Texas Neurosurgery, L.L.P.

The cervical spine (neck region) is one of the most important and agile parts of your body. It begins at the base of the skull and consists of seven bones separated by intervertebral discs that allow the spine to move freely. The neck has the greatest amount of movement of any area of the spine and is also responsible for protecting the spinal cord and supporting the skull. Because of its vital function in our everyday lives, injury or disease of the cervical spine is a very serious condition. Anterior cervical discectomy and fusion surgery removes an intervertebral disc and/or bone spurs that are putting pressure on nerve roots. This condition is a result of a herniated or degenerated disc and is known as nerve root compression. Nerve root compression can lead to pain in the neck and arms, lack of coordination, and numbness or weakness in the arms. CAUSES OF ANTERIOR CERVICAL DISC HERNIATION Once the disc is removed it may be replaced with a small bone graft that will allow the vertebrae to fuse together over time. The bone may be obtained from another part of the patient’s own body, a bone bank utilizing donor bone or a synthetic bone graft substitute. Space may also be left open, or a metal plate may be inserted to stabilize the spine while it heals. Another option is inserting an artificial disc into the open disc space to sustain motion. As the name describes, this procedure is done through the front, or anterior, of the body. An incision is made in the front of the neck, off to one side, and the disc is removed. Removing the herniated disc relieves the pressure placed on the nerve root and therefore relieves the symptoms as well. It is performed under general anesthesia. After surgery, a hospital stay is not usually required. Complete recovery time may take between four and six weeks. Although complications are rare in discectomy, any surgical procedure carries risks. Possible risks include infection, bleeding, reactions to anesthesia, injury to the spinal cord, pain at the treated site, damage to nerves or arteries, blood clots and paralysis. These risks can be minimized by choosing an experienced surgeon to perform your procedure, and by adhering to your surgeon’s instructions before and after your procedure.

A foraminotomy is a minimally invasive surgical procedure performed to expand the opening in the spinal column where the nerve roots exit the spinal canal. Its purpose is to relieve the pressure resulting from the foraminal stenosis. This is a painful condition caused by a narrowing of the foramen, the opening within each of the spinal bones that allows nerve roots to pass through. An anterior cervical foraminotomy is performed on the upper spine in the cervical, or neck, region. It frees the affected nerve from pressure and allows it to move again within the spinal column. The patient is given general anesthesia and an incision is made at the front of the neck, typically within a natural skin crease, for access through an anterior approach. A portion of bone is cut or shaved down to open up the passageway of the foramen. If any disc fragments or bone spurs are present, they are removed. After the surgery, patients are generally required to wear a soft neck collar to limit their head and neck movement. Physical therapy may be recommended for the first several weeks after surgery. The full recovery time is usually between two and three months.

Craniotomy is a surgical procedure in which part of the skull is removed in order to view the brain. The piece of skull removed is called a “bone flap.” After the necessary brain surgery is performed, the bone flap is fitted back into the skull. Craniotomies are designated in different ways. A frontotemporal, parietal, temporal or suboccipital craniotomy is named after the bone that is removed. The minimally invasive “keyhole” craniotomy, on the other hand, is named after the small dime-sized incision that is made in the skull. REASONS FOR CRANIOTOMY Craniotomies, which are performed by neurosurgeons, are appropriate in a number of situations, including for: Diagnosing/removing/treating brain tumors, including meningiomas Removing blood or blood clots, including subdural hematomas Repairing tears in the membrane that lines the brain Repairing or clipping aneurysms Draining brain abscesses Removing arteriovenous malformations (AVMs) Repairing skull fractures Repairing tears in the membrane lining the brain Treating epilepsy Implanting stimulator devices to treat movement disorders Craniotomies are also used to relieve pressure within the brain caused by traumatic injury or stroke. CRANIOTOMY PROCEDURE Craniotomy is performed, sometimes under general anesthesia, in a hospital. An incision is made in the scalp (which is shaved at the incision site), and the bone flap is removed to allow access to the treatment area. There are cases in which patients remain awake during surgery, and are asked to move their legs, recite the alphabet or tell stories to ascertain whether brain functioning has been affected. Location of the incision will depend upon the area being treated. A medical drill may be used to create small holes (as in keyhole craniotomy), or a special saw may be used to cut the bone flap. Once the procedure is complete, any tissue that has been cut into is stitched together, and the bone flap is reattached using plates, sutures or wires.

