Neurosurgery

 

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Our doctors provide state-of-the-art medicine in the treatment and management of neurological disorders, including brain and spinal tumors, degenerative spinal conditions, epilepsy, movement disorders, cerebrovascular disorders such as stroke and aneurysm, and pain.

Procedures include minimally invasive surgical techniques for the brain and spine, deep brain stimulation for the treatment of both movement (e.g. Parkinson’s) and mood disorders, awake craniotomy techniques for mapping brain function, radiosurgery (stereotactic approaches and whole brain), carotid artery stenting, and minimally invasive treatment of brain aneurysm (coiling).

General Neurosurgery

General neurosurgery covers a large number of procedures, including traditional open surgeries to remove brain tumors, relieve cranial pressure, treat traumatic brain injury, or correct malformations of blood vessels.

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Awake Craniotomy/Brain Mapping

To prepare for surgeries that target brain tumors or epilepsy, or for placement of devices such as a deep brain stimulation (DBS) implant, “awake” craniotomy is performed to determine which areas in the patient's brain are responsible for certain functions. In this procedure, surgeons electrically stimulate regions of the brain while the patient is awake, to create a map of areas that should be avoided during surgery, such as areas that govern speech and movement. This is a painless, but major, open brain surgery which can lead to excellent outcomes by preserving critical brain functions.

Most right-handed people are “left-brained,” meaning that speech and the understanding of words resides in the left hemisphere of the brain. The right hemisphere is most often associated with the ability to visualize in three dimensions, musical sense, and emotional response. While it is important to spare as much normal function as possible in any brain procedure, language is considered a very critical function, and thus much attention is paid to this ability when planning brain surgery. Movement is the other critical function, also controlled by very specific areas in both hemispheres- the left hemisphere controls the right side of the body, and vice versa.

No Anesthesia Necessary

Because the brain itself does not sense pain directly, an awake craniotomy can be performed while the patient is under local anesthesia. Awake craniotomy is major brain surgery that requires temporary removal of a portion of the skull to allow the surgeon access to the outer portion of the brain, or cerebral cortex.

Because he or she is conscious during the procedure, the patient can report sensations in response to stimulation of specific brain areas. Sensations can be as specific as seeing an image (in response to stimulation of the visual cortex), to a feeling of déjà vu, to the movement of an arm or leg. These verbal reports and physical clues allow the surgeon to carefully plot a three-dimensional map of the brain and to pinpoint areas of disease or injury. Subsequent surgery can then minimize any damage to the brain that might compromise normal function.

Brain & Spine Immediate Access Clinic

Immediate Access. No Prior Imaging necessary. There is no reason to wait when you have a neurosurgical issue. We offer same day and next day appointments and walk-ins are available as well.

Specialty Evaluations. You can be seen by one of our highly experienced, board certified physician assistants. We treat the full spectrum of neurosurgical issues including spine, brain, neurovascular and peripheral nerve pathology. We can review any of your prior imaging with you, order new imaging (MRI, CTs) if needed, and have on-site Xray to provide you with the most efficient care possible.

Coordinated Neurosurgical Care. At GW Neurosurgery, there is an emphasis non surgical treatments and we can order spine injections like epidural steroid injections or facet blocks. We make referrals to physical and occupational therapy and work closely with GWs Pain Management and Physical Medicine providers. We collaborate with our board certified physicians to tailor individualized treatment plans for our patients.

Common problems we treat are:

• Acute or chronic neck or back pain
• Disc herniations
• Scoliosis
• Spinal stenosis
• Spine surgery revisions
• Brain and spine tumors
• Brain aneurysms
• Compression fractures
• Carpal tunnel/Ulnar neuropathy

 

Learn more or schedule an appointment today:
Call 202.741.2750. Hours: Monday - Friday, 8:00am - 2:00pm (extended hours until 5 pm may be available)

Brain Tumor

Brain tumors can be either benign (non-cancerous) or malignant (cancerous). Depending on their location, brain tumors can be treated with open neurosurgical procedures, radiosurgery, or minimally invasive approaches. Cancerous brain tumors are usually treated with surgery, chemotherapy, radiotherapy, or a combination of these treatments.

Complex Spine

Complex spine procedures, such as fusion of the vertebrae to stabilize the spine, often require open surgeries to allow access to sensitive areas such as the cervical spine (neck). However, when the vertebrae are easily accessible, as in the lumbar spine (low back), minimally invasive procedures are increasingly used to treat more complicated disorders. Other complex spine procedures include general open surgeries to treat spinal injuries or to remove spinal tumors.

