Brain Conditions
Neurosurgeons treat a full spectrum of brain conditions – from congenital malformations to benign and cancerous brain tumours. Although brain conditions can affect infants to older adults, many conditions tend to follow specific demographic patterns. The most common and deadly type of brain tumour, glioblastoma multiforme (also called glioblastoma), is far more prevalent in people ages 45 to 70, but some benign tumours affect children more frequently. Cerebral aneurysms can occur in children, but are far more common in people ages 35 to 60.
Arteriovenous malformations
These are malformations of brain blood vessels that are present at birth (congenital). They are asymptomatic in nearly 90% of patients, but when they produce symptoms, this generally happens when the person is older – most frequently between the ages of 30 to 45. Symptoms can include severe headache and seizures, however, the most serious consequence is haemorrhaging (bleeding) in the brain. The primary goal of surgical treatment, whether traditional or endovascular, is to prevent haemorrhaging, although seizures may also be controlled through microsurgical resection.
Brain tumours
These are abnormal growths of tissue in the brain or central spine that can disrupt proper brain function. There are more than 120 types of brain and central nervous system tumours, these vary greatly depending on the area they affect. Brain tumours can be benign (noncancerous) and generally slow growing, or malignant (cancerous), which indicates they are life threatening because they often grow rapidly and invade surrounding brain tissue. Primary tumours originate in the brain, while metastatic tumours are primary tumours located in another part of the body, such as the lungs, that spread to the brain. Treatment is specific to the type of tumour and includes monitoring and surgery for low-grade tumours, while aggressive tumours may be treated with a combination of surgery, radiation, chemotherapy, targeted vaccines, and clinical trials when available.
Cerebral aneurysm
This occurs when a portion of a blood vessel in the brain weakens, resulting in a bulging or ballooning out of part of the vessel wall. Usually, aneurysms develop at the point where a blood vessel branches, because the ‘fork’ is structurally more vulnerable. An un-ruptured cerebral aneurysm may be asymptomatic, but when it ruptures, a subarachnoid haemorrhage (SAH) results, which is bleeding into the space between the brain and the membranes that cover the brain (subarachnoid). SAH is often immediately preceded by the “worst headache imaginable” according to many survivors. A ruptured cerebral aneurysm is a medical emergency and fatal in an estimated 50% of cases. The traditional surgical approach is microsurgical clipping, in which the blood supply to the aneurysm is occluded (closed off) using a metal clip. Endovascular coiling or embolization is a newer, minimally invasive procedure in which a catheter is threaded through the groin to the brain and a coil is inserted into the aneurysm to stop bleeding.
Hydrocephalus
This is a condition in which there is an excessive accumulation of cerebrospinal fluid (CSF) in the brain. CSF is a clear fluid that surrounds the brain and spinal cord. The excessive fluid causes abnormal widening of the ventricles (spaces in the brain), creating potentially harmful pressure in brain tissue. Infants can be born with congenital hydrocephalus and adults may develop two different types of hydrocephalus as a result of other brain conditions. Hydrocephalus ex-vacuo results from stroke or traumatic injury-related brain damage. Normal pressure hydrocephalus can result from a subarachnoid haemorrhage, head trauma, infection, tumour, or complications of surgery. Standard treatment is shunting to divert the flow of CSF away from the brain to another part of the body, where it is absorbed. Close and frequent monitoring of shunting is essential – if left untreated, progressive hydrocephalus can be fatal.
