Neurosurgery

1. Craniotomy

- Definition: A craniotomy is a surgical procedure where a part of

the skull (bone flap) is temporarily removed to access the brain for
various treatments. Once the surgery is complete, the bone flap is
replaced.
- Types:
- Supratentorial Craniotomy: Performed above the tentorium
cerebelli.
- Infratentorial Craniotomy: Below the tentorium (e.g., cerebellum,
brainstem).
- Keyhole Craniotomy: A minimally invasive variant.
- Indications:
- Brain tumors, hemorrhages, aneurysms, traumatic brain injury,
AVMs.
- Complications:
- Infection, bleeding, brain swelling, seizures, neurological
deficits, stroke.
2. Cranioplasty

- Definition: Cranioplasty is a reconstructive surgery to repair skull

defects resulting from trauma, surgery, or congenital anomalies, using
bone or synthetic materials.
- Types:
- Autologous Cranioplasty: Uses the patient's own bone.
- Alloplastic Cranioplasty: Uses synthetic materials (e.g., titanium,
acrylic).

- Indications:
- Skull defects from trauma, infection, or prior surgery
(craniectomy).
- Complications:
- Infection, rejection of implants, CSF leakage, seizures.
 2. Stereotactic Surgery

- Definition: A minimally invasive surgical procedure that uses a

three-dimensional coordinate system to precisely target small areas of
the brain for biopsy or treatment.
- Types:
- Stereotactic Radiosurgery: Uses focused radiation (Gamma
Knife, CyberKnife).
- Stereotactic Ablation: Destroys specific brain areas.
- Indications:
- Brain tumors, Parkinson’s disease, epilepsy, movement disorders,
biopsies.
- Complications:
- Bleeding, infection, stroke, tissue damage
 3. Deep Brain Stimulation (DBS)

- Introduction: DBS involves implanting electrodes in specific

areas of the brain to modulate abnormal signals, typically for
movement disorders. The electrodes are connected to an implanted
pulse generator (similar to a pacemaker).

- Types:
- STN DBS (Subthalamic Nucleus), GPi DBS (Globus Pallidus
Internus), VIM DBS (Ventral Intermediate Nucleus).
- Indications:
- Parkinson’s disease, essential tremor, dystonia, epilepsy, OCD.
- Complications:
- Infection, hardware failure, hemorrhage, cognitive/mood
changes.
 4. Burr-Hole Surgery

- Introduction: A burr hole is a small hole drilled into the skull to

provide access to the brain, often used in emergency or diagnostic
procedures.

- Types:
- Diagnostic Burr Hole: For brain biopsy or ICP monitoring.
- Therapeutic Burr Hole: For hematoma drainage or shunt
placement.
- Indications:
- Subdural hematomas, hydrocephalus (shunt placement), brain
biopsy.
- Complications:
- Infection, excessive bleeding, brain tissue damage, seizures.
6. Shunting
- Introduction: Shunt procedures involve the placement of a
catheter system to divert excess cerebrospinal fluid (CSF) from the
brain to another body cavity, typically to relieve hydrocephalus.
- Types:
- Ventriculoperitoneal (VP) Shunt, Ventriculoatrial (VA) Shunt,
Lumboperitoneal Shunt.
- Indications:
- Hydrocephalus, pseudotumor cerebri, normal pressure
hydrocephalus (NPH).
- Complications:
- Shunt infection, malfunction, over-drainage, subdural hematoma.
7. Laminectomy

- Introduction: A laminectomy involves removing part of the

vertebra called the lamina to decompress the spinal cord or nerves.
 - Types:
- Cervical, Thoracic, and Lumbar Laminectomy: Based on the
region of the spine.
- Indications:
- Spinal stenosis, herniated discs, spinal tumors, nerve
compression.
- Complications:
- Spinal instability, infection, nerve injury, persistent pain

8. Hemilaminectomy
- Definition: A hemilaminectomy is a more targeted form of
laminectomy where only one side of the vertebral lamina is removed,
typically to treat unilateral nerve compression.
- Types:
- Unilateral Hemilaminectomy, Bilateral Hemilaminectomy.
- Indications:
- Unilateral nerve root compression, herniated discs.
- Complications:
- Similar to laminectomy: infection, nerve damage, spinal
instability.
9. Rhizotomy

