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DESCRIPTIONS OF COMMON NEUROSURGICAL OPERATIONS |
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Burr Holes and Craniotomy
What are Burr Holes and Craniotomy? A Craniotomy is an operation that involves opening the skull to correct a problem in the brain or the layer around the brain. Craniotomies are performed for a variety of reasons, such as blood clots causing pressure on the brain, brain tumors, skull defects, etc. Sometimes, blood can be drained from the space between the brain and the skull through small holes, Burr Holes. Depending on the diagnosis and problem, an operating microscope may be used to facilitate the surgery. The operating microscope provides additional light and magnification, making the surgery safer. Sometimes, a Neuro-navigation system is used to precisely localize a lesion in the brain. Neuro-navigation is a computerized system working with CT or MRI scans similar to the way GPS (Global Positioning System) works with roadmaps in automobiles. Description of Surgery: Intravenous antibiotics are administered before surgery to decrease the risk of infection. You will be anesthetized (put to sleep). Exact position on the operating table depends on the area of the skull that needs to be opened. An incision is made. Equipment for opening the skull is then used. After exposing the region, the operation becomes more specific for the problem being treated. If needed, the operating microscope and neuro-navigation are used at this point. After completing the procedure inside the skull, a drain may be placed. If a section of skull was removed, it is repositioned and the scalp incision is sutured. The skin is closed with stitches or staples. A sterile dressing is placed over the incision. Sometimes, a thick head wrap may be applied. You will then be placed on your back in a hospital bed. The breathing tube will be removed (extubated) and you will be taken to the recovery room.
Anterior Cervical Discectomy and Fusion
What is an anterior cervical discectomy and fusion? Anterior Cervical Discectomy and Fusion is a procedure that uses an operating microscope to remove a herniated disc that is causing pressure on a cervical nerve root or the spinal cord. The magnification provided by the microscope enables the neurosurgeon to make a small incision in the skin of the neck to perform the discectomy. Description of the surgery: Before surgery, intravenous antibiotics are administered to decrease the risk of infection. You will be anesthetized (put to sleep) while lying on your back following which your head will be placed in special head-holder for the surgery. The surgery is performed through a small incision on either the right or left side of the neck over the diseased disc or discs. The surgical dissection continues down to the cervical spine by gently retracting the large artery in the neck (carotid artery) to one side, while retracting the swallowing tube (esophagus) and breathing tube (trachea) to the other side. The diseased disc level(s) is/are confirmed with an x-ray. The microscope is then used for the rest of the operation. Careful micro-dissection allows the disc to be removed. After the disc is removed, the neurosurgeon can see and remove the bone spurs pressing on the nerve or spinal cord. The area is then inspected to confirm that there are no other disc fragments pressing on the nerve or spinal cord. The wound is irrigated with antibiotic solution to decrease the likelihood of infection. A bone graft (usually from the bone bank) or a PEEK spacer and autograft bone is then placed in the discectomy site. Often, a titanium cervical plate will be positioned in front of the spine using screws into the vertebral bodies above and below the discectomy to maintain spinal alignment. Absorbable stitches are used under the skin to close the incision. Stitches or a special "skin glue," are used on the skin layer. A sterile dressing is placed over the incision. A hard cervical collar or a soft cervical collar may need to be worn after surgery. If needed, it will be placed on your neck at the end of the operation. The breathing tube is removed (extubated) and then you will be taken to the recovery room.
Lumbar Microdiscectomy
What is a lumbar microdiscectomy? Lumbar microdiscectomy is a procedure that uses an operating microscope to remove a herniated disc that is causing pressure on a nerve in the lower spine. The magnification provided by the microscope enables the neurosurgeon to make a small incision in the skin to perform the discectomy. Description of Surgery: Intravenous antibiotics are administered before surgery to decrease the risk of infection. You will be anesthetized (put to sleep), and turned face down on the operating table for the surgery. The appropriate disc level may need to be confirmed with an x-ray. A small piece of fat will be removed from under the skin and saved for later use. Muscle is then carefully dissected off the spine. The microscope is then used for better visualization during the remainder of the operation. A small amount of bone will be removed. This bone removal allows easy visualization and identification of the nerve and disc. The disc herniation and any loose fragments in the disc space are removed. The area is then inspected to confirm that there are no other disc fragments pressing on the nerve. The wound is then irrigated with antibiotic solution to decrease the risk of infection. The small piece of saved fat is then placed adjacent to the nerve to minimize scarring. Absorbable stitches are used under the skin to close the incision. Stitches, staples or special "skin glue" are used on the surface of the skin. A sterile dressing is placed over the incision. You will be placed on your back in a hospital bed. The breathing tube is removed (extubated) and you will be taken to the recovery room.
