Neck pain – your questions answered!

We asked Mr David Bell, one of London Neurosurgery Partnership’s complex spine experts, to explain a bit about neck pain, why we get it, what causes it and how to help.

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Neck pain is very common among individuals of all ages. It can be linked to the simple straining of neck muscles from hunching over a computer, moving awkwardly or as a result of conditions such as osteoarthritis. Less commonly, neck pain can be a symptom of an underlying problem.

What are the symptoms of neck pain?

  • Pain that becomes worse when the head is in one position for a long time such as driving or working at a computer.

  • Muscle stiffness and sometimes spasms.

  • Limited range of movement (especially side to side or up and down).

  • Headache.

When should you seek medical advice?

Usually, neck pain improves within a couple of weeks with at home treatment. If it doesn’t improve then it is always a good idea to see your doctor.

You should always seek medical advice if neck pain is:

  • As a result of a trauma – like a trip, fall or car accident.

  • Very severe.

  • Persistent for over a few days/a week without relief.

  • Spreads down your arms or legs.

  • Is accompanied by weakness, tingling or numbness.

So what actually causes neck pain?

The neck supports the weight of the head (which isn’t that light!) yet is flexible to allow movement which makes it susceptible to conditions which can cause pain, including:

  • Muscle strains: Over use of the muscles such as poor posture at a computer or sitting awkwardly for a while can strain neck muscles.

  • Joint wear and tear: Just like the rest of the spine and other joints in the body, the joints in the neck can wear down over time. When this happens it can contribute to neck pain.

  • Nerve compression: Disc bulges (called herniations) or little bony spurs can press down on and compress the nerves which branch out from the spinal cord to the arms. This can lead to neck pain, tingling, numbness and weakness.

  • Injuries: Trauma, such as trips, falls, car accidents and other actions which result in rapid jerking of the neck can result in soft tissue (muscles, tendons and ligaments) in the neck being strained which can contribute to neck pain.

  • Diseases: Much less frequently, diseases such as meningitis, cancer or arthritis can be the underlying cause of neck pain.

Can you prevent neck pain?

Given that most neck pain is associated with poor posture and/or wear and tear there are some simple life style changes which can help prevent some neck pain:

  • Improve posture when standing and sitting.

  • Take frequent breaks to get up and move around.

  • Adjust desk and screen height so the screen is at eye level.

  • Quit smoking!

  • Sleep in a good position.

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What are the treatment options?

Mostly neck pain will cure itself over a couple of weeks. Alternate hot and cold on your neck may help relieve the pain alongside over the counter pain relievers. If it persists your doctor may prescribe some stronger pain relief. Physical therapies can often help persistent neck pain.

If these do not work and your neck pain continues over several weeks into months your doctor may suggest steroid injections. These involve injecting corticosteroid near the nerve roots and into the facet joints to help relieve pain.

If the pain is really persistent the specialist consultant may recommend decompression surgery as a very last resort. This might be recommended for neck pain resulting from a compressed nerve. The aim of surgery would be to release the pressure on the nerve root. 

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

 

 

What is a colloid cyst

Mr Christopher Chandler explains to us what actually is a colloid cyst.

Overview

 A colloid cyst is a benign brain tumour, which means it’s non-cancerous. They do not spread but will slowly grow in size. Colloid cysts are small fluid-filled sacs located in or around the lateral and third ventricle of the brain. Because of it’s location in the ventricles, a colloid cyst can sometimes cause a blockage of cerebral spinal fluid (CSF). CSF is located in the ventricles where is protects and cushions the brain and spinal cord, if the flow of CSF is interrupted it can cause a person to develop hydrocephalus (excess CSF in the brain) as the colloid cyst is disrupting the body’s natural circulation of fluid. 

There is no defining cause why a colloid cyst develops but it is thought to be present from foetal development. They do tend to grow as a person grows in to an adult as it is rare to find a colloid cyst in a child.

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 Symptoms

Colloid cysts are usually diagnosed through incidental findings. This means that it was found almost by accident, maybe when a patient was having a scan for a different reason like headaches. This is because they do not often present with symptoms as they are slow growing, the brain has time to get used to it being there.

