Brain Topics

Anatomy of the Brain

The brain is an amazing three-pound organ that controls all functions of the body, interprets information from the outside world, and embodies the essence of the mind and soul. Intelligence, creativity, emotion, and memory are a few of the many things governed by the brain. Protected within the skull, the brain is composed of the cerebrum, cerebellum, and brainstem.

Concussion

A concussion is a mild brain injury caused by a blow to the head. Common in falls, sports, and car crashes, concussions temporarily affect the brain causing confusion and problems with memory, speech, vision, or balance. The person may appear fine at first, but show symptoms hours or days later. If untreated, repeated concussions can have severe outcomes. The best treatment is time and rest to allow the brain to heal.

Traumatic brain injury

Traumatic brain injury (TBI) is sudden damage to the brain caused by a blow to the head. Common causes include car or motorcycle crashes, falls, sports, and assaults. Injuries can range from mild concussions to severe permanent brain damage. While treatment for mild TBI may include rest and medication, severe TBI requires intensive care and/or life-saving surgery.

Normal Pressure Hydrocephalus (NPH)

NPH, despite its name, is an abnormal condition. It occurs in older adults when cerebrospinal fluid (CSF) builds up inside the brain's ventricles. The enlarged areas stretch and damage the brain, causing symptoms of mild dementia, walking difficulties, and urinary problems. NPH may be treated with a shunt device that drains fluid from the ventricles.

Balance activities for home

If you have dizziness as a result of a brain tumor, stroke, acoustic neuroma, Chiari malformation, or other condition, you will need to perform balance activities with caution. This means keeping a firm surface within reach and wearing proper footwear. Have another person with you for safety until your balance exercise regimen is safe to perform alone.

Brain tumors

Brain biopsy

A brain biopsy is a procedure to remove a sample of abnormal tissue for examination under a microscope. The tissue cells taken during the biopsy can show what kind of brain lesion (abscess, tumor) is present and whether it is benign (not cancerous) or cancerous (malignant). Knowing the specific cell type helps doctors recommend a treatment plan.

Brain tumors: an introduction

A tumor is an abnormal growth of cells in your brain. Brain tumors are named after the type of cell from which they grow — some are benign, others malignant. They may be primary (starting in the brain) or secondary (spreading to the brain from another area). Treatment options vary depending on the tumor type, size and location; whether the tumor has spread; and the age and health of the person.

Acoustic neuroma (vestibular schwannoma)

An acoustic neuroma is a tumor that grows from the nerves responsible for balance and hearing (vestibulocochlear nerve). They are not cancerous and usually grow slowly. Over time the tumor can cause gradual hearing loss, ringing in the ear, and dizziness. Because of their slow growth, not all acoustic neuromas need to be treated. Treatment options include observation, surgery, and radiation.

Acoustic neuroma surgery: suboccipital

A suboccipital craniotomy is a surgery performed to remove an acoustic neuroma growing from the nerve responsible for balance and hearing. During surgery, a section of the skull is removed behind the ear to access the tumor and nerves. The goals of surgery are: first, the maintenance of facial nerve function; second, the preservation of socially useful hearing; and third, tumor removal.

Craniotomy surgery

Craniotomy is a surgery to cut a bony opening in the skull. A section of the skull, called a bone flap, is removed to access the brain underneath. A craniotomy may be small or large depending on the problem. It may be performed to treat tumors, hematomas, aneurysms, AVMs, skull fractures, foreign objects, swelling of the brain, or infection. The bone flap is usually replaced with tiny plates and screws.

Glioma brain tumors (astrocytoma, oligodendroglioma, glioblastoma)

A glioma is a type of brain tumor that grows from glial cells. Glial cells support neurons with energy and nutrients and help maintain the blood-brain barrier. Glioma is an umbrella term used to describe the different types of glial tumors: astrocytoma, oligodendroglioma, and glioblastoma. Treatment options vary depending on the cell type and aggressiveness (grade I-IV).

Meningioma brain tumors

A meningioma is a tumor that grows from the protective membranes, called meninges, which surround the brain and spinal cord. Most meningiomas are benign (not cancer) and slow growing; however, some can be malignant. Symptoms typically appear gradually and vary depending on the tumor location. Because of their slow growth, not all meningiomas need to be treated immediately.