Lumbar Decompressive Laminectomy
What is a Lumbar Decompressive Laminectomy? Lumbar Stenosis is a narrowing of the spinal canal. Lumbar decompressive laminectomy is a procedure that uses an operating microscope to remove thickened ligaments and lamina (bone on the back side of the spine) that have encroached into the spinal canal causing Lumbar Stenosis. By removing the thickened ligaments and arthritic bone, the stenosis is corrected and the pressure on the nerves is relieved. The magnification provided by the microscope enables the neurosurgeon to thoroughly decompress (take pressure off) the nerves while maintaining the integrity of the nerves, their protective covering and the stability of the spine. Description of Surgery: Intravenous antibiotics are administered before surgery to decrease the risk of infection. You will be anesthetized (put to sleep), and turned face down on the operating table for the surgery. The appropriate levels may need to be confirmed with an x-ray. Muscle is then carefully dissected off the spine. The microscope is then used for better visualization during the remainder of the operation. The lamina will be removed at the stenotic levels. Along with removal of the bone, the thickened ligaments attached to the lamina are also removed. This removal "decompresses" the spinal canal. Some people who have spinal stenosis also have other problems that need to be addressed at the same time. These include herniated discs, cysts, tumors and instability. If any of these are present, your doctor will have explained them to you and your surgery will be modified appropriately. If you have a disc herniation, cyst, or tumor, the decompressive laminectomy allows the access to the lesion. It will be removed with careful dissection while using the microscope. Some patients have spinal instability (too much movement between the bones in the spine) requiring the use of bone grafting to help the bones of the spine heal with less movement. Hardware is used to mechanically hold the bones together while they heal. After completion of the decompressive laminectomy and correction of any additional problems, the wound is irrigated with antibiotic solution to decrease the risk of infection. Absorbable stitches are used under the skin to close the incision. Stitches, staples, or a special "skin glue" are used on the surface of the skin. A sterile dressing is placed over the incision. You will then be placed on your back in a hospital bed. The breathing tube will be removed (extubated) and you will be taken to the recovery room.
Carpal Tunnel Release
What is a Carpal Tunnel Release? Carpal Tunnel Syndrome is a group of symptoms caused by compression of the Median Nerve as it traverses the wrist in the Carpal Tunnel. Carpal Tunnel Release is an operation to take pressure off the Median Nerve in the wrist. Description of Surgery: Intravenous antibiotics are administered before surgery to decrease the risk of infection. You will receive regional anesthesia (a tourniquet will be applied to your upper arm and the veins of your arm will be filled with a numbing medication) and you will be given a mild sedative through a vein in the other arm). Some people receive general anesthesia (put to sleep). A small incision will be made in your palm. The ligament compressing the nerve in the carpal tunnel will be identified and incised. After completion of the carpal tunnel release, the wound is irrigated with antibiotic solution to decrease the risk of infection. If needed, absorbable stitches are used under the skin to close the incision. The skin is closed with a stitch that will need to be removed about 10 days after surgery. A sterile dressing and a bulky padding is placed over the incision. The tourniquet is then removed and numbing medicine flows out of the extremity. The extremity is then placed in a sling. Following surgery, you will be taken to the recovery room.
Ulnar Nerve Decompression or Transposition
What is Ulnar Nerve Decompression or Transposition? The Ulnar Nerve is a nerve in the arm. Part of its course from the neck to the hand is in a groove on the inside of the elbow. You may have heard someone say, "I hit my funny bone." In actuality, they hit their Ulnar Nerve near the elbow and caused a tingling in the hand. Sometimes, the nerve is entrapped in scar tissue at the level of the elbow. This usually happens after some type of trauma. Ulnar nerve decompression releases the nerve from the scar tissue. Sometimes, the nerve needs to be repositioned so that its course takes it in front of the elbow, ulnar transposition. Description of Surgery: Before surgery, intravenous antibiotics are administered to decrease the risk of infection. You will receive general anesthesia (put to sleep). Some people receive regional anesthesia (a tourniquet applied to your upper arm and the veins of your arm will be filled with a numbing medication) and you will be given a mild sedative through a vein in the other arm). An incision will be made in the region of your elbow. The ligament compressing the nerve will be identified and incised. If a transposition is necessary, a pocket will be created in the tissues below the skin on the front side of your elbow. The nerve will be positioned in the pocket. The pocket is then closed with stitches so that it forms a tube or tunnel and maintains the nerve in this position. After completion of the Ulnar Nerve decompression or transposition, the wound is irrigated with antibiotic solution to decrease the risk of infection. Absorbable stitches are used under the skin to close the incision. The skin is closed with a stitch (that will need to be removed about 10 days after surgery) or skin glue. A sterile dressing is placed over the incision. The extremity is then placed in a sling. The tourniquet, if used, is then removed and numbing medicine flows out of the extremity or the general anesthesia is discontinued and the breathing tube is removed (extubated). Following surgery, you will be taken to the recovery room. Top |
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