 A colloid cyst will start to cause symptoms when it begins to block the CSF flow the circulate the brain and spine. This will lead to hydrocephalus. Symptoms of this will include headaches and sometimes vomiting, visual disturbances, memory problems and in extreme cases loss of consciousness and coma.

Diagnosis

 If your doctor suspects your symptoms are being causes by something in the brain then they will investigate by asking the patient to have an MRI scan. This scan is will used specific sequences to capture images of the brain and spinal cord. They are able to identify colloid cysts. This is the quickest way to diagnose a colloid cyst. A doctor is able to see the imaging immediately after the scan is performed.  

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Treatment

Treatment for a colloid cyst will differ from person to person as it all depends on the age of the patient, location, size and severity of the cyst and if it is causing CSF blockage.

If a colloid cyst is found to be causing no symptoms or hydrocephalus, is small and is not affecting the patient’s life then a doctor may recommend a watch and wait technique. This means there is not a good enough reason to operate on the patient as its not affecting the brain. The doctor will be able to monitor the cyst with MRI scanning annually. If the cyst is growing in size and the patient starts to present with symptoms then surgical removal may be an option. If not, then the monitoring will continue.

If the cyst is interrupting the natural CSF flow of the brain and causing hydrocephalus then surgical intervention will be necessary. This will be in the form of an endoscopic craniotomy – a minimally invasive technique. The cyst will be carefully drained and then resected from the brain. If the hydrocephalus does not resolve then a shunt device will need to be inserted to drain the excess fluid from the brain.

 This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.  


 

Lumbar decompression surgery

Mr Irfan Malik is an expert in all thing’s spine related, so we have asked him what a lumbar spine decompression actually is and how it’s performed.

 It can be a scary situation if you have been told that spinal surgery is needed, any surgery for that matter can be nerve-racking. We hope this will help you put your mind at ease as we walk you through the what, where, why and hows.

Lumbar spine surgery would be recommended for patients who are suffering from chronic spinal stenosis, sciatica or a slipped disc, spinal injuries and fractures and even cancer if it is pressing on the spinal cord. These are just come of the common conditions are accompanied with symptoms such as weakness, numbness and pain in arms or legs, or difficulty walking and completing daily activities due to intense pain. Surgery will also be an option for people who have tried more conservative treatments like physical therapy or medications without any improvement.

Lumbar spine decompression is a surgical procedure performed to free up compressed nerves in the spinal cord. The surgeon will do this by making an incision in the lumbar spine, under X-ray control, appropriate nerves and tissues will be removed to take pressure off of the affected area. Once your surgeon is happy with the decompression and your nerves have been freed up, the muscles that were moved will be stitched back in to position and the incision will be closed.

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Depending on your individual condition there may be different procedures that need to be performed while having the operation. There are several types of decompressive surgery and you will be informed well in advance if you need any of these:

  • Laminectomy – Removal of the entire lamina that is putting pressure on the spinal cord.

  • Laminotomy – Part removal of lamina to relieve pressure on the spinal cord.

  • Foraminotomy – removal of the bone that is around the neural foramen.

  • Laminaplasty – Performed in the neck, the laminae is cut to create more space in the spinal cord.

  • Discectomy – Removing a bulging or slipped disc to release pressure of the spinal nerves.

Postoperatively, you will be placed back on a ward with close neuro observations for 24 hours. You will be able to mobilise as soon as possible. A physical therapist will visit you and your consultant before you are discharged. You may even need to have a MRI or X-ray before leaving the hospital just to check the surgery was a success. A follow up consultation will be made for 6-8 weeks’ time, during that time you will be following a guide on how to keep active after surgery which will includes the do’s and don’ts of daily activities. You will be discharged if there are no red flags in your follow up consultation.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.  

 

 

 

Epilepsy - The Basics

Mr Richard Selway is one of our leading epilepsy surgeons here at LNP. He is going to give us a rundown of what epilepsy is and how seizures affect us. Epilepsy is a very common neurological disorder which affects every 1 in 100 people in the UK. When a person is having an epileptic seizure it causes abnormal electrical activity in the brain which interrupts the way our brain normally works. Our brains cells are constantly sending electrical signals and messages to each other and throughout our body, so when an epileptic seizure is happening this can cause normal processes to be interrupted and can make a person jerk, become stiff and even be unaware of seizure they are experiencing.

