A brain biopsy involves making a small opening into the skull so that a tiny sample of tissue can be removed. This is done for brain tumors or masses that need to be further identified so that an appropriate treatment plan can be formulated for the patient. Surgeons take great care to avoid important structures of the brain and major blood vessels.
Often times, these procedures are image-guided, meaning surgeons use CT scans or MRIs to help navigate them to the right area to biopsy.
Chiari Decompression is a surgery done to allow more room for the cerebellum, the part of the brain that is just above the nape of the neck. The two halves of the cerebellum generally lie entirely within the skull. In a Chiari Malformation, however, the lowermost part of the cerebellum, called the tonsils, herniate through the opening at the base of the skull. This can result in pain and other neurologic disturbances. A Chiari Decompression relieves pressure on the brain and allows the cerebrospinal fluid to resume normal circulation.
A craniectomy is a procedure in which a piece of the skull bone is removed to relieve pressure on the brain. The removed bone flap is not replaced, leaving an opening in the cranium. This procedure can be performed for many reasons, including relieving pressure by giving the brain room to swell as in a traumatic injury or large bleeding into the brain.
A craniotomy is a procedure in which an opening is made in the skull to access the brain. These openings can range from the size of a dime to a very large portion of the skull. Craniotomies are done for many reasons including providing access for a biopsy of a brain tumor, repairing skull fractures, inserting pressure monitors, removal of a blood clot, removal of bullets, clipping aneurysms or relieving pressure caused by injury or bleeding in the brain. When the necessary treatments have been completed, the piece of skull is replaced to close the opening.
When removing brain tumors, Dr. Amini uses several imaging modalities including Stealth MRI to map the brain and the diseased tissue targeted for resection. He also uses intraoperative nerve monitoring to give patients the best possible outcome.
The cerebrospinal fluid (CSF) bathes the brain and spinal cord. Most of the CSF is in the ventricles of the brain, which are large cavities within the brain which produce and reabsorb the CSF. In hydrocephalus, the ventricles of the brain become enlarged with cerebrospinal fluid. This condition, which causes the brain to become compressed against the skull, can be caused by brain tumors or bleeding in the brain. Shunting, also called ventriculoperitoneal shunting, is necessary to drain the excess fluid and relieve the pressure in the brain.
Ventriculoperitoneal shunting is often crucial for preventing serious brain damage. Shunts, like any other medical device, can develop problems. VP shunts can become blocked, torn, or infected. In these cases, shunts need to be revised. Otherwise, shunts can be left in place for many years if they are functioning well.
Pituitary tumors are tumors of the pituitary gland. These are almost always benign tumors that can cause hormonal disturbances in patients such as irregular periods, infertility or lactation. In addition, they can also cause visual problems by compressing the nerves that serve the eyes. When these tumors cannot be treated with medications alone, they are surgically removed.
These tumors are usually removed via transsphenoidal surgery, an approach that goes through the nasal passage and back of the nose, across the sphenoid sinuses and into the skull base where the pituitary gland is located. Microscopes or endoscopes are used to visualize and remove the tumor. The tumor is generally surrounded by delicate and vital structures and great care must be taken not to compromise them.