Reasons Why Someone Might Need Brain Surgery

The term "brain surgery" refers to a wide variety of medical operations to repair structural problems with the brain. Brain surgery is a complex but necessary procedure used to treat a number of illnesses such as Parkinson's disease, tumors, blood clots, aneurysms, epilepsy, and brain damage.

A neurosurgeon must perform brain surgery, and it can be conducted using different types of surgery. The method used is dependent on the area of the brain and the problem being treated. Today, surgeons can even operate on sections of the brain without making a single incision in or near the skull thanks to medical improvements.

In this article, we will look at the different types of brain surgery, the reasons why someone may require brain surgery, and the surgical procedures available to address each of them.

Types of Brain Surgery

The brain is responsible for controlling and coordinating conscious and unconscious physiological activities and 'higher' functions such as memory, learning, and thought. It is prone to bleeding, infection, trauma, and other sorts of harm, much like any other region of the body.

Brain surgery is usually performed to repair physical brain abnormalities. These may be caused by a congenital defect, an illness, an accident, or other issues.

There are numerous different forms of brain surgery:

Craniotomy: A craniotomy is a surgical procedure involving removing a portion of the skull's bone to expose the brain. Specialized instruments are utilized to remove the bone flap. The bone flap is removed briefly and then restored after brain surgery.
Stereotactic brain biopsy: A biopsy examines a tissue or fluid sample from the brain, often to evaluate whether or not a tumor is cancerous.
DBS (deep brain stimulation): DBS is a treatment for Parkinson's disease, tremor, and other neurological illnesses.
Endovascular surgery: Endovascular surgery involves introducing a catheter (a thin, flexible tube) into a blood artery through a tiny incision in your groin. The catheter is inserted up to your brain without cutting through your skull. They may remove blood clots (thrombectomy) and treat aneurysms there.
Laser ablation: Some illnesses may be too deep in the brain for a craniotomy to be safe. In rare instances, a laser probe introduced through a tiny hole in the skull may be utilized to eliminate a tumor, radiation injury, or epileptic tissue.
Neuroendoscopy: A surgeon may occasionally undertake brain surgery through your nose or mouth.

The following are the most common forms of brain problems that may necessitate brain surgery:

Brain tissue changes: Such as cancer, infection, and swelling (edema).
Changes in the blood flow to the brain: Such as subdural hemorrhage, subarachnoid hemorrhage, and intraventricular bleed.
Cerebrospinal fluid abnormality: Often caused by infection or hydrocephalus.

In some cases, brain surgery necessitates an incision (cut) in your brain, but not always.

Today, with medical advancements, various treatments can allow access to your brain via your nose, mouth, or even a small incision in your leg. Minimally invasive brain surgeries are less risky than open brain surgery, and they also allow the patient a quicker recovery.

Depending on your circumstances and unique condition, your neurosurgeon will propose the best course of treatment for you.

Reasons Why Someone Might Need Brain Surgery

Here are some of the most common reasons why someone might require brain surgery:

Aneurysm

Aneurysm repair is surgery to repair a brain aneurysm. An aneurysm develops when the wall of a blood artery thins and bulges or balloons out. Many aneurysms go unnoticed because no symptoms are present until the aneurysm ruptures.

A brain aneurysm may cause a stroke or brain damage if left untreated. If your doctor discovers an aneurysm that hasn't burst, they'll probably advise you to get it repaired as soon as possible.

Before an aneurysm ruptures, you may have headaches, eye discomfort, neck pain, or no symptoms at all. Because an aneurysm may occur with no symptoms, they are often discovered by accident while your doctor is searching for something else. An aneurysm may be detected by an imaging test such as an MRI or CT scan.

Not all brain aneurysms need to be repaired right away. The chance of a brain aneurysm rupturing is determined by your age, medical history, aneurysm size, and location. Smaller aneurysms and aneurysms in the arteries towards the front of the brain are less prone to rupture. Those with a diameter of fewer than 7 millimeters are thought to be less susceptible to rupture. Your doctor will most likely still urge regular monitoring to ensure that the aneurysm does not grow in size.

Brain Tumor

Brain and spinal cord tumors are often surgically removed. First, your doctor will determine the size and location of the tumor. Certain forms of brain tumors develop quickly, while others grow slowly. Your doctor will discuss with you how soon treatment should begin.

Benign (non-cancerous) brain tumors may typically be surgically removed and do not grow back. On the other hand, a primary malignant brain tumor should be treated immediately since it has the potential to spread and cause harm to other areas of the brain and spinal cord. Typically, surgery will be required to remove as much of the tumor as feasible. Radiation treatment and chemotherapy may be utilized if a visible tumor remains after surgery. Surgery is generally the first step in treating higher-grade cancers, followed by radiation therapy and chemotherapy.