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Symptoms

 Epilepsy can cause a range of symptoms and varies from person to person. Here are some of the possible symptoms you may be experiencing:

  • Uncontrollable jolting or jerking, and shaking

  • Collapsing

  • Staring blankly

  • Loss of consciousness

  • Sensation of tingling or unusual sensations when an epileptic fit is about to begin.

The main symptom of epilepsy is a seizure but there are a whole host of different types of seizures. To find out more about them visit the NHS website here.

 Causes of epilepsy

In most cases of epilepsy there is no clear identifiable cause. Sometimes it can be due to family genes and you could have inherited it. Other possible causes are associated with damage to the brain like a brain tumour, stroke, head injury, substance abuse or infection.

 Generalised seizures

There are six types of generalised seizures that would help to be familiar with.

Tonic clonic seizures: There are two phases to this seizure as both sides of the brain are affected. In the tonic phase the person will be unconscious, muscles will become stiff and can cause a person to fall to the floor. Tongue biting in common and so are sounds of crying or groaning. Following the clonic phase, jerking of the limbs may take effect as well as loss of control of bladder and bowel function. This seizure can take between 1-3 minutes.

 Tonic seizures: When a tonic seizure take effect a person’s limbs will go stiff and arms will raise upwards. They will fall hard to the floor if they are standing and it is common for them to fall backwards. There is no jerking or moving of the limbs and the person is completely unconscious during this time and the seizure will usually last for 60 seconds.

Atonic seizures: Also known as a drop seizure, a person will lose all motor function and their muscles will go limp. This will cause them to fall to the floor, bang their head and result in other possible injuries. They are very brief and last just a couple of seconds.

 Absence seizures: Previously called a Petit mal seizure, this type will result in a person unconsciously being in a daydreaming episode. They will stare in to space and look like they are not listening, they may blink and have slight jerking movements. This seizure can begin in childhood and can sometimes be missed as it could be put down to a child not listening when really, they have no control over what is happening.

Myoclonic seizures: Myoclonic are short seconds long seizures and sometimes unnoticeable. They cause short symptoms of muscle movement and jerking. They can be very mild or strong which may cause a person to fall over but they remain conscious during this seizure.

Clonic seizures: Clonic seizures have repeated and rhythmic symptoms of jerking and limb movement. The person is unaware they are doing it and will last from 10 seconds up to 2 minutes.

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Treatments for epilepsy

There are various types of management and treatment methods for epilepsy. There are medications called anti-epileptic drugs that help prevent or control seizures from happening. Other types of treatment can be Vagus nerve stimulation VNS and Deep brain stimulation DBS. Obviously surgical intervention will be considered for serious and life-affecting types and causes of epilepsy.

 Surgery for epilepsy is not taken lightly and various tests will be carried out prior, like EEG, brain scans and memory/ability testing. All of this will feed information about a person epilepsy to us so we can give the best possible outcome of management for the patient.

If you are or know someone who is suffering with epilepsy, child or adult and need more information then please do not hesitate to get in-touch for an in-depth consultation discussing the type of epilepsy associated with you.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition. 


Back Pain

Mr Nicholas Thomas gives us the low-down on back pain and what we can be doing to help it:

Back pain is extremely common in people of all ages. Normally it will resolve itself within a couple of weeks or months but patients can also experience life-long symptoms of back pain. It can be felt anywhere in the back and can occur for various different reasons.

 There are many different ways to relieve and treat back pain but to also reduce it from coming back.

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  • Staying fit and healthy

  • Improving your posture

  • Knowing your limit and not performing over-strenuous activities

  • Being active and stretching your back and body. This can be done by walking, running, stretching, swimming, yoga, Pilates and much more.

  • Taking anti-inflammatory painkillers like paracetamol and ibuprofen

  • Using heat or cooling compressors to the area of pain

  • Using a supportive mattress

 If none of the above have worked and you are still experiencing pain and it is worsening and starting to affect your day to day activities then it may be worth a visit to your GP as there could be an underlying issue. Your GP will examine you, talk through your medical history and see if other ways of therapy could help. You may even be asked to have a scan like an X-ray or MRI to check if anything is causing the back pain specifically.  