Metastatic brain tumors

Metastatic brain tumors begin as cancer in another part of the body and spread to the brain via blood or nearby tissue. There can be one (metastasis) or multiple (metastases) tumors. The most common cancers that spread to the brain are lung, breast, skin, kidney and colon. Treatment options vary depending on the location and number of brain lesions along with the location and severity of the primary cancer.

Pituitary tumors

Tumors that grow from the pituitary gland can affect the whole body by interfering with normal hormone levels. They can also cause vision problems. There are various kinds of pituitary tumors: adenomas, craniopharyngiomas, and Rathke's cleft cysts. Most are benign (not cancer) and are often curable. Treatment options aim to remove the tumor or control its growth and restore normal hormone function.

Pituitary surgery: endoscopic

Endoscopic surgery is performed through the nose to remove tumors from the pituitary gland and skull base. In this minimally invasive surgery, the surgeon works through the nostrils with a tiny endoscope camera and light to remove tumors with long instruments. Pituitary tumors can cause hormone problems and vision loss. Tumor removal often reverses vision problems and restores hormone balance.

Radiosurgery: Gamma Knife (framed)

Gamma Knife radiosurgery uses high-energy rays to treat tumors and other diseases. Beams of radiation are aimed at the brain by a machine outside your body. Hundreds of low-dose beams come together at a single point to kill all the cells in the target area while avoiding damage to nearby healthy cells. When a small tumor is being treated, a single dose of radiation is given in a single session using a rigid frame.

Radiosurgery: Gamma Knife (frameless mask)

Gamma Knife radiosurgery uses high-energy rays to destroy tumors and other diseases. Beams of radiation are aimed at the brain by a machine outside your body. Hundreds of low-dose beams come together at a single point to kill all the cells in the target area while avoiding damage to nearby healthy cells. When a large tumor is being treated, radiation is given in 5 treatments using a mask system.

Radiosurgery of the brain: stereotactic

Radiosurgery uses high-energy rays to destroy tumors and other diseases. Beams of radiation are aimed at the brain by a machine outside your body. Radiosurgery uses very high dose beams meant to kill all the cells in the target area. The beams are tightly focused and accurate to avoid damaging healthy cells. It is often given in a one-time therapy in a single day or it can be broken into 2 to 5 treatments given over a week. Radiosurgery may be an alternative to open brain surgery.

Radiotherapy of the brain: fractionated

Radiotherapy uses high-energy rays to destroy tumors and other diseases. Beams of radiation are aimed at the brain by a machine outside your body. Radiotherapy uses low dose beams to treat the tumor and a margin of normal cells surrounding the target area to prevent recurrence. A fraction of the radiation dose is given every day for several weeks. Over time, the abnormal cells die and the tumor may shrink.

Stroke & Cerebrovascular

Aneurysm: ruptured

An aneurysm is a balloon-like bulge of an artery wall. As an aneurysm grows it puts pressure on nearby structures and may eventually rupture. A ruptured aneurysm releases blood into the spaces around the brain, called a subarachnoid hemorrhage, a life-threatening type of stroke. Treatment focuses on stopping the bleeding and repairing the aneurysm with clipping, coiling, or bypass.

Aneurysm: unruptured

An aneurysm is a balloon-like bulge of an artery wall. As an aneurysm grows it puts pressure on nearby structures and may eventually rupture. Most people find out they have an unruptured aneurysm by chance during a scan for some other problem. The risk of rupture varies depending on the aneurysm location and size. Treatment options include observation, clipping, coiling, or bypass.

Aneurysm surgery: clipping

Clipping is a surgery performed to treat an aneurysm — a balloon-like bulge or weakening of an artery wall. As an aneurysm grows, it can become so thin that it leaks or ruptures, releasing blood into the spaces around the brain. This bleeding is life threatening. A neurosurgeon opens the skull (craniotomy) and places a tiny clip across the neck of the aneurysm to stop or prevent an aneurysm from bleeding.

Aneurysm embolization: coiling, stenting, flow diversion

Embolization is a minimally invasive procedure to treat an aneurysm by filling it with material that closes off the sac and reduces the risk of rupturing or rebleeding. It is performed from "within" the artery (endovascular) through a steerable catheter inserted into the blood stream at the groin and guided to the brain. Tiny coils, glue, or mesh stents are used to promote clotting and close off the aneurysm.

