What Is Neurosurgery?

Neurosurgery is a kind of procedure involving the treatment of the nervous system

Types Of Neurological Procedures: Is Transcranial Magnetic Stimulation Right For You?

What Is Neurosurgery?

Most people think neurosurgery is only associated with the procedures done on the brain, and while the treatment of the brain is included in the branch of neurosurgery, it doesn’t get limited to brain surgery alone.

This medical specialty is concerned with the treatment and diagnosis of patients of both adult and pediatric age groups, that have injuries or disorders concerning the central nervous system (brain and spinal cord) as well as the peripheral nerve system, which can involve any part of the body.

Why Is Neurosurgery Done?

Neurosurgery is categorized as a very challenging surgical specialty where techniques and technologies are constantly developing. Depending on your condition and your doctor’s recommendations, you may be treated either via surgical or non-surgical procedures.

With the progress of new modern medicine and techniques, minimally-invasive procedures using surgical microscopes and endoscopes are being used more and more which sometimes can arguably showcase comparable or even better results than open surgery.

Neurosurgery can treat a wide spectrum of conditions and disorders, including:

  • Cerebral (brain) aneurysms and strokes
  • Tumors that grow in the brain, spine, and skull
  • Injuries resulted from trauma to the head and spinal cord
  • Degenerative spinal conditions and prolapsed discs
  • Cerebral (brain) aneurysms and strokes
  • Epilepsy
  • Infections
  • Certain psychiatric disorders
  • Congenital conditions such as spina bifida
  • Conditions associated with movement such as Parkinson’s disease
  • Conditions that affect cerebrospinal fluid flow such as hydrocephalus
  • Pituitary tumors and neuroendocrine disorders

Types Of Neurosurgery Procedures

Neurosurgeons perform a variety of surgeries related to neurological disorders, on a daily basis. Some of these treatments might be invasive or minimally-invasive surgical procedures, while other times non-surgical treatments might be recommended.

 Surgical Procedures

  • Brain Surgery
  • Clot Removal
  • Aneurysm Repair
  • Tumor Removal
  • Brain Bleed block
  • Trauma Repair
  • Shunt Insertion Or Revision
  • Endovascular Procedures – performed to treat problems with blood vessels
  • Carotid Endarterectomy – performed to remove plaque build-up from inside a carotid artery in your neck.
  • Deep Brain Stimulation (DBS) – in which electrodes are implanted surgically in certain brain areas, to treat movement disorders. The procedure may be used to treat Parkinson’s disease, dystonia, epilepsy, or tremors
  • Coil Embolization – performed to treat an aneurysm by filling it with material that closes off the sac and lowers the risk of bleeding.
  • Peripheral Nerve Surgery
  • Carpal Tunnel Release – performed to treat carpal tunnel syndrome
  • Ulnar Nerve Release – performed to treat cubital nerve syndrome (also known as ulnar nerve entrapment).
  • Vagus Nerve Stimulation – performed by delivering electrical impulses to the vagus nerve inside the body, to treat certain types of epilepsy and treatment-resistant depression (TRD).
  • Spine Surgery
  • Discectomy – removal of abnormal disc material that presses on a nerve root or the spinal cord
  • Laminectomy – performed to remove the back of one or more vertebrae, usually to give access to the spinal cord or to relieve pressure on the nerves.
  • Spinal Fusion – joining of 2 or more vertebrae
  • Vertebroplasty And Kyphoplasty – performed by injecting bone cement through a small hole in the skin into fractured vertebrae to relieve back pain caused by vertebral compression fractures.
  • Spine Stabilization And Reconstruction – installation of hardware and bone grafts to fuse segments of the spine, performed to treat any kind of degenerative condition, including scoliosis and herniated discs.

Non-Surgical Procedures

With different types of conditions, there are a variety of treatments available. Some disorders don’t require surgical solutions and can be treated via non-surgical procedures.

These include:

  • Stereotactic Radiosurgery (SRS)
  • Transcranial Magnetic Stimulation (TMS)

Stereotactic Radiosurgery (SRS)

This procedure involves the use of many precisely focused radiation beams to treat tumors and other abnormalities in the brain, spine, lungs, liver, spine, and other parts of the body, including cancer, epilepsy, trigeminal neuralgia, and arteriovenous malformations.

This type of treatment is not surgical, meaning there are no incisions or openings made by your surgeon. Instead, this procedure uses 3D imaging to carefully aim beams of x-rays at abnormal tissues through the skin from different and various directions, without damaging the surrounding healthy tissue.

How It’s Done

Like other forms of therapeutic radiology, stereotactic radiosurgery works by damaging the DNA of the targeted cells. The affected cells then lose the ability to reproduce, which causes tumors to shrink and blood vessels to close-off, which cause the tumors to lose their blood supply.

What Can SRS Treat?

The use of stereotactic radiosurgery has expanded widely to treat a variety of neurological and other conditions, including:

  • Brain Tumors
  • Arteriovenous Malformation (AVM) – an abnormal connection between arteries and veins, usually in the brain or spine
  • Trigeminal Neuralgia – the chronic pain of the trigeminal nerve that is located in the face
  • Acoustic Neuroma – a benign (non-cancerous) tumor on the main nerve that leads from the inner ear to the brain
  • Pituitary Tumors
  • Tremors
  • Other Cancers – such as cancer of liver, lungs, and spine

Risks And Side Effects

Since the procedure doesn’t involve making any cuts or incisions, there are significantly lower and milder risks than traditional surgeries.

