What is brain surgery?

The term “brain surgery” refers to various medical procedures that involve repairing structural problems in the brain.

There are numerous types of brain surgery. The type used is based on the area of the brain and the condition being treated. Advances in medical technology have enabled surgeons to operate on portions of the brain without a single incision in or near the head.

Brain surgery is a critical and complicated process. The type of brain surgery done depends highly on the condition being treated. For example, a brain aneurysm can be repaired using a catheter that’s introduced into an artery in the groin. If the aneurysm has ruptured, an open surgery called craniotomy may be used. Surgeons, while being as careful and thorough as possible, treat each surgery on a case-by-case basis.

Why brain surgery is done

Brain surgery is done to correct physical abnormalities in the brain. These can be due to birth defect, disease, injury, or other problems.

You may need brain surgery if you have any of the following conditions in or around the brain:

• abnormal blood vessels

• an aneurysm

• bleeding

• blood clots

• damage to the protective tissue called the “dura”

• epilepsy

• abscesses

• nerve damage or nerve irritation

• Parkinson’s disease

• pressure after head injury

• skull fracture

• a stroke

• brain tumors

• fluid building up in the brain

Not all of these conditions require brain surgery, but many may be helped by it, especially if they pose a risk for more serious health problems. For example, a brain aneurysm doesn’t require open brain surgery, but you may need open surgery if the vessel ruptures.

Types of brain surgery

There are several different types of brain surgery. The type used depends on the problem being treated.

Craniotomy

A craniotomy involves making an incision in the scalp and creating a hole known as a bone flap in the skull. The hole and incision are made near the area of the brain being treated.

During open brain surgery, your surgeon may opt to:

• remove tumors

• clip off an aneurysm

• drain blood or fluid from an infection

• remove abnormal brain tissue

When the procedure is complete, the bone flap is usually secured in place with plates, sutures, or wires. The hole may be left open in the case of tumors, infection, or brain swelling. When left open, the procedure is known as a craniectomy.

Biopsy

This procedure is used to remove a small amount of brain tissue or a tumor so it can be examined under a microscope. This involves a small incision and hole in the skull.

Minimally invasive endonasal endoscopic surgery

This type of surgery allows your surgeon to remove tumors or lesions through your nose and sinuses. It allows them to access parts of your brain without making an incision. The procedure involves the use of an endoscope, which is a telescopic device equipped with lights and a camera so the surgeon can see where they’re working. Your doctor can use this for tumors on the pituitary gland, tumors on the base of the skull, and tumors growing at the bottom part of the brain.

Minimally invasive neuroendoscopy

Similar to minimally invasive endonasal endoscopic surgery, neuroendoscopy uses endoscopes to remove brain tumors. Your surgeon may make small, dime-sized holes in the skull to access parts of your brain during this surgery.

Deep brain stimulation

As with a biopsy, this procedure involves making a small hole in the skull, but instead of removing a piece of tissue, your surgeon will insert a small electrode into a deep portion of the brain. The electrode will be connected to a battery at the chest, like a pacemaker, and electrical signals will be transmitted to help symptoms of different disorders, such as Parkinson’s disease.

Spinal fusion. This is the most common surgery for chronic nonspecific back pain with degenerative changes. The doctor will join spinal bones, called vertebrae, together. This limits the motion between them and how far your nerves can stretch. But it probably won’t limit your activity. It’s rare, but the bones don’t always fuse completely. Smoking can make this complication more likely. If it happens, you may need another operation to fix it.

Laminectomy. This is the most common surgery for lumbar spinal stenosis. In this procedure, a surgeon removes parts of the bone, bone spurs, or ligaments in your back. This relieves pressure on spinal nerves and can ease pain or weakness, but the procedure can make your spine less stable. If that happens, you’ll probably need a spinal fusion as well. Doctors sometimes do the two procedures together.