Our neurosurgeons, Dr. Arias, Dr. Kimball, Dr. Mian, and Dr. Robinson provide treatment plans for a wide range of neurological conditions involving the brain and spine.
Craniotomy for Epilepsy- For any patient with epilepsy that is not controlled with medications, one important goal for epilepsy neurologists and neurosurgeons is understanding where in the brain the seizures are arising. Once we understand where seizures begin, we can determine whether surgery might be an effective treatment.
If a patient’s seizures are coming from only one area in the brain, we first evaluate whether brain tissue is important for normal neurologic functions like movement, speech, and vision. If the seizure area is not important for these functions, a procedure to remove or burn the affected area gives the patient the best chance of seizure-freedom. If there are several diseased areas causing seizures or if one or more of these areas is essential for normal functions, we instead consider neuromodulation therapies, such as deep brain stimulation (DBS), responsive neurostimulation (RNS), and vagus nerve stimulation (VNS).
Removing diseased brain tissue causing seizures is performed with a craniotomy. This approach for treating seizures is both effective and has been in use for the better part of a century. In cases of temporal lobe epilepsy (the most common type of epilepsy in adults), for example, a craniotomy for removing part of the temporal lobe cures epilepsy in over 70% of patients. In cases where patients have a small area of brain tissue causing seizures, a newer, minimally invasive technique called laser ablation can be a safe and effective safe alternative.
Laser Interstitial Thermal Therapy - Laser interstitial thermal therapy (also called laser ablation) is a minimally invasive technique that does not require a craniotomy and can be used for patients with certain forms of epilepsy, brain tumors, or swelling resulting from previous brain radiation (radiation necrosis).
In this procedure, a neurosurgeon uses an MRI to guide the placement of a thin laser fiber into the brain lesion. Using the MRI, the laser is then used to burn the diseased tissue. Most patients are able to return home from the hospital the following day.
Vagus Nerve Stimulation - Vagus nerve stimulation (VNS) is a form of neuromodulation used most commonly for epilepsy but also for treatment-resistant depression. This is an outpatient procedure in which a thin wire is wrapped around the vagus nerve in the left side of the neck and then connected beneath the skin to a small battery implanted beneath the collarbone. When turned on, stimulator cycles every few minutes. Several studies have supported the effectiveness of VNS for reducing seizures, and this effect appears to grow stronger over time. Because VNS can also be helpful for depression, epilepsy patients who also have depression may experience an improvement in their depressive symptoms.
Responsive Neurostimulation - Responsive neurostimulation (RNS) is a procedure for treating focal epilepsy in patients who are not candidates for procedures to remove or burn their seizure zone with a craniotomy or laser ablation. In this procedure, a neurosurgeon implants small electrodes in the brain at the site where seizures are arising. These electrodes are then connected to a device (NeuroPace) that is embedded in the skull. The NeuroPace continuously monitors for brain activity that is suspicious for a seizure and, when needed, delivers electrical stimulation to interrupt it. Doctors are able to monitor how seizures are detected and how often electrical stimulation is triggered. Stimulation levels are low enough that they are not perceptible to patients. Long-term studies have found that RNS patients experience an average of roughly a 60-70% reduction in seizures.
Deep brain stimulation-
Stereotactic EEG- Stereotactic EEG (also called SEEG) is a minimally invasive technique used to help epilepsy neurologists and neurosurgeons determine where in the brain a patient’s seizures are arising. This procedure is performed when studies like a scalp EEG, brain MRI, and PET scan suggest that there is a single spot in the brain causing seizures but are unable to pinpoint it precisely enough to consider surgery.
In a stereotactic EEG procedure, a neurosurgeon introduces thin wires into the brain. A specialized robot is used to help place these wires with millimeter accuracy, and no craniotomy is needed. The implanted wires are then connected to a monitoring system - much like with a traditional scalp EEG. The patient is monitored in the hospital, and when seizures occur, the implanted electrodes are used to pinpoint where they start. When enough information is gathered from the electrodes, they are removed.
Microvascular decompression- Microvascular decompression (MVD) is a neurosurgical procedure for treating patients with disorders like trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia. These disorders commonly occur due to compression of a nerve beneath the brain by a nearby blood vessel. As the blood vessel pulsates with each heartbeat, it bumps up against the nerve, irritating it. The irritated nerve may then cause symptoms relating to its function, commonly intermittent pain or twitching in the face.
In a microvascular decompression, a neurosurgeon creates a small hole in the skull and works under a microscope to identify the affected nerve and the compressive blood vessel. The blood vessel is separated from the nerve, and a piece of padding is inserted between them. Long-term studies have established that MVD is both safe and effective. For trigeminal neuralgia, for example, roughly 80-85% of patients experience immediate, total- or near-total pain relief.
Gamma Knife radiosurgery- Gamma Knife radiosurgery is a minimally invasive technique used for treating a variety of neurologic disorders including trigeminal neuralgia and brain tumors. In a Gamma Knife procedure, a neurosurgeon delivers focused beams of radiation to a precise spot in the nervous system. Studies have established that radiosurgery can be similarly effective to open surgery for treating certain brain tumors, and radiosurgery is an excellent option for patients with trigeminal neuralgia who are not candidates for a microvascular decompression or percutaneous rhizotomyor who would prefer a less invasive approach.