The causes of back pain obviously differ but they are also very non-specific. It can be due to strain or injury, an accident or simply not being active enough. But there can be medical reasons like a slipped disc or even sciatica. These symptoms will be accompanied by more than just back pain, for example you may be experiencing tingling, weakness, numbness and pain radiating to the arms or legs.

It is important to seek urgent medical advice if you are experiencing these symptoms:

  •  Numbness or tingling around your genitals or buttock area

  • Bladder or bowel incontinence

  • High temperature

  • Chest pain

  • Swelling or deformity in the back

  • If you have been in a serious accident

  • If your back pain is not improving or getting significantly worse

We see patients will all types of back pain related problems and conditions. Even though back pain is common, there can be underlying issues that you may not be aware of. If your back pain and its symptoms are getting in the way of life and not resolving then it is important to get a second opinion. Contact us to book an appointment and get the diagnosis and help you need.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition. 


Spinal Cord Stimulation (SCS)

Mr Richard Gullan explains to us what Spinal Cord Stimulation is and how it is surgically inserted.

Overview

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A spinal cord stimulator is a device that is surgically implanted under the skin in your spine near the vertebrae with wires leading to the epidural space. SCS is a type of therapy to help deliver mild electrical pulses to mask the pain before it has time to reach the brain. The wires of the SCS are attached to the spines nerve fibres and when turned on, it stimulates those nerves where the pain is and blocks the pain signal from reaching the brain. 

A SCS does not erase the pain from your body, it is simple a deterrent. Each person will have a completely different experience from this type of therapy because of the different levels of pain they are experiencing and also how the body reacts to such stimulation. The goal is for the stimulator to reduce pain up to 70% but that can be more or less for each person. A patient may experience a tingling sensation due to the SCS working, it is not painful but some patients may find it unpleasant. 

 There are several different types of SCS and your consultant will help you choose the right one for you and the pain you are experiencing. All SCS have batteries that help create the electrical pulses, a hand-held remote that can turn on and off and also a lead wire that delivers electrical currents.Candidates

Candidates can vary but they all have one thing in common which is chronic pain. Steps are taken for each person before they are offered an SCS. They will need to have a full medical history check, see if medication can help with pain or physiotherapy and even surgery.

Candidates may benefit from SCS if:

  • Conservative and surgical solution has failed

  • More surgery will not be beneficial

  • Chronic neck and/or back pain

  • Chronic leg and/or arm pain

  • Complex pain syndrome

  • Arachnoiditis

  • Angina

  • Peripheral vascular disease

  • Multiple Sclerosis

The true goal is for the patient to be able to live a better standard of like and perform daily activities without being in chronic pain. Medication may still need to be taken but it will be reduced.

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SCS insertion

There will be a trial for SCS initially to see if it will actually reduce the pain but also to determine if the patient is still ok to go ahead after the trial.

During the surgery the patient will be under sedation and will lie on their stomach. X-ray is used to locate the area and the electrode wires are inserted in to the spine and lower near the buttock is where the generator will sit. A laminotomy is performed in the spinal cord to make space for the wires and then secured in to the epidural space.

A test stimulation will be performed during surgery which the patient has to be awake for. This is to determine if it is working and to help the surgeon change the settings or reposition if necessary. Once this has been established then the patient will again be sedated and the generator will be implanted in to the buttock. A lead wire will run from the generator and attached to the electrode wire. Once all is in place then sutures are used to close the skin and the patient will be taken to the ward to recover.

There will be restrictions in place as the patient recovers and your surgeon will talk you through those. Mostly is it about looking after yourself and the wound sites, so no strenuous activities or bending and twisting. It is also recommended not to smoke or intake nicotine products as they prevent bone healing.  

Some of the risks do include:

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  • Epidural haemorrhage, hematoma, infection, spinal cord compression, and/or paralysis (can be caused by placing a lead in the epidural space during a surgical procedure)

  • Battery failure and/or battery leakage

  • Cerebrospinal fluid leak

  • Persistent pain at the electrode or stimulator site

  • Lead migration, which can result in changes in stimulation and reduction in pain relief

  • Generator migration and/or local skin erosion

  • Paralysis, weakness, clumsiness, numbness, or pain below the level of implantation

The patient will be sent home with instructions on how to use the stimulator but of course everything will have already been explained to them. The consultant will provide follow up and check up consultations to see how the patient is getting on.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition. 

