Brain Surgery

Brain surgery, an extremely delicate and complex process, is performed by a neurosurgeon, or neurological surgeon. With anesthesia techniques, image guidance (computer assistance to visualize brain structures), and other advances, brain surgery is much more modern today

At Carilion Clinic, our surgeons have undergone extensive training in pediatric and adult brain surgery at the best programs in the country. They use a team approach in determining the care and treatment plans of patients, including involving the families when needed.

Our surgeons perform hundreds of procedures each year, and the operating rooms and intensive care units are supported with the latest equipment and experienced, dedicated support staff.

Conditions that might require brain surgery include:

  • Adult and pediatric brain tumors. Carilion Clinic neurosurgeons specialize in treating various types of brain tumors. The surgery is very technical and some brain tumors may require further treatment, including chemotherapy, radiation surgery or radiosurgery.
  • Arteriovenous malformations. “AVMs” are tangles of abnormal blood vessels in the brain that can hemorrhage, or bleed. Surgery may be combined with other treatments, including stereotactic radiosurgery and angiographic micro-catheter treatments.
  • Brain biopsy. Many brain disorders cannot be diagnosed by MRIs and CT scans alone. Sometimes it requires biopsy, but not removal. Computer-assisted systems are used to safely obtain small samples of tissue for evaluation. Patients generally suffer no side effects and can return home on the day following surgery.
  • Hydrocephalus and brain cysts. Small sections of the brain contain pockets of crystal-clear spinal fluid. Sometimes the passage ways for the fluid become blocked up. The pocket expands and pushes on the surrounding brain. This is called hydrocephalus or “water on the brain.” This is treated by diverting the fluid through thin silastic tubes (shunt) under the skin to other areas of the body. Sometimes “shunting” can be avoided by using a television scope to open a window between the fluid-filled pocket and free-fluid passages at the base of the brain.
  • Tic Dolareaux and hemifacial spasm. Some conditions of severe facial pain or constant facial twitching can be stopped by a brain operation where a small blood vessel is separated from a very fine nerve in the back of the brain. Other treatments for these conditions can include procedures using needles and CyberKnife radiosurgery.
  • Intractable epilepsy. Some patients with persistent poorly controlled seizures can have the location of seizure generation identified by extensive testing. In these patients, seizures can often be stopped or better controlled by removal of this section of the brain.

  • Cerebral aneurysms. Aneurysms, or bleeding, can often be cared for by placing a small metal clip across their base through microscopic brain surgery. Many aneurysms can be treated through catheters passed through the vein system into the brain. The best approach to the treatment of cerebral aneurysms is a multi-disciplinary team assessment and treatment combining all the best technologies.
  • Cranial fractures. Most skull fractures will heal well, but some require repair with small metal plates or complete artificial bone material reconstruction.
  • Head Injury. In severe injuries, the brain swells, causing pressure in the head to rise, further damaging the brain. Sometimes the pressure will not respond to medical management and surgery is required to relieve the pressure.
  • Parkinson’s disease and tremors. Some symptoms of Parkinson’s disease, and potentially many other brain conditions, can sometimes be improved (not cured) by placement of thin wires deep into the brain and connecting them to pacemaker-like devices to provide stimulation.
  • Cerebral hemorrhages. Intracranial hemorrhages (bleeding within the brain) is unfortunately fairly common. Patients on blood thinners, those with weakened arteries and uncontrolled high blood pressure, and trauma patients, are particularly vulnerable.
  • Pituitary tumors. The pituitary gland (located just above a sinus at the back of the nose) is a common location for the development of benign tumors. These tumors can cause problems by secreting too much of harmful hormones (such as growth hormone), by suppressing all hormone production from the gland, or by growing large enough to press on eye nerves and other structures. These tumors can be effectively treated with surgery. Sometimes other additional treatments such as stereotactic radiosurgery are required.
  • Synostosis. Some children are born with severely disfigured skulls and facial bones. This can often be significantly improved by reconstructive surgery. Sometimes teams of neurosurgeons, plastic surgeons, and oromaxillofacial surgeons combine their expertise for the surgery.
  • Infections. The brain can develop severe infections and abscesses that require extensive clean-up or debridement.
  • Stroke. A stroke occurs when a portion of the brain loses its blood supply. The section dies but it also swells. If the swelling is bad enough, it can push on and damage surrounding brain tissue.