Deep Brain Stimulation

Treatment for Intractable Pain, Movement Disorders, & Mood Disorders

Deep brain stimulation (DBS) uses an electrical device much like a heart pacemaker that is implanted within the deep structures of the brain. DBS has been most commonly used to treat intractable pain, but it also can be used in movement disorders such as Parkinson's disease and dystonia. More recently, DBS has been used in the treatment of mood disorders such as obsessive compulsive disorder (OCD), and depression that does not respond to other treatments. The implanted device sends out low-level electrical signals which are thought to interrupt nerve communications that underlie these disorders.

The device is implanted in deep areas of the brain that are associated with the transmission of very basic sensations; these areas are sometimes described as way stations and are some of the first brain structures that receive nerve signals from the spinal cord. The implant itself is an electrode that delivers continuous electrical impulses to the brain area. The electrode is attached to a wire that runs under the skin and is connected ultimately to a power supply (internal pulse generator; IPG), which is placed underneath the skin near the collarbone, chest, or abdomen. DBS is associated with risks that include brain hemorrhage and infection, and is not guaranteed to provide relief.

Minimally Invasive Spine (MIS)

In selected patients, the minimally invasive approach can be used in spinal surgeries. MIS procedures can be used to treat certain types of spinal conditions, including degenerative or herniated disc disorders, lumbar (lower back) spinal stenosis, curvature of the spine such as kyphosis or scoliosis, spinal infections, instability of the spine, and compression fractures of the spine, such as those caused by osteoporosis (thinning of the bones). The minimally invasive approach typically used one or two small incisions and an endoscope to visualize the structures of the spine. MIS reduces patient downtime and the risk of infection with typically excellent results.

More information about Minimally Invasive Spine Surgery

Pain

Pain is the body's response to injury and inflammation. There are nerve cells called pain receptors that are located all over the body, including the internal organs. Paradoxically, the brain itself has no comparable pain receptors, which is why neurosurgeons can perform a procedure called awake craniotomy to perform brain mapping procedures. Pain can be a very simple problem, such as that arising from a nerve being compressed as it exits the spinal cord.

“Neuropathic” or “central” pain, on the other hand, refers to discomfort that arises in the nervous system, but at no specific location. This type of pain is sometimes described as diffuse or burning, although sensations such as cold, numbness, or “pins and needles” fall in this category. An example of neuropathic pain is diabetic neuropathy, which causes numbness and tingling in the hands and feet. In mood disorders such as depression, the perception of pain is sometimes heightened; this is referred to as “somatization,” emotional distress that is expressed as a physical symptom.

Treatment Options for Pain

Pain can be treated with over-the-counter (OTC) acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin) or naproxen (Aleve); or prescription medications such as indomethacin (Indocin) or celecoxib (Celebrex). Narcotic medications for pain include acetaminophen with codeine (Tylenol-3) or oxycodone (OxyContin). Narcotics carry the disadvantage of being habit-forming, requiring increased dosages over time to treat the same amount of pain. Joint pain can sometimes be relieved by periodic injections of steroidal drugs.

Some types of pain, such as that resulting from injuries, osteoarthritis, or muscular spasms, can be relieved by targeted physical therapy. Regular exercise can both relieve pain and improve the stress often associated with pain. Meditation, stress reduction, and biofeedback techniques that increase physical awareness can also be quite helpful in moderating the body's response to pain.

Chronic Pain Treatment

For persistent pain that is not relieved by drugs, a nerve block can be used to prevent the irritated nerve from communicating pain back to the spinal cord and brain. A nerve block is an injection that contains a numbing drug such as lidocaine, and is delivered directly to the site that is causing pain, such as a vertebral disc. While not a permanent solution, this procedure can often bring about relief for weeks or months. In cases of chronic pain, which is often associated with other medical problems, a pacemaker-like device can be implanted in the brain to interrupt the “pain circuit” with continuous electrical signals. This procedure is called [deep brain stimulation] (DBS).

Pituitary

The pituitary gland sits in a bony structure at the base of the skull, and is sometimes the site of the benign (non-cancerous) growths. It is especially suited to minimally invasive procedures due both to its location, and to the thin, and therefore easily penetrated, bone layer surrounding it. Both benign and malignant tumors can cause many symptoms, from abnormal thickening of bone to secretion of milk from the breasts in both males and females.

Radiosurgery

Radiosurgery uses ionizing radiation (most commonly x-rays) to treat benign (non-cancerous) or malignant (cancerous) tumors in the brain. Modern radiosurgery is referred to as stereotactic radiosurgery (SRS), because a stereotactic device is used to hold the head in a carefully planned position for each treatment. This technology allows high doses of radiation to be delivered to the tumor with minimal exposure to surrounding healthy tissue.

