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TreatmentsAurora's therapies for neurological disorders.
Aneurysm clippingAneurysm clipping is a type of surgery to treat a ballooning (aneurysm) in the wall of a blood vessel in the brain. The procedure is done to prevent the aneurysm from bursting and causing a brain hemorrhage (severe bleeding) which could result in permanent brain damage or death. The patient is under general anesthesia (unconscious). An opening is made in the skull (craniotomy) to allow surgeons access to the aneurysm. A surgical microscope is used to view the aneurysm and place a tiny, spring-loaded clip over the aneurysm. Blood flow to the aneurysm is stopped by the clip and the aneurysm collapses, while blood continues to flow through the normal walls of the blood vessel. Hospitalization may last a week. Aneurysm clipping is a permanent treatment, but may be replaced in some cases with a less-invasive procedure, aneurysm coiling, a type of neuroendovascular surgery. - top of page -
Aneurysm coilingAneurysm coiling is a minimally invasive procedure that uses neuroendovascular surgery techniques to treat a ballooning (aneurysm) in the wall of a blood vessel in the brain. The procedure is done to prevent the aneurysm from bursting and causing a brain hemorrhage (severe bleeding) which could result in permanent brain damage or death. It may be used as an alternative to the more traditional treatment of aneurysm clipping as many patients are not good candidates for clipping due to their medical condition or the location of the aneurysm. Instead of an open incision used in aneurysm clipping, a platinum coil is delivered to the aneurysm through a serious of tiny catheters (thin, flexible tubes). Catheters are inserted into a small incision in the upper thigh and guided through the bloodstream to the site of the aneurysm in the brain. There, the coil is deployed into the aneurysm, forming a clot, which prevents blood from filling up the aneurysm. Instead, blood flows only through the normal walls of the blood vessel. Sometimes coiling is used in combination with stenting, in which a tiny, tube-like structure is placed near the aneurysm to keep a coiled aneurysm from collapsing the entire blood vessel and cutting off blood supply within the brain. - top of page -
Cervical discectomyA cervical discectomy involves removing all or a portion of a cartilage disc that separates bones (vertebrae) of the spine in the neck. A discectomy is performed to treat conditions such as disc herniation in which the disc or its gel-like contents rupture and press against nerves in the spine, causing pain, tingling, weakness or numbness. A discectomy may be performed after more conservative treatments, such as rest, medication, physical therapy, massage or chiropractic care, have proved unsuccessful. Discectomy is performed under general anesthesia while the patient is unconscious. An incision is made over the affected area. The hospital stay averages about 24 hours, but varies by the type of discectomy performed and its complexity. Medication and a neck collar may be prescribed. Recovery may take 3-4 weeks and may involve physical therapy and learning proper body mechanics, as well as strengthening and flexibility exercises and lifestyle modifications. A micro-discectomy involves a smaller incision and removal of disc fragments with the use of a microscope. Spinal fusion involves removing the disc and replacing it with bone chips and/or metal plates so that the vertebrae above and below the damaged disc grow together. - top of page -
CraniotomyA craniotomy is a surgical procedure that allows access to the brain and other tissues within the skull to treat various conditions and disorders, such as benign and cancerous brain tumors, cerebral aneurysm, hydrocephalus and Parkinson's disease. A craniotomy involves removing a section of bone from the skull. At the end of the procedure the bone is put back in place and eventually fuses together with the bones of the skull. A craniectomy is a similar procedure in which a portion of bone is removed from the skull, but not put back in place. For example, the bone may not be replaced under an area of the skull that is covered by muscle, or a tumor may have invaded that section of bone. A prosthetic plate may replace skull bone that is not put back in place. A craniotomy is performed by first making an incision in the scalp covering the skull near the tumor or disorder. A series of small burr holes are made in the skull roughly marking the edges of the bone to be removed. The bone "flap" is then created by cutting between the burr holes until it can be removed from the surrounding skull bone. The membranes covering the brain are then cut away to reveal the area of the brain to be treated. After the treatment is completed, the brain membranes are sutured (or replaced and sewn shut), the bone flap is restored to the skull and anchored with wire sutures, plates or screws. Burr holes may be covered with small plates. Finally, the scalp is sewn back together. The patient will be admitted to the intensive care unit and given antibiotics to prevent infection. - top of page -
Deep brain stimulationDeep brain stimulation is a procedure to help control movement problems and tremors for patients with conditions related to Parkinson's disease. An electrode is implanted in the brain to provide continuous electrical stimulation to parts of the brain, such as the globus pallidus, subthalamic nucleus or thalamus, that control body movement. Due to disease, these areas of the brain may become overactive, causing tremor, involuntary movement and rigidity. The electrical stimulation shuts down these overactive areas to help control movement impulses. As a result, patients may be able to reduce or discontinue their Parkinson's disease medications. The electrode placement is performed under local anesthetic while the patient is conscious. Surgeons can precisely place the electrode by monitoring the patient's tremors. Computed tomography (CT or CAT scan), magnetic resonance imaging (MRI), microelectrode recording and stimulation and a computer-assisted, stereotactic surgical planning and guidance system help place the electrode. The electrode is connected to a battery by a wire. The battery is implanted in the chest wall just below the collarbone. The wire is placed under the scalp and neck. Over a period of weeks, the level of stimulation is adjusted for maximum benefit. The battery has to be replaced every few years but requires only a small incision in the chest and is performed on an outpatient basis. Visit Aurora's Regional Parkinson Center for more information about the disease and its treatment. - top of page -