London Neuroscience Academy - Neuromonitoring & Mapping International Course 2018

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The London Neuromonitoring and Mapping International Course was held on the 23rd and 24th of November 2018. It was London Neuroscience Academy’s third time running this two day course and it was a success. It provides the attendees with a unique approach whereby both the neurophysiologist and the neurosurgeon deliver the teaching side-by-side giving a realistic environment and extensive knowledge into the daily workings of the operating theatre. 

The first day (Basic Course) provided delegates with knowledge on the principles of intraoperative neuromonitoring and brain and spinal cord mapping. The neurophysiological principles and the clinical interpretation of MEPs, SSEPs, D-WAVES, VEPs, EEG and EcoG was analysed. Principles and techniques of direct electrical stimulation for brain and spinal cord mapping will be discussed. The setup for intraoperative neuromonitoring was be shown and hands-on demonstrations with the intraoperative neuromonitoring equipment was most definitely available. Anaesthetic considerations for intraoperative neuromonitoring was also discussed. 


The second day (Advanced Course) demonstrated how to perform intraoperative neuromonitoring and direct mapping in Spine Surgery, Brainstem Surgery and Brain Surgery. Each section included the anatomy, the physiology and the pathophysiology and the different intraoperative neuromonitoring techniques necessary to tailor neurophysiological strategies to each patient. Case studies showed and hands-on demonstration on different intraoperative neuromonitoring equipment will be available. 

The advanced course also covered cortical and sub-cortical brain mapping techniques for motor, language and higher order functions and their correlation with the extra-operative mapping with Transmagnetic Stimulation.

London Neuroscience Academy are certain that the social opportunities in London and the highly educational content of the course will make your experience unforgettable and truly worthwhile.


What is a cavernoma?

Mr Christos Tolias explains to us about cavernomas.

A cavernoma is a gathering of abnormal blood vessels usually located in the brain and spinal cord. Cavernomas can also be known as cavernous angioma, cavernous haemangiomas or cavernous malformations (CCM). Cavernomas look like raspberries and usually measure from  a few millimetres to several centimetres in diameter.

They are usually solitary but can be multiple. 1 in 600 individuals may have one. They are usually located in the brain but can occur anywhere in the nervous system.

Most are incidental, non hereditary lesions, however a minority of cavernomas (less than 50%) are thought to be of a genetic form and genetic testing can be used to determine. Genetic predisposition is more common in patients with multiple cavernomas.

Symptoms of cavernoma

Cavernomas may not cause a person to have any symptoms but they are often diagnosed after a person has experienced symptoms and is being investigated.

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  • Seizures

  • Haemorrhage

  • Headache

  • Weakness, numbness, memory issues and trouble when concentrating

  • Other neurological problems such as slurred speech, double or blurred vision, balance problems, tremor or dizziness.

Cavernomas are different from patient to patient, it all depends on severity, location and duration. A person can experience problems with cavernomas when they are putting pressure or bleeding in certain areas of the brain. Severe cases of haemorrhage can potentially be life threatening and have long-term effects on the individual but more commonly the bleed is small and may not be symptomatic. The majority of cavernomas are incidental findings on scans performed for non related reasons.

 What causes a cavernoma?

 Cavernomas do occur without clear cause and there is no obvious reason, but there are genetic links to cavernomas but most cases are completely random. Genetic testing can be carried out on cavernomas.

Diagnosing cavernoma

Scanning is the best way of quickly diagnosing a person for many different conditions. An MRI scan may be used which will be able to show a detailed image of the brain and spine and will show the cavernoma.  Other imaging and testing is available, such as CT or angiography but MRI is preferable. Cavenomas do not show up on angiograms as they have very slow blood flow.

Treating the cavernoma

Treatment for a cavernoma does very from person to person. As mentioned before, it is all about severity, symptoms and location and effective treatment will vary depending on the cavernoma. The decision to treat will depend on a multitude of factors. The majority of these lesions are considered benign and are treated conservatively.