Learn About Benign & Malignant Brain Tumors And Your Treatment Options You hear you have brain tumors, and understandably you feel an overwhelming sense of fear. At Texas Neurosurgery, we know how intimidating a brain tumor can be, but we also know that there are options. Our neurosurgeons strive to soothe your fear and help you to understand what it is you are facing. Contact our offices in Dallas and Addison, TX to schedule a consultation. We are here for you, to help you fight, and to help you through your brain tumor treatment. What Type Of Brain Tumors Are There? Brain tumors are classified in two ways: Primary tumors are tumors that originate in the brain or the spinal canal. Secondary tumors are tumors that spread from other areas of the body to the brain or the spinal canal. Approximately 25 percent of brain tumors are secondary, and a majority of these tumors are caused by lung cancer that has metastasized. In turn, brain tumors are also classified as benign or malignant. They develop from different types of brain tissue and are often named after the areas in which they originate. Benign tumors usually grow very slowly; malignant tumors often grow rapidly and are life-threatening. Although a primary malignant brain tumor is sometimes referred to as a “brain cancer,” unlike most types of cancer, it rarely spreads to other parts of the body. It can, however, spread within the brain and spinal cord. All secondary brain tumors are malignant.Brain Tumors and Brain Tumor Evaluation Dallas, TX Addison, TX Brain Tumor Treatment Options The doctors at Texas Neurosurgery offer several treatment options for brain tumors. Which options are available to you will depend on the specifics of your situation. Read more about some of the treatments we offer below: Craniotomy Stereotactic Radio Surgery

Carpal tunnel release is an outpatient procedure performed to relieve pressure on the median nerve and reduce the symptoms of carpal tunnel syndrome. This procedure can help restore muscle strength and dexterity, and is typically performed on patients who have had persistent symptoms that do not respond to conservative treatment methods. Carpal tunnel release can be performed endoscopically or through an open procedure. Both types offer different advantages to the doctor and patient, and should be considered after a thorough evaluation of the patient’s individual condition. Open carpal tunnel release involves a two inch incision in the middle of the palm and gives the surgeon a better view of the treated area with less risk of accidentally damaging nerve tissue. Endoscopic carpal tunnel release involves two tiny incisions and offers patients less post-operative pain and the ability to return to work more quickly. Patients can return home the same day, but may need prescription pain medication at first to manage the pain from the procedure. The hand may be kept in a splint for the first few weeks after surgery in order to protect the wrist while it heals. Although patients may continue to experience carpal tunnel symptoms after this procedure, most report that symptoms are significantly reduced after carpal tunnel release. To learn more about our carpal tunnel treatment options, please click here.

Patients with chronic back pain often have severe damage to one or more intervertebral discs that cannot be sufficiently repaired to allow patients to restore their quality of life prior to damage. Many of these patients can find pain relief and effective treatment by replacing the damaged disc with an artificial disc during a procedure called arthroplasty. Arthroplasty helps to relieve a wide range of spinal problems by replacing the degenerated disc with an artificial one to act in the same way as the replaced disc. This procedure helps preserve natural movement and allow patients to restore strength and function to the affected area after a course of physical therapy. This procedure is performed through the front of the neck. Complications can include failure of the implant or spontaneous spine fusion. Artificial disc replacements are made of stainless steel and consist of a ball on top and trough on the bottom to replicate the structure and function of the discs. During the disc replacement procedure, the damaged disc is removed through an anterior (front) incision in the neck, similar to a discectomy with fusion procedure. But unlike traditional spinal fusion procedures, artificial disc arthroplasty allows patients to maintain movement and flexibility within the treated area after surgery. The Cervical Artificial Disc Replacement Procedure This procedure is most often performed on patients with severe pain that radiates through the arms or legs as well. Many patients also experience numbness, tingling and weakness as a result of nerve root compression or irritation. After surgery, patients can return home after a one or two day hospital stay, and can return to work and other light activity after two to three weeks, with full recovery taking approximately 12 weeks.

