach out to review results and discuss further treatments if needed.