These side effects may include:

  • Fatigue
  • Swelling near or at the treatment site
  • Headache
  • Skin irritation at the treatment site
  • Hair loss or scalp problems at the treatment site
  • Neurological symptoms, such as seizure, numbness/tingling or weakness
  • Gastrointestinal symptoms, such as nausea, vomiting or diarrhea

These side effects are generally temporary and get better within a few weeks.

Transcranial Magnetic Stimulation (TMS)

Transcranial Magnetic Stimulation (TMS) is a newly developed non-invasive brain stimulation method operating outside of the body for the treatment of psychiatric and neurological disorders.

The procedure involves the use of magnetic pulses to stimulate nerve cells in the brain, to typically help with Treatment-Resistant Depression (TRD). This is the type of depressive disorder that has not responded to other treatments.

When these TMS pulses are delivered at regular intervals it is known as repetitive TMS (or rTMS).

Who Are Good Candidates For TMS?

there are many effective treatments for depression, but regular well-known approaches such as antidepressants and psychotherapy may not be effective for everyone.  

In fact, according to Harvard Health Publishing, “approximately two-thirds of people with depression don’t get adequate relief from the first antidepressant they try. After two months of treatment, at least some symptoms will remain for these individuals, and each subsequent medication tried is actually less likely to help than the one prior.”

So you may be eligible for TMS if:

  • You have a diagnosis of Major Depressive Disorder
  • You have another illness that limits your ability to take medications for depression
  • Your depression and anxiety symptoms interfere with your daily life
  • The side effects of your current depression medication are intolerable
  • Traditional medications to treat depression haven’t worked
  • You’re not satisfied with the results you are getting from your current medication

You may NOT be eligible for TMS if:

  • You have metallic devices or non-removable metallic objects implanted in or around the head. (Metallic fillings of the teeth notwithstanding)
  • You have other implants such as pacemakers, implantable cardioverter defibrillators (ICDs), and vagus nerve stimulators (VNS)
  • You are a high-risk patient with epilepsy, a history of head injury, or other serious neurologic issues

What Can TMS Treat?

TMS is being studied extensively across disorders and even disciplines with the hope that it will evolve into new treatments for neurological disorders, pain management, and physical rehabilitation in addition to psychiatry. 

Apart from treatment-resistant depression, TMS has been approved in many European countries for various other common conditions.

These include:

  • Anxiety disorders such as Obsessive-Compulsive Disorder (OCD)
  • Post-Traumatic Stress Disorder (PTSD)
  • Stroke rehabilitation
  • Schizophrenia
  • Parkinson’s disease
  • Alzheimer’s disease
  • Chronic pain
  • Nicotine addiction

How Is TMS Done

Transcranial magnetic stimulation doesn’t involve surgery, so you are awake and alert throughout the therapy, and there’s no anesthesia or sedation required, and no downtime needed afterward.

TMS therapy is an intensive treatment option requiring sessions that occur five days a week that can take up to several weeks to take effect. Each session is relatively short and may last between 20 to 50 minutes, depending on the device and clinical protocol being used.

During an rTMS session, an electromagnetic coil is placed against your scalp near your forehead. The electromagnet painlessly delivers a magnetic pulse that stimulates nerve cells in the Dorsolateral Prefrontal Cortex, the brain target with the greatest evidence of clinical effectiveness and an area known to be involved in decreased activity and depression.

While it is not known and completely understood how rTMS works, the stimulation appears to affect the function of the brain, which can then ease depression symptoms and improve the overall mood.

This treatment does not affect the other areas of your body like sometimes antidepressants do.

Though one session may be enough to change the brain’s level of excitability, relief isn’t usually noticeable until the third, fourth, fifth, or even sixth week of treatment.

Risks And Side Effects Of TMS

Generally, rTMS treatments are safe because they don’t require anesthesia or electrode implants, but as with any medical procedure, they can carry some risks.

These include:

  • Headache
  • Dizziness
  • Scalp discomfort at the site of treatment
  • Tingling, spasms or twitching of facial muscles

Doctors usually alter the levels of stimulation to help reduce the symptoms you may be experiencing. They might sometimes recommend you take some over-the-counter medications for pain prevention before the start of the treatment.

Although rare, there are some serious but uncommon side effects that may occur after a session.

These can include:

  • Loss of hearing if there is insufficient ear protection during the procedure
  • Mania, more specifically in bipolar cases
  • Seizures

Recovery And Results Of TMS

After your treatment, you can go back to your normal daily activities.

If rTMS works for you, your depression symptoms may improve or subside completely. Symptom relief may take a few weeks of treatment.

According to Dr. Adam P. Stern, “Approximately 50% to 60% of people with depression who have tried and failed to receive benefit from medications experience a clinically meaningful response with TMS.”

It is expected, that with the development of new techniques and methods, the results of TMS treatments can improve even more as researchers try to enhance the effectiveness of the procedures.

For other inquiries regarding treatments, you can always aks our medical experts for a free medical consultation.

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