Neurosurgical Group of Texas

Cervical radiculopathies (Nerve Root Compression Syndrome) manifest themselves by shoulder and arm pain with or without neck pain. They are also frequently associated with symptoms of arm and hand numbness and weakness. The most common cause is that of degenerative spine disease (spondylosis). This can present itself in the form of a ruptured disc or an osteophytic spur. Most resolve spontaneously in a few days or weeks, with or without analgesics, anti-inflammatory medications, or other conservative measures or traction. Further evaluation is indicated if the symptoms persist for more than a month or two, if the pain becomes incapacitating, or the weakness increases. This consists of an MRI scan or a myelogram followed by a CT scan. If surgery is indicated, surgery can generally be done utilizing a small incision and microsurgical techniques. This can almost always be done in an outpatient setting. Our patients can usually return to restricted activities in a few days or weeks and unrestricted activities in two to three months. Symptoms rarely recur.

Lumbar disc disease generally manifests itself by pain in the lower back or lumbar region and also associated pain radiating down one or both legs (sciatica). Additional symptoms of weakness of muscles in the legs, tingling or numbness in the legs, or difficulty with bladder or bowel control imply that the clinical situation is more significant than when pain is the only symptomatology. Neurological deficits such as these are usually associated with disc herniations large enough to cause compression and compromise of nerve function, and generally should be evaluated promptly. After a detailed neurological exam the evaluation usually consists of MRI scanning and/or lumbar myelography combined with CT scanning. Patients who are stable and without neurological deficit are initially managed conservatively with diminution of activity, anti-inflammatory medication, pain medication, and sometimes physical therapy. In situations where the symptoms or clinical problems persist or progress, a microsurgical procedure can be performed to relieve the compression on the affected nerve or nerves. The main purpose of the surgery is to relieve pain radiating down the legs rather than pain in the lower back. An uncomplicated disc herniation is usually managed by microsurgical technique performed in an outpatient setting. Usually the patient is discharged home within a few hours of surgery after walking, eating, and showing normal bladder function. Office work or school activities can usually be restarted within days of the surgery. Heavy physical activity or strenuous sports usually are avoided for several months.

Complex spinal disorders include those that involve degeneration or instability of the spine with or without compression of the spinal cord or nerve roots and can result in neck and back pain, in addition to arm and leg pain. This includes instability due to degenerative arthritis, fractures, tumors, infection, scoliosis and spondylolisthesis. Patients often require surgical fusion of the spine for stabilization. Spinal fusion is an operation that creates a solid union between two or more vertebrae. This procedure may assist in strengthening and stabilizing the spine and may thereby help to alleviate severe neck or back pain and prevent neurological injury. Almost all of the surgical treatment options for fusing the spine involve placement of cage or spacer between the vertebrae. Spacers are often supplemented with bone from the hip or from another bone in the same patient (autograft) or from a bone bank (allograft). Bone graft extenders and bone morphogenetic proteins (hormones that cause bone to grow inside the body) can also be used to reduce or eliminate the need for bone grafts. Fusion may or may not involve use of supplemental hardware (instrumentation) such as plates, screws, and cages. This fusing of the bone graft with the bones of the spine will provide a permanent union between those bones. Once that occurs, the hardware is no longer needed, but the hardware is generally left in place rather than go through another surgery to remove it. Fusion can often be performed via smaller incisions through minimally invasive surgical (MIS) techniques. The use of advanced fluoroscopy, CT guided stereotactic navigation, and endoscopy has improved the accuracy of incisions and hardware placement, minimizing tissue trauma while enabling an MIS approach. The doctors at the Neurosurgical Group of Texas are experts that specialize in these minimally invasive techniques.

A spinal tumor is an abnormal mass of tissue within or surrounding the spinal cord and spinal column, in which cells grow and multiply uncontrollably, seemingly unchecked by the mechanisms that control normal cells. Spinal tumors can be benign (non-cancerous) or malignant (cancerous). Primary tumors originate in the spine or spinal cord and metastatic or secondary tumors result from cancer spreading from another site to the spine. The surgeons in the group are well trained and experienced in the management of complex spinal tumors, and are situated in one of the foremost neurological centers in the country for treatment of these disorders. Indications for surgery vary depending on the type of tumor. Primary spinal tumors may be removed through complete en bloc resection for a possible cure. In patients with metastatic tumors, treatment is primarily palliative, with the goal of restoring or preserving neurological function, stabilizing the spine, and alleviating pain. Indications for surgery include intractable pain, spinal cord compression, and the need for stabilization of impending pathological fractures. The physicians at the Neurosurgical Group of Texas have pioneered and promoted the removal of spinal tumors through minimally invasive approaches when possible. These approaches maximize patient recovery and help to preserve spinal stability. More complex lesions may require short-segment fixation devices. The doctors in the Neurosurgical Group of Texas confine their treatment of serious spinal tumors to the Texas Medical Center hospitals, recognized around the world for excellence in state of the art medicine and neurosurgery.