- Introduction: A surgical procedure to cut nerve roots in the spinal

cord, often to reduce pain or spasticity.
- Types:
- Dorsal Rhizotomy, Selective Dorsal Rhizotomy (SDR),
Percutaneous Rhizotomy.
- Indications:
- Spasticity (cerebral palsy), chronic pain, trigeminal neuralgia.
- Complications:
- Weakness, numbness, infection, continued or worsening pain.
10. Microvascular Decompression (MVD)

- Definition: MVD is a surgical procedure to relieve compression of

cranial nerves by repositioning blood vessels pressing against them.
- Types:
- Trigeminal MVD, Glossopharyngeal MVD, Hemifacial Spasm
MVD.
- Indications:
 - Trigeminal neuralgia, hemifacial spasm, glossopharyngeal
neuralgia.
- Complications:
- Hearing loss, facial weakness, CSF leak, stroke.

11. Endarterectomy

- Introduction: Endarterectomy involves removing plaque buildup

from the inner walls of arteries to improve blood flow and prevent
stroke.
- Types:
- Carotid Endarterectomy, Femoral Endarterectomy.
- Indications:
- Carotid artery stenosis, peripheral artery disease, atherosclerosis.
- Complications:
- Stroke, bleeding, nerve injury, restenosis.
12. Embolization
- Definition: Embolization is a minimally invasive procedure that
involves blocking abnormal blood vessels with embolic agents to
prevent or stop bleeding, reduce tumor blood supply, or treat vascular
malformations.
- Types:
- Aneurysm Coiling, AVM Embolization, Tumor Embolization.
- Indications:
- Brain aneurysms, AVMs, tumors, traumatic vascular injuries.
- Complications:
- Stroke, vessel rupture, ischemia, infection.

13. Pituitary Surgery (Transsphenoidal Surgery)

 - Definition: Transsphenoidal surgery is a minimally invasive
technique to remove pituitary tumors by accessing the pituitary gland
through the nasal cavity.

- Types:
- Endoscopic Transsphenoidal Surgery, Microscopic
Transsphenoidal Surgery.
- Indications:
- Pituitary adenomas, Cushing’s disease, acromegaly, tumors
affecting vision.
Complications:
- CSF leak, hypopituitarism, vision changes, meningitis.

14. Ablative Surgery (Thalamotomy and Pallidotomy)

 - Introduction: Ablative surgery involves destroying specific parts
of the brain to reduce symptoms of movement disorders.
Thalamotomy targets the thalamus, while pallidotomy targets the
globus pallidus.
- Types:
- Unilateral Thalamotomy/Pallidotomy, Bilateral (rare).
- Indications:
- Parkinson’s disease, essential tremor, dystonia.
- Complications:
- Speech/cognitive deficits, weakness, infection

15. Coiling of Aneurysm

 - Definition: A minimally invasive procedure where soft coils are
inserted into a brain aneurysm to promote clotting and prevent
rupture.
- Types:
- Simple Coiling, Balloon-Assisted Coiling, Stent-Assisted
Coiling.
- Indications:
- Brain aneurysms at risk of rupture.
- Complications:
- Aneurysm rupture, stroke, coil migration, recurrence.

16. Clipping of Aneurysm

 Introduction: Involves surgically placing a metal clip at the
base of the aneurysm to cut off blood flow and prevent rupture.
Indications: Large or ruptured aneurysms that pose a risk of
hemorrhage.
Complications: Stroke, bleeding, infection, aneurysm
recurrence, brain swelling, and neurological deficits
- Types:
- Standard Clipping: A metal clip is placed at the base of the
aneurysm during an open craniotomy.
- Fusiform Aneurysm Clipping: Special clipping techniques are
used for spindle-shaped aneurysms.
- Complex Clipping: Multiple clips are sometimes required for
larger or irregularly shaped aneurysms.

17. Neural Implantation

Introduction: Involves implanting electrodes, stem cells, or
other devices into the brain or spinal cord to restore lost neurological
functions.
 Indications: Parkinson’s disease, spinal cord injuries, brain-
machine interfaces, and brain disorders requiring neurostimulation.
Complications: Infection, hardware malfunction, immune
response, bleeding, neurological impairment, and ethical concerns
regarding manipulation of brain function
- Types:
- Neural Stem Cell Implantation: Implantation of neural stem cells
to replace damaged neurons.
- Electrode Implantation: For conditions like epilepsy or for brain-
computer interfaces.
- Spinal Cord Stimulators: Devices implanted to manage chronic
pain.
- Cochlear Implants: For hearing restoration in cases of deafness.