A neurosurgeon is a physician that trained many years after medical school learning how to diagnose and treat conditions affecting the brain, skull, spine, spinal cord and peripheral nerves.
Neurosurgeons treat many conditions in addition to the following:

  1. Degenerative diseases of the spine and spinal cord
  2. Tumors of the brain, spine, spinal cord or peripheral nerves. These tumors may be benign, malignant, or vascular in nature.
  3. Neck and back pain. This pain can be as a result of a herniated disk, vertebral stenosis, arthritis, cancer or degenerative bone disease.
  4. Aneurysms of the major blood vessels in the brain
  5. Peripheral nerve disease such as carpal tunnel disease, trigeminal neuralgia, or conditions producing a pain in the radial, ulnar or brachial nerves.
  6. Pituitary tumors
  7. Atherosclerotic vascular disease of the major vessels to the brain, in other words carotid artery stenosis.
  • Hydrocephalus

Hydrocephalus is a neurological disorder in which there is excessive accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain. Most forms of hydrocephalus are the result of obstructed CSF flow in the ventricular system which may be caused by a birth defect, hemorrhage, viral infection, meningitis, a tumor, or head injury. In adults, symptoms of hydrocephalus include severe nausea and vomiting, migraine-like headaches, lethargy, difficulty waking or staying awake, seizures, visual impairment, irritability, and tiredness. Two forms of hydrocephalus -- hydrocephalus ex-vacuo and normal pressure hydrocephalus (NPH) -- occur most commonly in adults. Hydrocephalus ex-vacuo occurs when there is damage to the brain caused by stroke or injury, and there may be an actual shrinkage of brain substance. In old age or in individuals with Alzheimer's disease the entire brain may shrink and the CSF increases to fill up the space created by the shrinkage. NPH is caused by a gradual blockage of the CSF draining pathways in the brain. Although the ventricles enlarge, the pressure of the CSF remains within normal range. NPH is characterized by memory loss (dementia), gait disorder, urinary incontinence and a general slowing of activity.

Treatment

Due to the multiple underlying disorders and conditions which result in hydrocephalus, there is often no permanent cure. The most effective treatment is the surgical insertion of a shunt -- a flexible, artificial tube -- into the ventricular system of the brain to divert the flow of CSF into another area of the body, where the CSF can drain and be absorbed into the bloodstream.

  • Brain Tumors

The body is made up of many types of cells. Each type of cell has special functions. Most cells in the body grow and then divide in an orderly way to form new cells as they are needed to keep the body healthy and working properly. When cells lose the ability to control their growth, they divide too often and without any order. The extra cells form a mass of tissue called a tumor. Tumors are benign or malignant.

Benign brain tumors do not contain cancer cells. Usually these tumors can be removed, and they are not likely to recur. Benign brain tumors have clear borders. Although they do not invade nearby tissue, they can press on sensitive areas of the brain and cause symptoms.

Malignant brain tumors contain cancer cells. They interfere with vital functions and are life threatening. Malignant brain tumors are likely to grow rapidly and crowd or invade the tissue around them. Like a plant, these tumors may put out "roots" that grow into healthy brain tissue. If a malignant tumor remains compact and does not have roots, it is said to be encapsulated. When an otherwise benign tumor is located in a vital area of the brain and interferes with vital functions, it may be considered malignant (even though it contains no cancer cells).

Doctors refer to some brain tumors by grade -- from low grade (grade I) to high grade (grade IV). The grade of a tumor refers to the way the cells look under a microscope. Cells from higher grade tumors are more abnormal looking and generally grow faster than cells from lower grade tumors; higher grade tumors are more malignant than lower grade tumors.

Possible Causes

The causes of brain tumors are not known. Researchers are trying to solve this problem. The more they can find out about the causes of brain tumors, the better the chances of finding ways to prevent them. Doctors cannot explain why one person gets a brain tumor and another doesn't, but they do know that no one can "catch" a brain tumor from another person. Brain tumors are not contagious.

Although brain tumors can occur at any age, studies show that they are most common in two age groups. The first group is children 3 to 12 years old; the second is adults 40 to 70 years old.

By studying large numbers of patients, researchers have found certain risk factors that increase a person's chance of developing a brain tumor. People with these risk factors have a higher-than-average risk of getting a brain tumor. For example, studies show that some types of brain tumors are more frequent among workers in certain industries, such as oil refining, rubber manufacturing, and drug manufacturing. Other studies have shown that chemists and embalmers have a higher incidence of brain tumors. Researchers also are looking at exposure to viruses as a possible cause. Because brain tumors sometimes occur in several members of the same family, researchers are studying families with a history of brain tumors to see whether heredity is a cause. At this time, scientists do not believe that head injuries cause brain tumors to develop.