The Neurosurgical Group of Texas is uniquely suited for the aggressive treatment of various kinds of brain tumors, both malignant and benign. The surgeons in the group are well trained and experienced in the management of complex intracranial growths, and are situated in one of the foremost neurological centers in the country for treatment of these disorders. The surgical treatment of brain tumors requires a multidisciplinary or team approach. Often the best surgery will involve the talents and skills of qualified physicians from many other related fields including neuro-oncologists, pathologist and neuroanesthesiologists. Intracranial surgical patients are convalesced and recovered immediately in a postsurgical recovery room by a nursing staff thoroughly versed in neurological vital signs. Following the recovery room patients go to a dedicated neurosurgical intensive care unit where nursing staff is tailored and trained to meet the unique needs of these patients. All of these different disciplines represent the outlay of significant equipment, personnel, and financial overhead, and as a result quality intracranial neurosurgery is really limited to large urban centers. The doctors in the Neurosurgical Group of Texas confine their treatment of serious brain tumors to the Texas Medical Center hospitals, recognized around the world for excellence in state of the art medicine and neurosurgery. The doctors in the Neurosurgical Group of Texas are also at the forefront of technological advances in the field of brain tumor surgery, including image guided stereotactic surgery and radiosurgery.

The pituitary is a small gland attached to the base of the brain (behind the nose) in an area called the pituitary fossa or sella turcica. The pituitary is often called the "master gland" because it controls the secretion of hormones. A normal pituitary gland weighs less than one gram, and is about the size and shape of a kidney bean. The large majority of pituitary adenomas (tumors) are benign (not malignant) and are fairly slow growing. Adenomas are by far the most common disease affecting the pituitary. Most of these tumors can be successfully treated. Pituitary tumors can vary in size and behavior. Tumors that produce hormones are called functioning tumors, while those that do not produce hormones are called nonfunctioning tumors. The symptoms of a pituitary tumor generally result from endocrine dysfunction. For example, this dysfunction can cause overproduction of growth hormones, as in acromegaly (giantism), or underproduction of growth hormones, as in hypothyroidism. Hormonal imbalances can impact fertility, menstrual periods, heat and cold tolerance, as well as affect the skin and body in other ways. Because of the pituitary gland’s strategic location within the skull, tumors of the pituitary can compress important brain structures as they enlarge. The most common circumstance involves compression of the optic nerves, leading to a gradual loss of vision. This vision loss usually begins with a deterioration of lateral peripheral vision on both sides. Surgical resection may be indicated. The transsphenoidal approach involves using endoscopes in a minimally invasive trans-nasal approach to the sphenoid sinus and sella. This approach is usually the procedure of choice because it is less invasive, has fewer side effects, and patients generally recover more quickly. Patients can often leave the hospital as early as two to four days after surgery. The doctors in the Neurosurgical Group of Texas confine their treatment of pituitary tumors to the Texas Medical Center hospitals, recognized around the world for excellence in state of the art medicine and neurosurgery.

Members of the Neurosurgical Group of Texas are skilled and experienced in the treatment of complex neurovascular disorders including cerebral aneurysms and arteriovenous malformations, and have the ability to treat these lesions with state-of-the-art techniques. Practicing in the Texas Medical Center, we have access to the most sophisticated neuroradiology practitioners and interventional neuroangiographic techniques including coil embolization and flow-diverting stents for non-surgical treatment of many vascular lesions. We provide surgical treatment with the support of advanced operating room techniques and a highly advanced neurosurgical intensive care unit monitoring for both the pre- and post-operative stages. We feel that the use of modern techniques, with the aid of specialized neuroradiographic support, allows us to offer state-of-the-art treatment for these lesions at the highest possible level. Lesions treated have included giant and skull base intracranial aneurysms, as well as occlusive cerebrovasular lesions, highly complex arteriovenous malformations, and hemangioblastomas. A full range of vascular and neurovascular lesions can be treated at our centers.

Trigeminal neuralgia and hemifacial spasm are debilitating disorders that cause pain or uncontrollable movements in the facial region. Trigeminal neuralgia or tic douloureux is sometimes described as the most excruciating pain known to humanity. The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye. This intense, stabbing, electric shock-like pain is caused by irritation of the trigeminal nerve (also known as cranial nerve V), which sends branches to the forehead, cheek, and lower jaw. It is usually limited to one side of the face. Hemifacial spasm is a neuromuscular disorder characterized by frequent involuntary contractions (spasms) of the muscles on one side (hemi-) of the face (facial). The first symptom is usually an intermittent twitching of the eyelid muscle that can lead to forced closure of the eye. The spasm may then gradually spread to involve the muscles of the lower face, which may cause the mouth to be pulled to one side. Eventually the spasms involve all of the muscles on one side of the face almost continuously. Both conditions may be caused by a nerve injury, or a tumor, or it may have no apparent cause. Most often hemifacial spasm and trigeminal neuralgia are caused by a blood vessel pressing on a nerve at the place where it exits the brainstem. Both conditions can be surgically treated through a procedure called Microvascular Decompression (MVD). MVD involves microsurgical exposure of either the trigeminal nerve root or facial nerve root, identification of a blood vessel that may be compressing the nerve, and gentle displacement of it away from the point of compression. “Decompression" may allow the nerve to recover. This often results in pain relief (trigeminal neuralgia) or resolution of spasm (hemifacial spasm). The doctors in the Neurosurgical Group of Texas confine their treatment of trigeminal neuralgia and hemifacial spasm to the Texas Medical Center hospitals, recognized around the world for excellence in state of the art medicine and neurosurgery.