Cerebrovascular Surgery

Overview

Blood vessel conditions and disorders can occasionally cause significant symptoms affecting your brain and central nervous system. Arteries and veins in the brain and spine are also susceptible to diseases that, if not treated immediately, can lead to serious problems.

 

What is Cerebrovascular surgery?

The term "cerebrovascular" refers to your arteries and veins, while "cerebro" refers to the major region of your brain. Cerebrovascular surgery is a specialist operation done on the blood arteries that provide blood to your brain by a neurosurgeon.

It is a therapy for a variety of blood vessel problems and illnesses. It is also known as "neurovascular surgery" and "cerebrovascular neurosurgery." A cerebrovascular surgeon can undertake surgeries to assist treat vascular disorders in the brain or spine, such as: addressing blood flow limitations, burst blood vessels, and clots.

• Arteriovenous malformation (AVM), an abnormal tangle of blood vessels in your head that disrupts normal blood and oxygen flow
• Blood vessel disorders
• Brain aneurysm, a weakness in the wall of a brain artery that bulges and fills with blood
• Brain vascular malformation, abnormal growth of blood vessels present at birth that alters blood flow to the brain
• Carotid artery disease, a narrowing of the carotid arteries that carry blood from the heart to the head through the sides of the neck
• Cavernoma, a cluster of abnormal blood vessels with small bubbles filled with blood
• Chronic subdural hematoma, a collection of blood on the outer covering of the brain’s surface (dura)
• Dural arteriovenous fistula, abnormal connection (fistula) between an artery and vein in the dura-mater, the lining between the brain and the skull
• Hemangioblastoma, a benign and highly vascular brain tumor
• Idiopathic hypertension, high blood pressure of unknown cause
• Moyamoya disease, a condition in which arteries in the brain narrow and can lead to blockages that cause stroke or seizures
• Stroke, lack of oxygen to the brain due to a blocked artery (ischemic stroke) or an artery that ruptures and bleeds (hemorrhagic stroke)
• Transient ischemic attack (TIA), a mini-stroke caused by temporary disruption in blood supply to the brain

It is critical for your health that blood flows freely to your brain. When that flow is disrupted, brain cells start dying within minutes. This can result in inflammation and brain damage. We can help you prevent significant long-term complications by providing prompt diagnosis and treatment for a vascular problem.

 

Are you the right candidate for brain surgery?

Only when a problem is considered to be too serious to be treated with medicine or therapy is brain surgery recommended. A neurosurgeon may evaluate the need for brain surgery in the following situations:

• Spine disorder:

Pain, numbness, and tingling sensations in the limbs might indicate spinal injury. After diagnosing the condition generating these concerns and checking for damage, a brain procedure may be advised.

• Recurrent headaches:

While migraines are a frequent worry, chronic and recurring headaches may indicate a more serious problem, and a test for brain-related problems may be recommended. If a cause for brain surgery is identified, a neurosurgeon will address the issue using one of the brain surgery kinds.

• Trauma due to accident:

A big accident or even a fall can cause brain damage and head injuries. Typically, brain surgery is used to treat this. To avoid the possibility of brain edema, abscess, or bleeding, it is preferable to get examined for brain injury as soon as possible following the occurrence.

1. Stroke:

A stroke can impair a section of the brain, and extensive brain surgery may be necessary to restore full brain function. If detected in time, brain surgery may be performed to avoid a stroke caused by plaque buildup or clots in major artery arteries.

• CSF build-up:

Cerebrospinal fluid (CSF) is a fluid that surrounds the brain and is required for appropriate brain function. In hydrocephalus, CSF is produced and pumped in excess around brain tissue, creating swelling and pressure. Patients, particularly youngsters, experience nausea and vomiting in addition to fever, and the underlying reason is treated by brain surgery that involves draining fluid from damaged areas.