In most cases, patients with a brain tumor have no clear risk factors. The disease is probably the result of several factors acting together.

Treatment

Treatment for a brain tumor depends on a number of factors. Among these are the type, location, and size of the tumor, as well as the patient's age and general health. Treatment methods and schedules often vary for children and adults. The doctor develops a treatment plan to fit each patient's needs.

The patient's doctor may want to discuss the case with other doctors who treat brain tumors. Also, the patient may want to talk with the doctor about taking part in a research study of new treatment methods. Such studies, called clinical trials, are discussed in the Clinical Trials section.

Many patients want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. A person with a brain tumor will have many questions, and the doctor is the best person to answer them. Most patients want to know what kind of tumor they have, how it can be treated, and how effective the treatment is likely to be. Many people find it helpful to make a list of their questions, as well as have a family member or friend with them when they talk with the doctor. Patients and their families have a lot to learn about brain tumors and their treatment. They should not feel that they need to understand everything the first time they hear it. They will have other chances to ask the doctor to explain things that are not clear.

  • Acoustic Neuroma (tumor of the 8th cranial nerve in the brain)

An acoustic neuroma, sometimes also called a vestibular schwannoma or neurolemmoma, is a benign (non-cancerous) growth or tumor that is located on the eight cranial nerve (acoustic nerve) that leads from the inner ear to the brain. The problem with acoustic neuromas is that as they expand in size and grow larger, they can push against the brain. While the tumor does not actually invade the brain, the pressure of the tumor can displace brain tissue.

The exact cause of acoustic neuromas is unknown and most occur spontaneously. Although they can occur as early as age 7, most people with acoustic neuromas are diagnosed between the ages of 30 and 60. The incidence of acoustic neuromas is slightly higher among women (60%) than men (40%).

Thanks to modern imagining tests, the diagnosis of acoustic neuromas can now be made earlier when the majority of tumors are smaller. Due to advances in microsurgery, including intraoperative monitoring of facial and cochlear function, the risks of facial paralysis and hearing loss have been greatly reduced. Today, many tumors can be treated effectively with both surgery and radiation therapy.

  • Chiari Malformation

Arnold-Chiari malformation is a rare malformation of the brain that is sometimes, but not always, apparent at birth. It is characterized by abnormalities in the area where the brain and spinal cord meet that cause part of the cerebellum to protrude through the bottom of the skull (foramen magnum) into the spinal canal. This interferes with the flow of cerebral spinal fluid to and from the brain, leading to accumulation of cerebral spinal fluid in the empty spaces of the spine and brain. The portion of the cerebellum that protrudes into the spinal canal can become elongated and is called the "cerebellar tonsils" because it resembles the tonsils. There are four types of Chiari malformation. Depending on the type, the impact on the affected individual may range from mild to severe.

Treatment
Infants and children with myelomeningocele may require surgery to repair protrusion of the meningeal sac into the spinal cord. Hydrocephalus may be treated with surgical implantation of a shunt to relieve increased pressure on the brain. Some adults with Arnold-Chiari Malformation may benefit from surgery in which the existing opening in the back of the skull is enlarged.

  • Carpal Tunnel Syndrome

Carpal tunnel syndrome is a specific group of symptoms that can include tingling, numbness, weakness, or pain in the fingers, thumb, hand, and occasionally n the arm. These symptoms occur when there is pressure on the median nerve within the wrist. Thecarpal tunnel is a small space or "tunnel" in the wrist formed by the wrist bones (carpal bones) and a ligament (transverse carpal ligament). The median nerve and several tendons pass through the carpal tunnel from the forearm to the hand. The tendons are surrounded by tubes of tissue (tendon sheaths). The median nerve controls some movements of the thumb, and this nerve supplies feeling to most of the thumb and to the index finger, middle finger, and part of the ring finger.

Non-Surgical Treatment

If you have mild symptoms, such as occasional tingling, numbness, weakness, or pain in your fingers or hand, follow these steps to reduce inflammation:

  • Rest your fingers, hand, and wrist. Stop activities that you suspect are causing numbness and pain.
  • Ice your wrist for 10 to 15 minutes at a time, as often as once or twice an hour, and take nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce swelling. Although studies have not shown NSAIDs to be effective for carpal tunnel syndrome, they may help you to relieve symptoms.
  • Wear a wrist splint at night to keep your wrist in a neutral position and relieve pressure on your median nerve.
  • Do simple range-of-motion exercises with your fingers and wrist to prevent stiffening. Stop if you have pain or numbness.

