NEUROSURGERY ARTICLES

FREQENTLY ASKED QUESTIONS 2

What is the role of neuroprosthetics in neurosurgery?

Neuroprosthetic devices are undergoing intense development at this time. These devices help brain and nerve function by inducing artificial signals such as, for example, a perceived tingle to replace pain. Deep brain stimulation is now being utilized for control of tremor of Parkinson's disease. Spinal cord stimulation is used to decrease painful sensations throughout the body. Vagal nerve stimulation is used to partially control some forms of epilepsy and has recently been approved for treating depression. Further from clinical use are studies being undertaken at a number of institutions looking at the use of fine microelectrodes to detect the brain's intent for action, and subsequently to use these signals to control external devices, such as a robotic arm. Some researchers believe that severely disabled patients, such as those who are quadriplegic because of spinal cord injury, will be able to control devices such as a wheelchair, a keyboard, or a robotic arm utilizing these techniques, and will enhance their quality of life and independence.

How has radiosurgery effected the treatment of brain tumors?

Stereotactic radiosurgery, according to an article in the May 2004 Lancet, can reduce the risk of local recurrences, decrease tumor size and brain edema, improve performance status, and reduce reliance of steroids in patients with up to three brain metastases; that is tumors spread from other parts of the body to the brain. Radiosurgery offers patients a minimally invasive, outpatient alternative to surgery as part of a treatment plan. The entire procedure is carried out in a single day, permitting patients to undergo other necessary treatments with minimal delay. During radiosurgery, beams of radiation are focused directly on the tumor or tumors avoiding normal brain tissue. Radiosurgery is also being used for treating benign tumors such as meningiomas and acoustic neuromas, as well as arteriovenous malformations. Patients with trigeminal neuralgia can be treated as well.

Dr. Mark Linskey, Chairman of the Department of Neurological Surgery, is actively involved in providing these treatments for patients with metastatic brain tumors as well as for many other intracranial lesions.

Is MRI scanning now available for surgical patients in the operating room?

Until the recent past, neurosurgeons have relied on images of the brain obtained before surgery to guide them in complex intracranial procedures. Now, new technology permits surgeons to perform tumor surgery while viewing the brain in real time. The intraoperative MRI system utilizes electromagnetic waves to produce detailed pictures of the brain as the operation progresses. The brain, because it is composed of soft tissue, constantly shifts during surgery and therefore is never in exactly the same position before an operation as during it. Now, instead of reviewing scans taken before and after surgery, doctors can visualize the brain in three-dimensional detail during all stages of an operation. Scans are obtained immediately before the first incision is made revealing the exact location of the tumor. This permits an operative approach which minimizes contact with normal brain. During surgery, the scans allow minor adjustments to be made in the removal of the tumor so that the neurosurgeon can remain precisely on target. At the termination of the procedure, scans can also reveal whether any tumor remains allowing for it to be removed without another surgical procedure.

The machine is portable, and when not in use, is stored in a special compartment in the operating room. The intraoperative MRI is being installed during the spring and is expected to be functional by this summer. UCI will then be the only medical center south of Los Angeles to possess such technology. The bottom line is that this technological advance will increase the precision and safety of many neurosurgical procedures performed to remove tumors.

How can the carpal tunnel syndrome effect me and what can be done about it?

The carpal tunnel syndrome (CTS) is not a new condition of the computer age, caused by long hours at the computer keyboard. Instead, evidence of this syndrome dates back to the 19th century. The carpal tunnel is a narrow passageway, bounded by ligaments and bones, on the palm side of your wrist. This tunnel protects the median nerve, a main nerve to your hand, and nine tendons that bend your fingers. The syndrome usually starts gradually, with mild aching in your wrist that can extend to your hand or forearm. Other common signs and symptoms include tingling or numbness in your fingers or hand, especially your thumb, index, or middle fingers, but not your little finger. There may also be pain radiating from your wrist up your arm to your shoulder or down into your palm or fingers. You may experience a sense of weakness in your hands and in severe cases a constant loss of feeling in some fingers.

Studies have shown that CTS can result from overuse or strain in certain jobs that require a combination of repetitive, forceful and awkward, or stressed motions of your wrists and hands. Examples include the use of power tools such as grinders, chippers, chain saws, or jackhammers, and heavy assembly line work. Repetitive computer work is commonly assumed to cause the syndrome, but the scientific evidence for this is weak. Women are three times as likely as men to develop CTS with the incidence being highest after menopause. The risk in men increases during middle age. CTS sometimes occurs during pregnancy but almost always improves after childbirth.

The diagnosis depends on the pattern of sensory and motor involvement in your hand and arm. Often, after a careful examination, an electromyogram and nerve conduction studies are performed. These tests are important in checking for conditions that may mimic CTS. Treatment includes taking more hand rest breaks and applying cold packs to reduce swelling. If these techniques are ineffective, treatment options include wrist splinting and medications. When the pain or numbness of CTS persists, surgery may be the best option. Your surgeon may use one of a few accepted techniques. But in all techniques, the ligament pressing on your nerve is cut. Surgery usually results in marked improvement, but you may experience some residual numbness, pain, stiffness, and weakness. If you think you have CTS, the Department of Neurological Surgery at UCI offers facilities for evaluation and treatment of this disorder.

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