    2. Tumors:

If a patient is known to have brain tumors, a brain surgery for biopsy will be conducted. If only surgery can cure the tumor, a brain procedure to remove it will be performed following the biopsy. Both benign and malignant tumors can be removed by brain surgery.

    3. Epilepsy:

Patients with epilepsy may not necessarily require brain surgery, but in certain situations, seizure control is achieved by specialist brain surgery. It contributes to the patient's improved quality of life. Deep brain surgery or awake brain surgery may be beneficial to an epileptic patient who will undertake testing to establish the likelihood of a successful brain surgery treatment.

• Trigeminal neuralgia:

Trigeminal neuralgia is a painful and persistent illness that affects the trigeminal nerve in the face. Patients may have excruciating discomfort in the lower jaw. The nerve damage can be treated with brain surgery.

 

Symptoms of conditions needing brain surgery

Depending on the nature and severity of the ailment, the symptoms of disorders needing brain surgery may vary. Among the general signs are:

• Headache
• Nausea
• Vomiting
• Drowsiness
• Seizures.

 

Types of brain surgery

• Biopsy

A biopsy involves the removal of a tiny piece of tissue to be examined for abnormalities in order to prevent subsequent clinical issues. During a brain surgical operation, a biopsy may be conducted to detect tumors or other abnormalities.

• Craniotomy

In this sort of brain surgery, an incision in the scalp bone is required to access the brain tissue. That is why it is sometimes referred to as open brain surgery. A bone flap is generated, and the issue to be addressed by the brain surgical operation, such as an aneurysm or fluid draining, is conducted. The bone flap is then removed to minimize additional strain and stress to the brain in circumstances when postoperative edema is predicted or tumor development is probable. Because a part of the skull is removed, it is called a craniectomy. After the brain surgery, the bone flap is usually fixed back on the skull using screws and plates.

• Neuroendoscopy

In certain situations, brain surgery may be performed using an endoscope, in which tiny holes in the cranium are produced and the endoscope is passed through them to guide the brain surgery operation. When compared to open brain surgery, this is considered less invasive and lowers the impact on the patient's health while speeding up recovery time. Endoscopic brain surgery is commonly used to treat tumors in the brain and is also known as keyhole surgery due to the tiny holes used during this type of brain surgery.

• Deep brain stimulation

Deep brain surgery is implanting electrodes deep into the brain to trigger nerve impulses that are normally absent in a patient. This is more commonly accomplished through minimally invasive brain surgery methods that allow the neurosurgeon to insert electrode leads into brain tissue. The pulse generator, which generates electrical impulses to stimulate the brain, is housed in a box device in the chest area, similar to a pacemaker. Patients suffering from neurodegenerative illnesses such as Parkinson's disease, tremors, and epilepsy often benefit from this sort of brain surgery.

• Endonasal endoscopic surgery

A narrow tube containing an endoscope is introduced into the nasal cavity and up to the front areas of the brain, giving this form of brain surgery its name. This brain surgery targets tumor growth in the frontal areas of the brain as well as the top of the spine without the need for open brain surgery. Endoscopic brain surgery has a shorter recovery period and a lower risk of infection than standard brain surgery.

• Awake brain surgery

As the name implies, awake brain surgery is a type of open brain surgery performed while the patient is awake and receptive and under local anaesthetic. This sort of brain surgery allows surgeons to observe a patient's responses to stimulation of specific parts of the brain and ensure that signals for eye movement and vision, speech, motor function, and memory are not harmed during surgery for tumor removal or epilepsy correction. This sort of brain surgery is used in severe situations where the anomaly is in a part of the brain that is responsible for key functions including movement, speech, and vision.

During awake brain surgery, the surgeon or nurses may continue to ask you questions about how you feel or keep you alert throughout the procedure to identify if nerve injury happens inadvertently during tissue removal or device implantation.

