There are numerous forms of brain tumours, ranging from benign lesions to highly malignant cancers, which are amenable to surgical excision. To remove or resect these tumours, a craniotomy is first carried out. This involves the removal of a piece of bone (bone flap) from the skull to allow for access to the brain. The coverings of the brain (dura mater) is then opened over the area of interest. The procedure to remove the lesion will depend on the location of the tumour, the type of tumour and the ease of access to the tumour. An operating microscope may be used to define the fine structures. A “neuron-navigation” device may also be used to achieve even more accurate localisation of the tumour and surrounding structures.

At the end of the procedure, the dura is usually sutured closed. The bone flap is usually returned to its position and secured by small metal plates and screws which are non-ferrous (iron-based) which means that they should not set off metal detectors. The scalp incision is closed with staples or sutures.

Depending on the type of tumour, further treatment may be required. This may include radiation therapy or chemical therapy. A review with your neurosurgeon at Laccon Neurosurgery will take place between 6-8 weeks following surgery.

Cervical spinal derangement is a common condition resulting in compression of the cervical nerves or the spinal cord. If the cervical nerves are compressed, it may result in pain, mobility problems and altered sensation in the upper limbs. There may be accompanied neck pain but the aim of treatment is not to correct the neck pain, but rather, to correct and improve arm and hand symptoms. Any improvement in neck pain can be viewed as a bonus.

If the spinal cord is compressed, the major problems may be walking difficulties, inco-ordination in movement or altered sensation. When the spinal cord is compressed, treatment is aimed at stabilizing the clinical state and “preventing the clinical state from getting worse”. It is, often, impossible to gain any improvement in the neurological deficits when the cervical cord is compressed.

Cervical spinal surgery takes the form of:

In foraminotomy, a window of bone is drilled out over the compressed nerve root. This transforms the tight canal into a “half-pipe”, freeing the compressed nerve root.

In laminectomy, the window of bone removed is much larger. This will allow not only the decompression of the nerve root but also the spinal cord. There is no danger in removing a large portion of the spinal canal and lamina as muscle, fascia, subcutaneous tissue and skin will help protect the operative site.

In cervical discectomy and vertebrectomy, entire disc and the entire vertebral body are removed respectively, at the affected level in the cervical spine. By doing so, the nerve and / or the spinal cord are decompressed. This will destabilize the cervical spinal column. To maintain stability, the affected region is fused with an artificial polymer cage packed with bone stimulating granules and bone, with a cervical metal plate and screws if vertebrectomy is performed.

Please discuss with your surgeon the risks, options and benefits of these options.

Lumbar spine degenerative disease results in compression of lumbar nerve roots and may lead to pain, numbness, weakness and muscle wasting in the legs. It may result in problems urinating or incontinence of urine. If urinary symptoms occur, emergency treatment is required.

The causes of lumbar spine diseases include:

Lumbar disc prolapse
Almost all lumbar degenerative diseases result from dehydration of the lumbar disc. Depending on the rate, location and extent of dehydration, the disc may fragment and parts may “break-off” and cause compression of the adjacent nerve root. The disc may also “bulge” and compress the nerve root.

Lumbar canal stenosis
The spine may also wear and result in ligament thickening, joint bulge or bone spur formation. These will cause narrowing of the spinal canal at that level. The nerves in the lumbar region will be irritated by the tight canal and cause pain in the legs especially when you are walking or standing up. Interestingly, the pain usually improves when you sit or bend over.

Spondylolisthesis
Owing to degeneration of the lumbar spine, the vertebral column may sometimes present a “step” or a problem with alignment. This step may cause compression of the spinal nerve roots at that level. The same symptoms as lumbar canal stenosis may then result.

Lumbar spinal surgery takes the form of:

Lumbar discectomy is where the part of the disc that is causing the nerve compression is removed. This will give more space for the nerve root. The remaining “healthy” disc is kept intact so that the spine remains stable. The discectomy is usually performed after a small window of bone is drilled out to allow access to the disc site.

Lumbar laminectomy involves removing a greater amount of bone from the back of the spine than in discectomy. This will decompress the entire spinal canal and free up many nerve roots. This procedure is the basis for all posterior lumbar spine surgery.

Spinal fusion is used to stabilize an unstable spine. When the degeneration is severe or if there is a step in the spinal column, the decompression of the nerves may result in weakness or instability in the spine. Fusion requires “building” a construct connecting the various spinal levels with a combination of metallic screws, rods and polymer cages. Around this construct, biological “mortar” must be placed to secure the fusion. The metal construct itself is not strong enough to stabilize the spine. This mortar is usually in the form of the patient’s own bone or bone fragments which can be taken from the site of surgery or the hip bones.

Please discuss with your surgeon the risks, options and benefits of these options.