Learn How Deep Brain Stimulation Can Be An Effective Parkinson’s Disease Treatment Parkinson’s Disease, an achronic motor system disorder, can be a debilitating disease. It can lead to tremors, stiffness in the muscles, slow movement, difficulty walking or balancing. While medication can sometimes be an effective Parkinson’s Disease Treatment, at times, it is not enough. That is why the Neurosurgeons at Texas Neurosurgery in Dallas, TX offer Deep Brain Stimulation (DBS), to their patients. This surgical procedure is a more dramatic Parkinson’s Disease Treatment. If you are interested in this treatment, contact our office in Dallas, TX. What Is Deep Brain Stimulation? Deep brain stimulation (DBS) is a surgical procedure that serves as a Parkinson’s disease treatment. This procedure is for patients who do not respond to medication. Deep Brain Stimulation (DBS) deactivates the parts of the brain that trigger the disease without destroying nearby brain tissue. The Procedure During the DBS procedure, your surgeon will implant a small device called a neurostimulator under the skin of the chest. This battery-operated device is similar to a pacemaker for the heart. It is designed to prevent tremors and other symptoms of Parkinson’s disease through electrical stimulation to the areas of the brain that control movement. Your surgeon will connect the device to electrodes that placed in the brain to directly deliver the electrical signals. Before the procedure, your doctor will use MRI or CT Scanning to determine where they will place the electrodes. For most patients, the electrodes will be put on the thalamus, subthalamic nucleus and globus pallidus. After Your Surgery After the Deep Brain Stimulation (DBS) procedure, most patients experience significant symptom relief. However, you may still need to take medication to treat the disease, although typically at a reduced dosage. Dosage reduction also helps limit the occurrence of side effects and can lead to an overall higher quality of life for patients with Parkinson’s disease.

A tumor that forms in the area of the spinal cord can upset the connection between the brain and the nerves or inhibit the cord’s blood supply. Intradural spinal tumors occur in the arachnoid membrane of the spinal cord as well as in the nerve roots that stretch out of the spinal cord. This type of tumor may be benign or malignant, but in both cases they often require removal. Complete tumor resection is usually most effective in treating spinal tumors. The surgery is performed under general anesthesia while the spinal cord is constantly monitored. The dura is opened to expose the spinal cord and nerves. The tumor is removed as thoroughly as possible without disrupting healthy surrounding tissue. A laser is used to help the surgeon reach these tumors, which are often hard to access. Other benefits of a laser technique include a lower risk of complications, a greater likelihood that the entire tumor can be extracted and the potential of less damage occurring to the nerve tissue nearby. The laser affords a higher level of precision and shortens the typical operating time, resulting in a procedure that is safer and more effective.

A microdiscectomy, also known as microdecompression spine surgery, is a surgical procedure that removes part of an impinged intervertebral disc in order to relieve pain, weakness, and numbness throughout the body. It is usually reserved for patients with severe symptoms that do not respond to more conservative treatments and significantly affect the patient’s quality of life. The microdiscectomy procedure is most effective in relieving lower back and leg pain caused by lumbar disc herniation, although it may be performed in the cervical and thoracic spine as well. A herniated disc is a common condition that occurs as a result of gradual wear and tear or an injury to the intervertebral discs, causing it to bulge and break open. Patients with this condition often experience pain, numbness, and weakness in the affected area, as well as through the legs or arms, depending on the location of the disc. INDICATIONS FOR MICRODISCECTOMY Symptoms caused by a disc herniation often improve through conservative treatments or on its own. However, patients experiencing leg pain and numbness for more than six weeks may benefit from surgery. Surgery may also be recommended for severe pain that interferes with a patient’s ability to function normally. It is important for patients to be healthy enough to undergo major surgery and a rehabilitation program, as well as to have realistic expectations for the outcome of this procedure. While surgery is not needed in all cases, microdiscectomy is considered a highly effective option that can relieve pain quickly. Your doctor will determine whether or not this procedure is right for you after a thorough evaluation of your condition. MICRODISCECTOMY PROCEDURE During the microdiscectomy procedure, an incision is made in the back at the location of the affected disc, and the muscles are lifted away to access the spine. Small surgical instruments and a microscope are inserted into this incision to repair the affected disc using minimally invasive techniques. Once the targeted nerve root is identified, the disc is removed from under the root, and a small portion of the facet joint may be removed as well to relieve pressure on the nerve. The muscles are then placed back in their original position and the incision closed with sutures. This procedure is performed under general anesthesia in a hospital setting. A short hospital stay is often required after surgery.

Ulnar release is an inflammation of the ulnar nerve, which controls the muscles in the forearm and hand. This allows us to feel the sense of touch, texture and temperature throughout most of our hand and forearm. When this nerve is damaged, often at the wrist or elbow, patients may experience pain, numbness, weakness and restricted thumb movement. This condition affects men more often than women and can occur as a result of trauma, anesthesia, malnutrition or tumors. Treatment of ulnar nerve neuropathy depends on the severity of the condition, but may include medication, exercises, splints and sometimes surgery to remove a cyst or correct damage from an injury. Your doctor will discuss your options with you, as well as home remedies you can take to help treat symptoms of ulnar nerve neuropathy.