 

Surgery for Cerebrovascular disorders

Cerebral (brain) aneurysm surgery

A cerebral aneurysm is a weakened region in the wall of a cerebral artery. The swelling increases the likelihood of aneurysm rupture (bursting). The following surgical methods are used to repair cerebral aneurysms:

• Open craniotomy (brain surgery), or surgical clipping: In order to block blood from flowing into the aneurysm, a neurosurgeon creates an incision in the scalp and skull.
• Endovascular coiling, or coil embolization: This minimally invasive method is well-suited to neuro-interventional radiologists. Coiling does not necessitate any incisions. A neuro-interventional radiologist inserts a thin tube (catheter) into the brain via a blood vessel in the groin. The catheter is directed into the aneurysm using fluoroscopy (live video X-ray) and small platinum coils are placed inside it. The coils conform to the aneurysm's shape, forcing it to clot (embolization).

 

Surgery for cerebral arteriovenous malformation (AVM)

AVMs develop when a cluster of blood vessels grows improperly, placing them at danger of rupture. Surgical treatments to correct AVMs often entail a multimodal approach that includes:

• Endovascular embolization: Neuro-interventional radiologists use a catheter to route a blood artery from the groin to the brain during this minimally invasive technique. Fluoroscopy is used to precisely direct it. They then inject a glue-like material into the AVM via the catheter, slowing blood flow to prevent rupture.
• Open craniotomy (brain surgery): A neurosurgeon removes part of the skull to expose and remove the AVM.
• Gamma Knife® Icon™ radiosurgery: Surgeons target particular areas of the brain with concentrated radiation beams. The radiation causes scar tissue to form in the AVM, causing it to shrink. Learn more about radiosurgery with the Gamma Knife Icon.

 

Stroke treatment

When blood flow to the brain is disturbed, a stroke ensues. When a blood clot plugs a blood artery or a blood vessel in the brain breaks, this occurs. Stroke Alert is used to treat the greatest number of stroke victims in the region. Stroke Alert is a quick procedure that entails:

• First responders who bring patients to our Comprehensive Stroke Center
• Our team of emergency and neurology specialists who use early testing and prompt evaluation to get patients rapid, effective care

 

Stroke treatments are performed by fellowship-trained neuro-interventional radiologists. Treatments include:

• Thrombolysis:  including the clot-buster tPA, to break down blood clots.
• Intra-arterial stroke therapy:  micro-catheter – a tiny, flexible tube – directly into the brain to precisely deliver tPA.
• Clot retrieval devices 
• Cerebral angioplasty

 

How do I recover from Brain Surgery?

Brain surgery recovery is a slow process that might take two months or longer. It finally improves the patient's quality of life and is worth the wait. The treatment team develops a rehabilitation strategy for you. Following brain surgery, all elements of the treatment plan must be followed to avoid problems.

Depending on the type of brain surgery conducted, a patient is usually need to stay in the hospital for a few days after the procedure. In the event of a minimally invasive brain operation, the patient can depart after 2-3 days, depending on general patient health and the doctors' assessment of the risk of following problems. The post-operative evaluation is ongoing during the hospital stay and includes periodic testing of reactions and blood flow.

Recovery from brain surgery is frequently improved by lifestyle modifications that include a more active lifestyle with less stress, a reduction in alcohol use, and periodic check-ups to monitor symptoms. Brain surgery is known to leave patients quite weak and exhausted soon following the procedure, and the body need appropriate rest at this time.

With certain situations, patients who have undergone brain surgery are advised to seek physiotherapy or speech therapy to aid in their rehabilitation. If considerable life and lifestyle changes are expected as a result of brain surgery, psychological counseling may be required.

 

 Precautions to take after brain surgery

• During the healing period, it is critical to care for the wound caused by the brain surgery process. Inadvertent prodding or straining in the wound region may cause a suture to open, increasing the risk of severe brain injury.
• Rest and reduced stress are two significant variables that contribute to a quick recovery after brain surgery. Consult your doctor to determine what procedures you should take to guarantee a complete recovery following the treatment.
• Even after brain surgery recovery, follow-up visits to the clinic to address any symptoms and postoperative examinations are advised.

