This section summarizes sample case reports to help patients and families understand the various types of neurological disorders our team of doctors treat at UW Medicine’s Neurological Surgery, based at Harborview Medical Center and University of Washington Medical Center in Seattle, Washington.
There are a range of techniques for treating cerebrovascular disorders, depending on the condition.
Arteriovenous malformations (AVM)
are treated by microsurgery, embolization therapy, and radiosurgery, in various combinations. The presence of an AVM can disrupt the body’s ability to cycle blood to the body’s cells and back to the heart.
can be treated with microsurgical clipping or endovascular coiling. Endovascular therapy is a minimally invasive procedure that uses the blood vessel to access the area in need of treatment. In the case of aneurysms, this treatment is called coil embolization, or simply "coiling.” Embolization refers to the technique of closing or occluding a blood vessel that is doing harm.
may require brain bypass operations or clipping conducted with patient under deep hypothermic circulatory arrest. Patients with stroke or medically refractory cerebral ischemia, (a condition where the flow of blood to the brain is restricted), may be treatable with brain bypass procedures, carotid surgery, or endovascular revascularization.
Complex Brain Tumors
Many patients with complex brain tumors require advanced neurosurgical procedures. Examples of such tumors include meningiomas involving the venous sinuses. Meningiomas are tumors that occur within the meninges, or membranous layers of connective tissue that envelop the brain and spinal cord. The outermost layer is called the dura mater. Venous sinuses are spaces within layers of the dura.
Other examples of complex brain tumors include large or giant sized tumors, and deep seated tumors in the ventricles, pineal region, or the posterior fossa, which houses the brainstem and cerebellum.
Microvascular Compression Disorders
Compression of the cranial nerves V, VII, VIII and IX by arteries or veins near the brain stem may lead to disorders such as trigeminal or glossopharyngeal neuralgia, hemifacial spasm, disabling vertigo or tinnitus. Neuralgia describes sharp pain that extends along a nerve or group of nerves. Glossopharyngeal neuralgia can cause episodes of severe pain in the tongue, throat, ear, and tonsils. Trigeminal Neuralgia, also known as “tic douloureux,” can cause episodes of intense, electric shock-like pain in areas of the face where the branches of the nerve are distributed. Hemifacial spasm is an involuntary twitching of one side of the face.
When these problems do not respond to medical treatment, it can indicate the need for microvascular decompression, performed by a retrosigmoid craniotomy. Microsurgery is assisted with visualizations provided by an endoscope. Retrosigmoid refers to that area of the skull base immediately behind the ear.
Cervical and Craniocervical Junction Disorders
Disorders of the cervical spine and especially at the craniocervical junction demand specialized approaches for decompression and stabilization. Minimally invasive endoscopic approaches are also being developed for these disorders.
The purpose of cerebral revascularization is to bring more blood to areas of brain ischemia. Ischemia is a condition where the flow of oxygen-rich blood to a part of the body is restricted. The types of revascularization are “therapeutic revascularization” for emergent cases, and “preventive revascularization” which are elective cases.
Indications for revascularization are:
- Cerebral ischemia, chronic and intractable
- Cerebral ischemia, progressive
- Moya moya disease
- Inoperable (surgical-endovascular) aneurysms
- Skull base tumors
Skull Base Tumors
Tumors at the cranial base, or skull base tumors, require specialized operative techniques for approach, removal, and repair. These include:
Radiosurgery may be used in conjunction with microsurgery. Experience and expertise play a major role in positive patient outcome.