Fluid Buildup

Fluid can accumulate in your brain, increasing the pressure within your skull. This is referred to as hydrocephalus. The cerebrospinal fluid (CSF) is a colorless, transparent fluid surrounding and protecting the brain and spine. Cerebrospinal fluid circulates through the ventricles, bathing the brain and spinal cord before being reabsorbed into the circulation. The body generally creates and absorbs an adequate quantity of CSF each day. However, when CSF's normal flow or absorption is obstructed, a buildup of CSF may occur. Excessive CSF pressure may impair the brain's ability to function normally, resulting in brain damage and possibly death.

Hydrocephalus may affect anyone at any age. However, it is most prevalent in newborns and individuals aged 60 and older. Hydrocephalus is considered to affect around one to two out of every 1,000 infants born in the United States, according to the National Institute of Neurological Disorders and Stroke (NINDS). The bulk of these instances are often diagnosed before birth, during labor, or throughout early infancy.

Hydrocephalus is often treated with shunt surgery or endoscopic third ventriculostomy (ETV), both of which are endoscopic procedures:

A shunt (tube) is surgically implanted into the brain and coupled to a flexible tube put under the skin to drain excess fluid into the chest cavity or belly for absorption by the body.
An endoscopic Third Ventriculostomy (ETV) is a procedure that enhances the flow of cerebrospinal fluid (CSF) out of the brain. A small hole is created at the bottom of the third ventricle to alleviate pressure, and the CSF is channeled there. Occasionally, this is used with choroid plexus cauterization to reduce CSF production. Choroid plexus cauterization burns the CSF-producing tissue (i.e., the choroid plexus) in the brain's lateral ventricles, causing it to generate less CSF.

Epilepsy

Epilepsy surgery is a technique that involves the removal of a portion of the brain associated with seizures. It is used to either eliminate the brain area that causes seizures or to halt the spread of seizure activity. It is a therapeutic option for patients who cannot manage their episodes with medicines. Although epilepsy surgery is not the first line of therapy, it is considered when at least two anti-seizure drugs have been ineffective in controlling seizures. When seizures constantly occur in a single region in the brain, epilepsy surgery is most successful.

Epilepsy surgery may be a possibility if you have any of the following:

Seizures that have a significant negative impact on your quality of life.
Focal point epileptic seizures that consistently begin in the same place of the brain.
Seizures that are resistant to medicine or you are experiencing severe adverse effects from medicine.
Seizures caused by a lesion.

Numerous surgical procedures are available to treat epilepsy, including:

Resective surgery
Hemispherectomy
Corpus callosotomy
Multiple subpial transections

Trauma or Damage to the Head or Brain

Acquired brain damage (ABI) refers to any brain dysfunction after birth. The specific symptoms or functional losses are determined by which brain areas are injured.

The following are some reasons a person may suffer from acquired brain injury:

As a result of excessive drinking or drug use.
As a result of illness, such as AIDS, Alzheimer's disease, cancer, multiple sclerosis, or Parkinson's disease.
As a result of a lack of oxygen: this is known as anoxic brain damage (for example, injury caused by a near-drowning).
Physical injury, such as head trauma from a vehicle accident, a fight, or a fall.
As a result of a stroke - this happens when a blood artery inside the brain ruptures or gets blocked, resulting in the death of local brain tissue.

On the other hand, Traumatic brain injury (TBI) refers to a loss of brain function caused by the head colliding fast and forcibly with an item, a blow, bump or jolt to the head, or when an object pierces the skull and penetrates the brain tissue. It is a primary cause of disability and death in adults.

The degree and mechanism of harm of traumatic brain injuries are categorized as follows:

Mild: The individual is awake and aware; eyes are open. Confusion, disorientation, memory loss, headache, and momentary loss of consciousness are all possible symptoms.
Moderate: The individual is sluggish; eyes are open to stimuli. Consciousness loss lasts between 20 minutes and 6 hours. Some edema or bleeding in the brain, resulting in lethargy, but still arousable.
Severe: The individual is unconscious; eyes remain closed despite stimulation. Consciousness loss lasting longer than six hours.

According to the National Institute on Neurological Disorders and Stroke, almost half of patients with severe head injuries require surgery.

Treatment for brain damage varies according to the injury and the severity of the patient's symptoms. In some cases, if surgery is performed promptly after a head injury, it can save a person's life.

A range of diagnostic methods, such as x-rays and CT scans, may be used to diagnose brain damage. The extent and location of brain damage, an individual's age, general health, how early they received medical attention, and with what method they have been treated all influence a person's chances of recovery.

There are several types of surgeries doctors can perform for brain damage; these include:

Craniotomy with open surgery
Endoscopic Ventriculostomy
Ventriculoperitoneal shunt surgery (VPS)
Decompressive craniectomy
Cranioplasty

Conclusion

When undergoing a complex medical operation such as brain surgery, it is critical to choose a qualified Neurosurgeon who is an expert in the field.

Dr. Dickinson is a board-certified neurosurgeon who performs surgery for brain tumors and trauma-related injuries. He uses cutting-edge neurosurgical treatments and methods in his practice and prefers examining all treatment options before deciding on brain surgery.

16 Mar 2022

Head & Brain