Cranial Disorders and Head & Spinal Injury
NJBSC provides emergency care 24/7 to all head injury victims through the Emergency Departments of the area hospitals. Our offices have access to the radiology departments of all the participating hospitals in the county so the X rays, CT scans and other images can be reviewed by our surgeons and treatment decisions conveyed to doctors, nurses and other health care professionals expeditiously.
All our surgeons have trained in major trauma centers with many years of experience in the acute and intensive care management of multiple trauma patients. They work closely with the trauma surgeons, and intensivists in the day to day care of head and spinal injured patients. They collaborate with orthopedic, plastic, ENT and maxillo-facial surgeons for the treatment of complex head, neck and facial injuries.
They perform emergent craniotomies for the evacuation of epidural, subdural and intracerebral hematomas (blood clot), intracranial pressure monitoring, elevation of depressed skull fractures, craniotomy decompression for raised intracranial pressure and removal of brain contusions and repair of cerebrospinal fluid leaks. A detailed description of the different types of brain injury can be found at www.biausa.org/education.htm Unstable spinal column injuries are stabilized using advanced, minimally invasive fixation systems to optimize early mobilization and to decompress the spinal cord to hasten recovery of lost function.
Trigeminal neuralgia
Surgeons at NJBSC have extensive experience in treating Trigeminal Neuralgia. They offer the whole range of treatment options in the management of this extremely painful condition. The pros and cons of different treatment methods are discussed extensively with the patients and their family (see patient education section for details). Treatment decisions are made taking into consideration both patient preference and optimal medical recommendation.
Most patients are first optimized on medical management using a variety of different drugs such as Carbamazapine (Tegretol), Trileptal, Dilantin, Neurontin and Baclofen. Patients who are otherwise healthy are offered microvascular decompression of the trigeminal nerve performed through a small scalp incision behind the ear. Patients in acute distress due to intractable exacerbation can often be scheduled for percutaneous radiofrequency coagulation of trigeminal nerve fibers under conscious sedation on an urgent basis. Radiosurgical ablation of the trigeminal nerve using Xnife, BrainLab and Cyberknife technology is also available. Over 90% of patients will note immediate relief. About half will experience some amount of numbness. Relief may last for several years, but if necessary some of these procedures can always be repeated. The option of deep brain stimulation surgery is there for those with otherwise intractable facial pain.
Hemifacial Spasm
Microvascular decompression of the VIIth cranial nerve is a very effective surgical procedure for this condition. NJBSC surgeons perform this procedure with intra operative brain stem and facial nerve monitoring with excellent success rate.
Hydrocephalus
Hydrocephalus or build of spinal fluid within the brain can have several causes. While brain hemorrhage, congenital defects and infection lead the list among children, adults develop hydrocephalus due to obstruction of spinal fluid pathways caused by benign tumors and cysts or due to defective absorption of the fluid due to minor often unrecognized injury, hemorrhage or infection. Normal pressure hydrocephalus (NPH) among adults manifests insidiously as walking / balance difficulty, urinary urgency or incontinence and mild memory and cognitive deficits. Our surgeons use magnetically programmable ventriculo peritoneal shunts systems, antibiotic impregnated catheters and computer guided navigation technology depending upon individual patient’s pathology. We have performed a large number of successful endoscopic third ventriculostomies for the treatment of obstructive hydrocephalus thereby eliminating the need to place indwelling shunt catheters.
Cerebral Cysts
Colloid cysts of the third ventricle have been treated by both open surgical resection as well as by endoscopic techniques. Fenestration of ventricular cysts, arachnoid cysts and biopsy of ventricular and other deep seated tumors have been performed using the neuro endoscope. Our surgeons have received specialized training in the use of the endoscope for the treatment of intra ventricular as well as skull base tumors.