Brain Surgery

Dr. Gary Simonds talks about the treatment of Intractable Epilepsy.

Brain surgery is performed only by a neurosurgeon. Carilion Clinic neurosurgeons went through exceptional training in pediatric and adult brain surgery at the best programs in the country. All possess extensive experience and expertise in brain surgery. Our surgeons use a team approach for the care of each brain surgery patient. Proposed brain operations and treatment options are discussed extensively and the team makes every effort to spare the patient from surgery, if at all possible. At Carilion, we perform hundreds of brain surgeries every year. Our operating facilities are equipped with the most advanced equipment and staffed with experienced, dedicated professionals.

Some types of brain surgery Carilion neurosurgeons perform include:

Craniotomy. Craniotomy refers to the creation of a window in the skull through which a neurosurgeon can manipulate regions of the brain and its surroundings. At the end of the procedure, the window of skull is put back and secured with small titanium plates and screws.

Adult and pediatric brain tumor surgery. Carilion neurosurgeons perform hundreds of brain tumor surgeries every year. Some tumors can be completely removed, some can be partially removed, and some can only be biopsied. All patients with brain tumors are extensively evaluated and discussed by the entire neurosurgical team as well as multiple other experts in radiology, radiation therapy, and oncology.

Arteriovenous malformation removal. Surgery may be combined with other treatments including stereotactic radiosurgery and angiographic micro-catheter treatment.

Brain biopsy. Many brain disorders cannot be diagnosed by MRIs and CT scans alone. Sometimes the abnormality requires biopsy but not removal of the abnormality. High-tech computer assisted systems are used to safely obtain small samples of tissue for pathologic evaluation. Patients generally have no side effects, and can return home on the day after the biopsy.

Ventricular and cyst shunting and endoscopic fenestration. Used for patients with hydrocephalus, this technique diverts the excess brain fluid to other areas of the body through thin tubes placed under the skin. Sometimes this "shunting" can be avoided by using an endoscope (television scope) to free fluid passages in the brain.

Microvascular decompression. 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 may involve mildly damaging the affected nerves with various non-surgical methods including CyberKnife® radiosurgery.

Aneurysm surgery and endovascular treatment. Patients who survive a brain aneurysm rupture have a 50 percent chance of experiencing re-rupture within a year, usually with devastating consequences. An aneurysm can often be cared for by placing a small metal clip across its base through microscopic brain surgery. Some aneurysms can be treated with a less-invasive treatment called "coiling." At Carilion, we approach cerebral aneurysms with a multi-disciplinary team assessment and treatment combining all of the best technologies and experts.

Cranial fracture repair. Most skull fractures will heal well. However, some, such as "depressed" skull fractures, where sections of skull have been driven into the brain, require repair with small metal plates or complete artificial bone material reconstruction.

Intra-cranial monitor placement/decompressive craniectomy. When a patient sustains a bad brain injury, the brain swells and the pressure in the head rises, causing further damage to the brain. Treatment involves placing monitoring devices into the brain through small holes in the skull. If the pressure in the head does not respond to medical management, the surgeons will need to remove a large section of the patient's skull to allow the brain to swell. The removed bone is replaced weeks or months later, once the brain injuries have settled down.

Stimulator placement for Parkinson's disease and tremors (Deep Brain Stimulation). Symptoms of Parkinson's disease, and potentially many other brain conditions, can sometimes be improved (not cured) by placing thin wires deep into the brain and connecting them to pacemaker-like devices.

Cerebral hemorrhage removal. Intracranial hemorrhages (bleeding within the brain) are unfortunately very common. A large number of patients may survive and potentially recover if the collection of clotted blood is surgically removed from their brain.

Infections. The brain and spine can develop severe infections and abscesses that require extensive clean-up. Sometimes the spine can be damaged enough that it requires reconstruction and stabilization with metal screws and connecting rods.

Additional brain disorder treatments and procedures include:

  • Awake craniotomies for tumor
  • Brain mapping for tumors
  • Stereotactic volumetric resections
  • Stereotactic biopsy
  • Placement of chemotherapeutic wafers
  • Placement of radiation sources
  • VP shunts
  • Third ventriculostomies
  • Ventriculostomies
  • Microvascular decompressions for trigeminal neuralgia, glossophayngeal neuralgia, and hemifacial spasm
  • Hemorrhage evacuation
  • Decompression of stroke
  • Chiari malformation repair
  • Intra-operative electrocorticography
  • Brain biopsy for vasculitis/encephalitis
  • Placement of ommaya reservoirs for intrathecal chemotherapy

Minimally Invasive Forms of Brain Surgery

Performing Brain Surgery