Surgical Treatment

Surgery is considered when:

  • Symptoms have not improved after a long period of nonsurgical treatment.
  • Severe symptoms restrict normal daily activities, such as when there is a persistent loss of feeling or coordination in the fingers or hand, no strength in the thumb, or when sleep is severely disturbed by pain.
  • There is damage to the median nerve (shown by nerve test results and loss of hand, thumb, or finger function) or a risk of damage to the nerve.

Carpal tunnel release surgery is used to reduce the pressure on the median nerve in the wrist. This is done by cutting the ligament that forms the top of the carpal tunnel. Cutting this ligament relieves pressure on the median nerve. Any other tissue (such as a tumor) that may be putting pressure on the median nerve can also be removed during surgery.

  • Aneurysms

A brain (cerebral) aneurysm is a bulging, weak area in the wall of an artery that supplies blood to the brain. In most cases, a brain aneurysm causes no symptoms and goes unnoticed. In rare cases, the brain aneurysm ruptures, releasing blood into the skull and causing a stroke. When a brain aneurysm ruptures, the result is called a subarachnoid hemorrhage. Depending on the severity of the hemorrhage, brain damage or death may result. The most common location for brain aneurysms is in the network of blood vessels at the base of the brain called the circle of Willis.

What causes a brain aneurysm?

A person may inherit the tendency to form aneurysms, or aneurysms may develop because of hardening of the arteries (atherosclerosis) and aging. Some risk factors that can lead to brain aneurysms can be controlled; others can't. The following risk factors may increase your risk of developing an aneurysm or, if you already have an aneurysm, of it rupturing:1

  • Family history. People with a family history of brain aneurysms are twice as likely to have an aneurysm as those who don't.
  • Previous aneurysm. About 20% of patients with brain aneurysms have more than one.
  • Gender. Women are twice as likely to develop a brain aneurysm or suffer a subarachnoid hemorrhage as men.
  • Race. African-Americans have twice as many subarachnoid hemorrhages as whites.
  • Hypertension. The risk of subarachnoid hemorrhage is greater in people with a history of high blood pressure (hypertension).
  • Smoking. In addition to being a cause of hypertension, the use of cigarettes may greatly increase the chances of a brain aneurysm rupturing.

What are the symptoms?

Most brain aneurysms cause no symptoms and may only be discovered during tests for another, usually unrelated, condition. In other cases, an unruptured aneurysm will cause problems by pressing on areas within the brain. When this happens, the person may suffer from severe headaches, blurred vision, changes in speech, and neck pain, depending on the areas of the brain that are affected and the severity of the aneurysm. If you have any of the following symptoms or notice them in someone you know, see a health professional immediately.

Symptoms of a ruptured brain aneurysm often come on suddenly. They may include:

  • Sudden, severe headache (sometimes described as a "thunderclap" headache that is very different from any normal headache).
  • Neck pain.
  • Nausea and vomiting.
  • Sensitivity to light.
  • Fainting or loss of consciousness.
  • Seizures.

Treatment

Your doctor will consider several factors before deciding the best treatment for you. Factors that will determine the type of treatment you receive include your age, size of the aneurysm, any additional risk factors, and your overall health.

Because the risk of a small (less than 10 mm) aneurysm rupturing is low and surgery for a brain aneurysm is often risky, your health professional may want to continue to observe your condition rather than perform surgery. However, if your aneurysm is large or causing pain or other symptoms, or if you have had a previous ruptured aneurysm, your health professional may recommend surgery.

The following surgeries are used to treat both ruptured and unruptured brain aneurysms:

  • Coil embolization. During this surgery, a small tube is inserted into the affected artery and positioned near the aneurysm. Tiny metal coils are then moved through the tube into the aneurysm, relieving pressure on the aneurysm and making it less likely to rupture. This procedure is less invasive and is believed to be safer than surgical clipping, although it may not be as effective at reducing the risk of a later rupture. It should be done in a large hospital where many such procedures are performed.
  • Surgical clipping. This surgery involves placing a small metal clip around the base of the aneurysm to isolate it from normal blood circulation. This decreases the pressure on the aneurysm and prevents it from rupturing. Whether this surgery can be done depends on the location of the aneurysm, its size, and your general health.

Some aneurysms bulge in such a way that the aneurysm has to be cut out and the ends of the blood vessel stitched together, but this is very rare. Occasionally the artery is not long enough to stitch together, and a piece of another artery has to be used.

  • Stroke

A stroke occurs when a blood vessel (artery) that supplies blood to the brain bursts or is blocked by a blood clot. Within minutes, the nerve cells in that area of the brain are damaged, and they may die within a few hours. As a result, the part of the body controlled by the damaged section of the brain cannot function properly.