Skull Base Surgery

A Skull Base tumor is one which occurs around the base of the brain, at the intersection between the cranium (where the brain lies) and the face. This is the area where you’ll find openings for your spinal cord, and the nerves that control vital structures of your head, face, neck and the rest of the body. It’s important to understand that many of these tumors are benign – they are not cancerous However, these tumors may cause significant impairments due to their compression of vital structures, including the brainstem.

More information about Skull Base Surgery

Spinal Tumor Treatment

Spinal tumors may be cancerous or non-cancerous. The treatment of benign tumors depends on patient symptoms such as pain or lack of mobility, and may be treated with a watch-and-wait approach, various medications, radiation, or surgery. Cancerous tumors can be treated with radiation or chemotherapy, but if these fail, surgery can often be used to relieve pain, stabilize the spine, and to improve quality of life.

Spinal tumors that arise from the spine itself are divided into three categories, depending on where they originate in the spinal cord. Many spinal tumors are benign and cause problems largely because they interfere with nerve conduction or with the structure of the spine:

• Intradural-extramedullary: menigioma, schwannoma, neurofibroma, nerve root tumors
• Intramedullary: astrocytoma, ependymoma, lipoma

Metastatic Spinal Tumor

The skeletal spine is often a site for metastasis (spread) from cancers that originate elsewhere in the body. The vertebrae are commonly affected by metastasized lung, breast, and prostate cancers. Metastatic cancers of the bony portion of the spine can often be successfully managed with radiation therapy, especially for pain relief. Bone-building drugs, such as agents used to treat osteoporosis, along with continued chemotherapy, can also help to slow or stop the progress of bone metastases for a significant period.

Vascular (Cerebrovascular/Endovascular)

Vascular neurology is concerned with the blood vessels that supply the brain and nervous system. The brain is critically dependent on blood flow and can incur damage within minutes of that flow being interrupted. Atherosclerosis, or “hardening of the arteries,” can narrow blood vessels that lead to the brain or are in the brain, causing transient ischemic attacks (TIAs or “mini-strokes”), and ischemic (blocked blood vessel) stroke itself. Hemorrhagic stroke, or bleeding in the brain, can be caused by weakened blood vessels that swell like a bubble in response to blood flow (aneurysm). In recent decades, much progress has been made in treating these disorders with minimally invasive techniques.

Cartoid Endaterectomy

The most familiar cerebrovascular procedure is the carotid endarterectomy, in which excess plaque, a mixture of cholesterol, fat, and calcium, is removed from the inside of the carotid artery. The carotid arteries, one on each side of the neck, carry oxygenated blood to the brain, and are a frequent site of plaque build-up. An endarterectomy can be an open procedure, in which the carotid is surgically removed and replaced with a blood vessel graft, or is repaired with sutures. The plaque can also be removed with a surgical device called a curette, essentially a small scraping tool.

Cartoid Angioplasty

Carotid angioplasty and stenting uses a deflated balloon that is inflated when it reaches the blockage in the artery, leaving in place a stent, or mesh tube, that compresses the plaque and enlarges the blood vessel opening (lumen). Both carotid endarterectomy and angioplasty/stenting can be done by threading a wire through a major artery, such as the femoral artery in the upper thigh.

Cerebral Aneurysms

Cerebral aneurysms can be treated by clipping either side of the ballooned vessel, usually through an open surgery called a craniotomy. A minimally invasive approach called coiling, or coil embolization, can be used in selected aneurysm patients. This procedure entails placing a tiny coil in the ballooned portion of the vessel. The vessel closes around the coil, preventing rupture and bleeding of the aneurysm. As in carotid angioplasty, the coil is typically delivered through a major artery.

Cerebrovascular Procedures

Cerebrovascular procedures similar to those used to treat carotid blockage and aneurysm can also be used to treat arteriovenous malformations (AVMs), where the blood vessels appear to be a tangle of wires, or a “bag of worms.” AVMs have a risk of rupturing and causing bleeding into the brain. They can be treated angiographically, using x-rays to monitor the placement of “occlusives” or biological glues to fill the AVM and close it off from the vessels around it; like carotid angioplasty, the filler substance is delivered through an artery. AVMs, when located in an appropriate site, can also be treated with [stereotactic radiosurgery. Some AVMs are treated with the use of microsurgery, which requires a craniotomy (opening of the skull), and a microscope for the visualization of individual blood vessels.