Arteriovenous malformation (AVM)

An arteriovenous malformation (AVM) is an abnormal tangle of blood vessels in the brain or spine. AVM arteries connect directly to veins without a capillary bed in between causing the vessels to stretch and sometimes rupture. Symptoms include stroke, seizures, headache, and other problems. Treatment options include surgery, embolization, and radiosurgery.

Carotid stenosis (carotid artery disease)

Carotid stenosis is a narrowing of the carotid arteries, the two major arteries that carry oxygen-rich blood from the heart to the brain. Also called carotid artery disease, the stenosis is caused by a buildup of plaque (atherosclerosis) inside the artery wall that reduces blood flow to the brain. Treatment aims to reduce the risk of stroke by controlling or removing the plaque and preventing blood clots.

Cerebral bypass surgery

Cerebral bypass surgery is performed to restore, or "revascularize," blood flow to the brain. A cerebral bypass is the brain's equivalent of a coronary bypass in the heart. The surgery connects a blood vessel from outside the brain to a vessel inside the brain to reroute blood flow around a damaged or blocked artery. The goal of bypass surgery is to restore blood supply to the brain and prevent strokes.

Craniotomy surgery

Intracerebral hemorrhage (ICH)

Intracerebral hemorrhage (ICH) is caused by bleeding within the brain tissue itself — a life-threatening type of stroke. A stroke occurs when the brain is deprived of oxygen and blood supply. ICH is most commonly caused by hypertension, arteriovenous malformations, or head trauma. Treatment focuses on stopping the bleeding, removing the blood clot, and relieving the pressure on the brain.

Intracranial artery stenosis

Intracranial stenosis is a narrowing of an artery inside the brain. A buildup of plaque (atherosclerosis) inside the artery wall reduces blood flow to the brain. Atherosclerosis that is severe enough to cause symptoms carries a high risk of stroke and can lead to brain damage and death. Treatments aim to reduce the risk of stroke by controlling or removing plaque buildup and by preventing blood clots.

Moyamoya disease

Moyamoya disease is caused by blocked arteries at the base of the brain. The name "moyamoya" means "puff of smoke" in Japanese and describes the appearance of tiny vessels that form to compensate for the blockage. As the normal blood vessels narrow and become blocked, a person may suffer a stroke. No medication can stop or reverse the progression of moyamoya disease. Treatment focuses on reducing the risk of stroke and restoring blood flow to the brain.

Subarachnoid hemorrhage & vasospasm

Subarachnoid hemorrhage (SAH) is a life-threatening type of stroke caused by bleeding into the space surrounding the brain. SAH can be caused by a ruptured aneurysm, AVM, or head injury. One-third of patients will survive with good recovery; one-third will survive with a disability; and one-third will die. Treatment focuses on stopping the bleeding, restoring normal blood flow, and preventing vasospasm.

Stroke

Think of a stroke as a "brain attack" — it is an emergency! When symptoms appear call 911 immediately; every minute counts. A stroke occurs when the brain is deprived of oxygen and blood supply. A person may have problems speaking, walking, seeing, or thinking. It may result in permanent brain damage or death. If the stroke is caused by a blood clot, a clot-busting drug or retrieval device may be used to restore blood flow.

Chiari Malformation

Chiari I malformation

Chiari I malformation is a condition in which the lower part of the brain, called the cerebellar tonsil, herniates down through the skull and into the spinal canal. The herniated tissue presses against the brainstem and blocks the normal flow of cerebrospinal fluid (CSF). Depending on the extent of herniation, these malformations cause a variety of symptoms that range from mild to severe.

Chiari decompression surgery

Chiari decompression surgery removes bone at the back of the skull to widen the foramen magnum and create space for the brain. The dura overlying the tonsils is opened and a patch is sewn to expand the space, similar to letting out the waistband on a pair of pants. The goals of surgery are to control the progression of symptoms, relieve compression, and restore the normal flow of cerebrospinal fluid (CSF).

Facial Pain

Trigeminal neuralgia

Trigeminal neuralgia is extreme pain and muscle spasms in the face. Attacks of intense, electric shock-like facial pain can occur without warning or be triggered by touching specific areas of the face. Although the exact cause of trigeminal neuralgia is not fully understood, a blood vessel is often found compressing the nerve. Medication, injections, surgery, and radiation may be used to treat the pain.