Intra-arterial thrombolysisIntra-arterial thrombolysis is a technique to break up a blood vessel obstruction, called a thrombus, and restore blood flow through the artery. It must be done within six hours of the onset of a stroke. This is an innovative technique used for patients who are at risk for severe neurological damage related to their stroke. This procedure involves placing a catheter (thin, flexible tube) into an artery in the leg, and guiding it through the bloodstream to the blood clot in the brain. There, an enzyme, tissue plasminogen activator (TpA), is injected through the catheter directly into the thrombus in an effort to break up the blood clot and restore blood flow to brain tissues. The risk of bleeding or intracranial hemorrhage, is increased in patients who receive intra-arterial thrombolysis, so its use is restricted to very controlled circumstances. Patients must present to the emergency department as soon as possible after the onset of stroke symptoms, as risks increase and benefits of TPA decrease as time passes. In some cases, both peripheral, intravenous TPA and intra-arterial TPA may be used. Patients will spend at least 24-48 hours in the ICU after intra-arterial thrombolysis. - top of page -
Lumbar discectomyA lumbar discectomy involves removing all or part of a cartilage disc that separates bones (vertebrae) of the spine in the lower back. A discectomy is performed to treat conditions such as disc herniation in which the disc or its gel-like contents rupture and press against nerves in the spine, causing pain, tingling, weakness or numbness. A discectomy may be performed after more conservative treatments, such as rest, medication, physical therapy, massage or chiropractic care, have proved unsuccessful. Discectomy is performed under general anesthesia while the patient is asleep. An incision is made over the affected area. The hospital stay averages about three days, but varies by the type of discectomy performed and its complexity. Medication may be prescribed. Recovery takes several weeks and may involve physical therapy and learning proper body mechanics, as well as strengthening and flexibility exercises and lifestyle modifications. Cardiovascular exercise and maintaining an appropriate weight may aid recovery and prevent pain. A micro-discectomy involves a smaller incision and removal of disc fragments with the use of a microscope. Spinal fusion involves removing the disc and replacing it with bone chips and/or metal plates so that the vertebrae above and below the damaged disc grow together. - top of page -
Lumbar laminectomyLumbar laminectomy is a surgical procedure used to treat disorders of the spine in the lower back. It is typically used to treat conditions such as lumbar stenosis or spinal tumors in which bone or other tissues in the area have grown in such a way as to put pressure on nerves, causing pain, tingling, numbness or weakness. Diagnosis may be made with X-rays, computed tomography (CT or CAT scan), magnetic resonance imaging (MRI) and/or myelogram. Lumbar laminectomy is performed under general anesthesia in which the patient is asleep. An incision is made over the affected area of the spine. Typically, the bone covering the spinal column (lamina) and any other tissue pressing against spinal nerves is removed. The opening through which the nerves pass may also be enlarged to relieve pressure. Sometimes a rod and screws and/or a bone graft may be used to strengthen the area, in a process known as spinal fusion. Depending on the complexity of the surgery, the patient will stay in the hospital several days to a week. Medication, physical therapy and a brace may be prescribed. Recovery from a lumbar laminectomy takes about four weeks. Lifestyle modifications may be necessary to promote a rapid return to normal activity. - top of page -
Neuroendovascular surgeryNeuroendovascular medicine uses microcatheters (tiny, flexible tubes) to provide a minimally invasive approach to treat vascular diseases of the central nervous system, including brain aneurysms and hemorrhages, vascular (arteriovenous) malformations, tumors of the brain and spine, carotid stenosis and other related conditions, such as spasming brain arteries and acute stroke. Without neuroendovascular treatments, many of these conditions would be considered to be inoperable or to carry significant operative risk. Neuroendovascular treatment generally results in a shorter hospital stay and decreased recovery period, a decreased risk of infection and decreased level of disruption to lifestyle. These treatments often eliminate the need for general anesthesia and blood transfusion. When used in place of brain surgery, neuroendovascular treatment eliminates the need for head shaving and cutting a hole in the skull (craniotomy). Neuroendovascular treatments usually involve inserting a catheter into an artery in the upper thigh and guiding it through the bloodstream to the site of the disorder. Typically, an angiogram will be performed in which contrast dye is injected through the catheter into the site of the disorder and then viewed with X-ray imaging. After diagnosing the condition, a series of catheter exchanges may be performed to deploy special devices and/or drugs to treat the disorder. Neuroendovascular treatments can open arteries blocked by blood clots and other causes, place tiny balloons and scaffold-like stents to keep arteries open, deliver medication directly to the site of the disorder and place special clotting particles to close off blood supply to tumors and abnormal vein formations. - top of page -
Spinal fusionSpinal fusion is a surgical treatment for abnormal spine conditions such as disc herniation, spinal tumors, spinal fractures, arthritis, scoliosis or infection. Spinal fusion stabilizes the spine by replacing a cartilage disc that separates the bones of the spine (vertebrae) with a bone graft that fuses together the vertebrae above and below the removed disc. Instrumentation, such as rods, plates, screws or "cages," may also be used to fuse the spine. Sometimes instrumentation is used without a bone graft; other times, instrumentation supports the bone graft and helps it heal properly. The procedure is done under general anesthetic in which the patient is asleep. Lumbar fusion may involve an incision along the back (posterior) or at the front of the abdomen (anterior). Cervical fusion may involve an incision at the front or side of the neck. Thoracic fusion usually involves an incision in the chest and abdomen. Spinal fusion requires about five days of hospitalization. It is a more invasive surgery than discectomy or laminectomy. Pain medication will be needed during and after the hospital stay. A back brace is worn for about three months. Physical therapy to strengthen muscles and learn proper body mechanics and posture may be prescribed. Cardiovascular exercise as well as a regimen to increase strength and flexibility in the back and abdomen may also be prescribed.
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