Watch and wait – If a person is not experiencing symptoms or very little and the cavernoma is not causing any type of risk to the brain then the option of watching and waiting may be more beneficial.

Medication – Medication will not resolve or change a cavernoma but it will help manage the symptoms it is causing such as seizures.

Neurosurgery – The decision to treat a cavernoma is complex and discussions among specialists (MDT) is usually required to provide the optimal treatment plan.

Neurosurgery can be carried out to remove the cavernoma. There can be risks involved but usually the benefits of surgery outweigh the risks.

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Other avenues of treatment can be stereotactic radiosurgery such as GammaKnife or CyberKnife which is non-invasive. Their indications are usually for deep located lesions that are less amenable to surgery. The indications and suitability of patients as well as their preferences are all discussed and agreed.

A patient who has a cavernoma or has undergone treatment for this will need regular check-ups and scans such as MRI.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition. 


London headache and Facial Pain Symposium

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London Neurosurgery Partnership works closely with London Neuroscience Academy to provide some of the best academic courses for continued professional development. We are excited to share LNA’s recent Headache and Facial Pain Symposium short video with you to give an in-sight of what happens on an LNA course.

We had our own Mr Sinan Barazi and colleague Dr Giorgio Lambru host and speak at the event along with special guest speakers such as Mr Ranj Bhangoo, Dr S Chong, Professor T Renton, Dr P Surda, Professor L Bendtsen, Dr s Palmisani and Dr A Al-Kaisy. Together they provided a comprehensive approach to facial pain and extensive teaching of diagnosis, pathogenesis and the treatment and options for headaches and facial pain.

Take a look at our video and if you are interested LNAs website for more upcoming courses!

Why we use CyberKnife Radiosurgery at London Neurosurgery Partnership.

Professor Ashkan explains why we use CyberKnife at LNP.

CyberKnife is a non-invasive form of radiotherapy treating benign and cancerous tumours. It is specifically used to treat inoperable tumours located throughout the body in places such as the brain, spine, head, neck, lungs and liver. The robotic system delivers targeted mapping throughout the body to locate the tumour and with sub-millimetre precision it delivers radiation to the affected area.

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We use CyberKnife treatment because it is a pivotal part of treatment for inoperable tumours and it absolutely lifesaving. The technology it uses is extremely precise and advanced in locating and treating tumours. It is also very patient friendly, unlike some other technologies like GammaKnife, there is no bolting of the skull or frame and the patient is completely awake. It is pain free and non-invasive and does not require an overnight stay in hospital.

Here are some clinical studies CyberKnife Accuray have performed:

In a clinical study of 133 patients treated for tumor metastases to the brain presenting with clinical symptoms such as headaches and seizures, 90 percent of patients either stabilized or improved performance status following treatment with the CyberKnife System. 1

In a clinical study of 333 patients using the CyberKnife System to treat tumor metastases to the brain, more than 85 percent of evaluable patients achieved local tumor control at two years post treatment.1 That is, the tumor either decreased in size or stopped growing.

A clinical study of 199 patients whose lesions were unsuitable for treatment with surgery and/or a portion of the lesion remained after surgery found that more than 92 percent of patients either experienced stabilization or a significant improvement of their symptoms following treatment with the CyberKnife System. 2

If you would like to discuss the option of CyberKnife radiosurgery in more detail then please do not hesitate to contact us for an appointment.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition. 

Flat Head Syndrome

Mr Sanj Bassi explains what is plagiocephaly and brachycephaly:

As a paediatric consultant I frequently see babies who have been born or even developed plagiocephaly. Today I am going to be explaining what it exactly is and why you should not be worried.

There is often a slight misconception when it comes to babies having plagiocephaly and brachycephaly, the words in itself are complicated enough to make even the most resilient parents fear for the worst - but do not demise I am here to explain.

As mentioned above, there are two types of flat head syndrome 

Plagiocephaly – Is the flattening on one side of the baby’s head. This can be caused due to continued pressure on one side of the head and causes it to look asymmetrical. The ear can be more forward than the other and there can be an unbalanced or bulging look to the face.

