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Brain and Cranial Surgery

Chronic Subdural Hematoma

Bedside Procedure Avoids Dangerous Craniotomy

One of the most common brain disorders requiring neurosurgery is a chronic subdural hematoma.  A subdural hematoma is a blood clot between the skull and the brain, i.e. on the surface of the brain.  Acute or fresh subdural hematomas typically result from head trauma and require immediate neurosurgical evaluation and may require emergency craniotomy surgery.  However sometimes subdural hematomas arise incidiously over a long period. These are called chronic subdural hematomas because by the time they are discovered, the blood clot has already liquified.  


Chronic subdural hematomas most often arise from head trauma that causes a small acute or fresh subdural hematoma.  These initially small blood clots usually do not need surgery and usually are resorbed by the body.  However a small number of them can liquify and enlarge over several weeks to months.  The patient usually presents with headache but can also present with weakness, confusion, and language difficulty.  Chronic subdural hematomas are more common in patients who are taking blood thinning agents such as coumadin and aspirin. Rarely subdural hematomas can arise spontaneously without any trauma or risk factors.


Since chronic subdural hematomas have liquified, they can usually be drained through a small burr hole, or hole drilled through the skull.  Since the subdural fluid is pushing the brain away from the skull, the risks of damaging the brain from making the hole is fairly low.  A new device called the Subdural Evacuating Port System (SEPS) is a small hollow screw that is screwed into the burr hole and attached to a small drain.  This device can be placed at the bedside in the ICU and slowly allows the liquified blood to drain out slowly over 1 to 2 days in the ICU.


This minimally invasive procedure is significantly safer than a craniotomy.  Dr. Hua has used the SEPS system with exceedingly high success rate, thereby nearly eliminating the need for craniotomy in these patients.  If there is any concern regarding the need for craniotomy in managing a chronic subdural hematoma, please contact Dr. Hua for a consultation.


Trigeminal Neuralgia and Facial Pain

Minimally Invasive Injection versus Brain Surgery


Trigeminal neuralgia is one of the most painful conditions known to mankind.  Stabbing and electric shock like pain shoots across the face rendering the patient helpless and in agony. Most cases respond to medications in the early stages of the disease.  However over time the effectiveness of the medication can wear off.  Once the pain becomes medically intractable, surgical intervention may be necessary.


The surgical treatment for trigeminal neuralgia centers around purposefully damaging part of the trigeminal nerve by radiation (Gamma Knife), heat (radiofrequency rhizotomy), mechanical damage (balloon rhizotomy), or chemical (glycerol rhizotomy).  These procedures are either noninvasive (gamma knife) or require a small puncture wound in the face for the needle to pass through to access the trigeminal nerve center (ganglion). Alternatively, microvascular decompression (MVD) is a full surgical treatment that requires a small craniotomy just behind the ear allowing the trigeminal nerve to be manipulated and separated from the surrounding blood vessels near the nerve's entry into the brain stem.


MVD has been shown to have the best outcomes in terms of level of pain relief and duration of the relief.  However MVD is full brain surgery near very important structures by the brain stem.  Thus the risks and benefits of this surgery must be weighed carefully.  


Of the minimally invasive treatments, Gamma Knife is the least invasive because it entails converging 201 beams of focused radiation onto the trigeminal nerve near the brainstem. The effects of the radiation are very safe, but pain relief can take up to several months to be effective.  In general Gamma Knife is not recommended in younger patients due to the theoretical risks of radiation that can occur many decades after the treatment.  


Of the other minimally invasive treatents, Dr. Hua favors glycerol rhizotomy.  Glycerol rhizotomy involves injecting a small amount of medical grade glycerol (glycerin) into and around the trigeminal nerve ganglion.  Glycerol rhizotomy seems to be safer than both radiofrequency rhizotomy which burns the nerve ganglion and balloon rhizotomy which compresses the nerve ganglion by inflating a balloon.  Glycerol rhizotomy is effective for most patients and is a safe, outpatient procedure.  Also if the pain returns, glycerol is safe enough that it can be injected again.


The treatment and management for trigeminal neuralgia can be very complicated especially in patients who have failed some of these treatment modalities.  Newer techniques such as implanted electrical nerve stimulations have also been used with good effectiveness.  Call Dr. Hua for a consultation regarding the latest treatment options.


Brain Tumor Surgery

Advanced Technology with Minimal Hair Shave


Being diagnosed with a brain tumor is a devastating experience.  Brain tumors can be benign or malignant.  Depending on the suspected variety, brain tumors can be watched conservatively or may need to be treated with surgery or radiation or both.  When surgery is indicated, you need the most advanced technology available to pinpoint the location and boundaries of the tumor.  This intraoperative navigation similar to GPS in a car is sometimes critical to localizing the tumor through a small incision as well as removing the tumor as completely as possible without damaging important parts of the brain.


Furthermore, a large incision with half of the hair shaved from the head is very traumatic to a patient's self image during the healing process.  Dr. Hua pays particular attention to detail in making an incision just large enough to safely and effectively remove the tumor. Additionally in most cases, Dr. Hua is able to perform cranial surgery with a minimal strip shave.  This strip shave allows patients to return to normal activities within a few days with very minimal signs that he/ she has had any surgery at all.  This is not only a cosmetic effect but also gives the patient a sense of wholeness and well being, which is very important in the recovery period.