 

Complications and risks that may arise

Despite significant advances in safety and precision, brain surgery, like any invasive operation, carries some hazards. Some of the most serious adverse effects of brain surgery include:

• Bleeding: Brain surgery can result in unexpected bleeding in the brain area, which can be treated if it occurs under medical supervision.
• Allergic reactions: Reactions to anesthesia have been noted in some cases, but is otherwise rare.
• Blood clots: If left untreated, thrombosis in the brain can result in a stroke, and brain surgery may occasionally result in this as a side effect.
• Brain swelling: Swelling can occur due to trauma or fluid buildup in the brain after a brain operation.
• Coma: If brain surgery fails, a patient may have a prolonged period of unconsciousness known as coma, and may sometimes become a vegetative condition. However, most brain operations today have a good success rate, and such a case is uncommon.
• Infection: Infection in the location where the brain surgery was performed might result in consequences such as edema and further brain damage.
• Amnesia: Short-term or long-term memory loss may occur due to nerve damage during brain surgery.
• Impairment of bodily functions: The neurological system controls speech, vision, and motor coordination, and brain injury caused by brain surgery can impact any of these processes.
• Seizures: Seizures can occur following brain surgery in some situations and are caused by injury to the brain's nerve centers.

 

Cerebrovascular surgery FAQS

• What can I expect after my brain surgery procedure?

After brain surgery, most patients may anticipate to return to normal life with increased energy and activity levels, as well as the eradication of any disabilities caused by brain injury. Depending on the exact condition and the type of brain surgery, as well as your overall health, you can expect to live a better and longer life. Major life adjustments, such as moving jobs, may be required in some instances. Diet and exercise regimens may also differ from what was followed before to surgery. You should expect some fatigue in the weeks following brain surgery.

• What is the survival rate after the brain surgery?

The success rate of brain surgery is determined by the degree of the damage to be repaired, the type of brain surgery done, and the patient's age and condition. Except in situations of malignant tumors, where chances are reduced, the typical long-term survival rate after brain surgery is 50-70%. The odds of survival are greatly increased in situations of brain surgery conducted for non-tumor related brain injury.

• Can I work out after brain surgery?

Heavy lifting and intense jogging should be avoided immediately following a brain procedure. Pushing or swimming are also not suggested since they might produce unexpected internal motions and tension. Before beginning any strenuous physical activity following brain surgery, you should talk with your doctor and have a comprehensive follow-up examination completed.

• How long does it take to recover from a brain surgery procedure?

It might take some time to recover from a brain tumor procedure. Everyone takes their own time recovering from brain tumor surgery. After the procedure, you may need to stay in the hospital for 3-10 days. However, the length of your hospital stay is also determined by your procedure and how long it takes you to recuperate. It is not usually possible to return to work immediately following brain surgery.

• How long do I have to stay in the hospital for brain surgery?

Following brain surgery, it is common to require some time before you can resume your typical activities. Rest is essential for complete healing. Each person takes a different amount of time to recuperate from surgery. The recovery time is determined by:

• The procedure followed to remove the brain tumor
• The location of the tumor
• The areas affected as a result of the surgery
• Your age and overall health at the time of surgery.

 

Conclusion 

Cerebrovascular or brain surgery refers to surgical treatments performed on the brain or its surrounding tissues to repair anomalies such as tumors or aneurysms. It is a vital surgery that is carried out in a highly specialized setting by qualified neurosurgeons. Recent improvements in brain surgery have enabled a greater number of doctors to prescribe it in certain cases, and the brain surgery kinds to be conducted are advised by the doctor based on the location of the structural aberration, the individual's health, and the severity of the issue.

With increased technical advancement in this field, minimally invasive brain surgery techniques using precision equipment are now available, minimizing the number of brain surgery dangers involved with the process.