Glossopharyngeal neuralgia

Glossopharyngeal neuralgia is an irritation of the ninth cranial nerve causing extreme pain in the back of the throat, tongue and ear. Attacks of intense, electric shock-like pain can occur without warning or be triggered by swallowing. Although the exact cause is not known, a blood vessel is often found compressing the nerve. It can also occur in people with throat or neck cancer. Medications may initially relieve the pain, but surgery is often needed for long-term relief.

Hemifacial spasm

Hemifacial spasm (HFS) is an involuntary twitching or contraction of the facial muscles on one side of the face. Medication, surgery, and Botox injections are treatment options to stop the spasms and relieve the discomfort. Each treatment offers benefits, but each has limitations. You and your doctor should determine which treatment is best.

Microvascular decompression surgery

Microvascular decompression (MVD) is a surgery to relieve abnormal compression of a cranial nerve. It is performed to treat trigeminal neuralgia, glossopharyngeal neuralgia, and hemifacial spasm. MVD involves opening the skull (craniotomy) and inserting a sponge between the nerve and offending artery or vein causing the pain signals. Medications often provide relief to patients, but when medications become ineffective or cause serious side effects, MVD is an option.

Percutaneous stereotactic rhizotomy

Percutaneous stereotactic radiofrequency rhizotomy (PSR) is a minimally invasive procedure performed to relieve pain caused by: trigeminal neuralgia, glossopharyngeal neuralgia and cluster headaches. Medications often provide initial pain relief, but may become ineffective or cause serious side effects. PSR uses a heating current to destroy some of the nerve fibers carrying pain signals to the brain. The patient will now feel some numbness in the area rather than pain.

Radiosurgery: Gamma Knife (framed)

Seizures & Epilepsy

Epilepsy

A seizure (often called a fit, spell, convulsion, or attack) is a visible sign of a problem in the electrical system that controls your brain. A single seizure can have many causes. Those who continue to have unprovoked seizures may have a chronic disorder called epilepsy. The term "seizure disorder" is often used as another way to describe epilepsy.

Epilepsy surgery

Epilepsy surgery is performed to either remove the brain area where seizures begin or stop the spread of seizure activity. It is a treatment option for people with seizures that are not controlled with medication. "Medically intractable seizures" are defined as persistent seizures despite trials of three or more antiepileptic drugs, alone or in combination. The goal of surgery is to achieve better seizure control without causing loss of brain function.

Seizures

A seizure (also called a fit, spell, convulsion, or attack) is the visible sign of a problem in the electrical system that controls your brain. A single seizure can have many causes, such as a high fever, lack of oxygen, poisoning, trauma, a tumor, infection, or after brain surgery. Most seizures are controlled with medication. If your seizures occur repeatedly, then you may have the chronic disorder called epilepsy.

Parkinson's & Movement Disorders

Essential tremor

Essential tremor (ET) is a disorder of the brain that causes a rhythmic trembling of the hands, arms, head, voice, legs, or trunk. It is not related to Parkinson's disease. Treatments focus on reducing symptoms and maximizing quality of life. Treatments for this progressive disorder include medication, physical therapy, deep brain stimulation, and radiosurgery.

Parkinson's disease

Parkinson's disease is a progressive disorder that affects cells in the brain responsible for body movement. When dopamine-producing neurons die, symptoms such as tremor, slowness, stiffness, and balance problems occur. Treatments focus on reducing symptoms to enable a more active lifestyle and include medication, diet, exercise, and deep brain stimulation surgery.

Coping with Parkinson's disease

Parkinson's disease is a progressive disorder that affects the way you move. Treatment focuses on reducing the symptoms to enable a normal, active lifestyle. While medication is necessary, you can do your part to maintain a healthy lifestyle by eating a balanced diet and staying physically active in order to contribute to your overall health and well-being.

Deep Brain Stimulation (DBS)

Deep brain stimulation (DBS) is a surgery to implant a device that sends electrical signals to brain areas responsible for body movement. Electrodes are placed deep in the brain and are connected to a stimulator device. Similar to a heart pacemaker, a neurostimulator uses electric pulses to regulate brain activity. DBS can help reduce the symptoms of tremor, slowness, stiffness, and walking problems caused by Parkinson's, dystonia, or essential tremor.