The walls of blood vessels are specially designed to withstand the constant pressure associated with the arterial system. In some instances, however, an aneurysm (or out-pouching) may develop. The cause of this abnormality is not known.

This interruption of the normal vessel wall is frequently thin and weak and subject to bursting or leaking. When this happens, the patient may experience headache, nausea, vomiting, double vision, sensitivity to light, neck pain or stiffness, weakness, paralysis, memory loss, coma or death.

Angiography 

An angiogram is a procedure where a radiopaque dye is injected into the arteries. It casts a white shadow on the x-ray film that represents a cast of the inside of the blood vessels. The portion of the study that examines the arteries is often referred to as an arteriogram. This is performed to determine the exact size, shape and location of the aneurysm.

MRA (Magnetic Resonance Angiography)

By applying the unique characteristics of MR, imaging techniques have been developed to allow for the visualization of blood vessels without the injection of radiopaque dye or use of x-ray. The procedure provides very good images that are often acceptable. In many cases, however, conventional angiography is required for evaluating intracranial aneurysm's since MRA does not provide the same degree clarity and accuracy.

Surgical Treatment

In order to prevent the aneurysm from hemorrhaging (bleeding) or re-bleeding, the neurosurgeon places a clip across the neck of the aneurysm. This surgery is performed with the aid of a surgical microscope.

Types of Aneurysm's

The difficulty of this procedure depends upon the type of aneurysm and its location. A "saccular" aneurysm with a narrow neck is less difficult to clip than one with a broad neck. The most difficult aneurysm to manage is the "fusiform" type. Also difficult to manage is the "giant" aneurysm (2.5cm or greater).

Embolization

In some instances, when it is not possible to surgically clip an aneurysm because of its location or when the patient cannot undergo a surgical procedure because of other risk factors, embolization is an option. The procedure used most commonly involves the insertion of a "coil" of wire into the aneurysm. The coil is delivered to the aneurysm through catheters (tubes) placed in the arteries. The procedure does not involve an open craniotomy and can be done under local anesthesia. Other methods of embolization include balloons and rapidly solidifying polymers. Surgical clipping remains the procedure of choice whenever it is possible because of its known effectiveness in permanently closing off the aneurysm to the flow of blood.

Early Intervention

Blood relatives of patients with aneurysms should be evaluated by a neurosurgeon since this condition is hereditary. Early treatment can help to prevent complications.

The excruciating facial pain of Trigeminal Neuralgia is caused by compression of the trigeminal nerve at the root entry zone by a blood vessel in 96% of cases. The offending vessel is usually a tortuous loop of the superior cerebellar artery although other vessels can be involved. The neurosurgeon can perform direct microvascular decompression of the trigeminal nerve. This achieves long term complete pain relief in the majority of patients and avoids destruction of the trigeminal nerve, thereby avoiding the complications of facial numbness, dysesthesia, corneal anesthesia and ulceration as well as the dreaded anesthesia dolorosa (extreme constant burning pain after neural destructive procedures).

The pain of Trigeminal Neuralgia is distinctive when it manifests itself in full; in fact it is the history of the pain and only the history that can make the diagnosis. There is no diagnostic study, not even an MRI scan, that can make the diagnosis. Even the physical examination is most often normal with no evidence of sensory loss or motor weakness of the face, although touching “trigger points” on the face during the physical exam may reproduce the pain.

To view a PDF file providing a detailed presentation of Trigeminal Neuralgia click above.

Unfortunately, many patients with Trigeminal Neuralgia undergo unsuccessful dental procedures (tooth extractions, root canals) in the early stages of the disease.

There is medical treatment for Trigeminal Neuralgia and the medication of choice is Tegretol, an anti-epileptic drug. In fact, an initial good response to Tegretol is another confirmatory characteristic of the correct diagnosis of Trigeminal Neuralgia. This fact can be very helpful in distinguishing Trigeminal Neuralgia from other conditions such as atypical facial pain. Unfortunately, the positive response of pain control that Tegretol has is just that – control, and not a cure. Although medications are extremely helpful in controlling pain for patients, they unfortunately do not cure pain and at higher doses, side effects are very common and often debilitating. The most gratifying neurosurgical procedures performed for pain are those that can completely eliminate the pain like the Microvascular Decompression procedure for Trigeminal Neuralgia. Please click on the link below for more detailed information on Trigeminal Neuralgia.

Brain tumors are diagnosed through a clinical exam and the results of tests such as CT and MRI. The neurosurgeon discusses available treatments with the patient. Treatments which neurosurgeons provide include surgical resection and Gamma Knife Radiosurgery.

Neuronavigation provides the neurosurgeon a probe, which when placed on or in the patients head, shows him what is just beyond the probe in all directions. The images are presented in 3D on a computer screen.

This information is helpful even before the surgery begins since it allows for planning the best approach to the tumor. During the procedure neuronavigation guides the neurosurgeon directly to the tumor and also informs him of the locations of sensitive structures within the brain.

In many cases neurosurgeons use an operating microscope to obtain the best view of the surgical field.