Brachycephaly – Is the flattening of the back of the head, resulting in a wider and shorter head. This can be caused when the baby is laying down on their back for a long period of time.

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Babies have soft skulls when they are born, this makes them vulnerable to conditions like this. It is also very common, affecting 1 in every 5 babies. 

The causes of these conditions do vary. Here are some of the reasons as to why babies can be born with or develop plagiocephaly or brachycephaly:

Problems in the womb – Due to increased pressure in the womb or a decrease in amniotic fluid, the baby may be a bit squashed with not much room to move around, which causes the skull to flatten.

Premature babies – They can be vulnerable to flat head syndrome because their skulls are underdeveloped.

Sleeping position – Sometimes due to babies constantly sleeping on their back, it can cause the head to become flat at the back because of the constant pressure when the baby is sleeping.

Tightened neck muscles – Some babies can have tight neck muscles which can prevent them from turning their head, this can cause the head to flatten due to increased pressure on one side.

Here are some suggestions to help your baby take pressure off the flattened part of the head and also strengthen neck muscles.

Tummy time – Tummy time is an important part of a baby’s development, it encourages them to strengthen their neck muscles and improve their co-ordination. As they get older they will be able to lift their head and push up.

When sleeping – The Safest way for your baby to sleep is on their back, this is to prevent SIDS (sudden infant death syndrome) but if your baby constantly lays on a preferred side or the flattened side then you can move their head the other way.

Feeding or holding – When feeding or holding your baby you can change the position so they are not always on one side. Moving from left arm to right arm can do this.

The thing is, the more you change your baby’s position the less chance they have of getting a flattened head. This does not mean to constantly move them in fear that this will happen, but just to be aware and if you notice your baby favours one side then you can take the steps to encourage them to move to another side.

 If your baby does have a misshaped head and you are wondering if your baby’s head will ever round out then I am here to tell you that by the time your baby is 1 or 2 years old then any flattening should have improved by then and will hardly if not at all noticeable, especially as their hair grows.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition. 

A private consultation with a London Neurosurgery Partnership surgeon – what actually happens.

How do I book an appointment with a surgeon?

It’s extremely simple to book an appointment with one of our surgeons, either call or email our team on 02070348709 or info@londonneurosurgerypartnership.co.uk.

You can also check us out on various certified medical booking websites, like Doctify, Topdoctors and HCA Healthcare.

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How can I be referred to an LNP surgeon through my private healthcare insurance?

If you have health insurance then your likely to have been referred to us by another healthcare professional - like your GP.

Some insurance companies require a referral letter or confirmation your referring doctor to cover your initial consultation with us, so it’s always important to check your level of cover before you book your appointment.

But rest assured, we’re recognised by all the big insurance companies like Bupa, Aviva, Alliance, AXA PPP and WPA along with many others.

Do you accept patients without insurance?

Of course, if you choose to self-fund, we will take a card pre-authorisation to secure the appointment. The payment won’t leave your account until after the appointment has taken place or if the appointment has been cancelled in line with our 24 hour policy.

How do I know my appointment has definitely been booked?

All appointments are confirmed by a confirmation letter sent via secure email or post, depending on how you’ve told us you’d like to be contacted.  

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What happens during my appointment?

Each appointment is tailored specifically to each individual patient and therefore it’s hard to specify what will happen in your consultation. However, generally most initial appointments will cover your medical history, symptoms and potential treatment options.

We understand that you may feel anxious during your appointment, but rest assured, our internationally-recognised surgeons offer an unparalleled level of care and will take the time to explain everything to you, including any possible examinations and treatments.

Should I bring anything with me to my appointment?

It’s extremely beneficial to bring along any medical history documents or scans relating to the appointment, or if you’re feeling organised, you can post or e-mail your paperwork to our office prior to your appointment.

What happens if my consultation discovers something worrying?

 If your case is urgent, then we ensure scans are performed on the same day, with a written report and findings available within hours of your consultation. 

Our priority is always you, our patient, and our teams are well equipped to give you the best and safest treatment.

It goes without saying that should we need to expedite your treatment, we are prepared to admit patients immediately after a consultation with priority surgery appointments usually offered within the week.

We are partnered with major private hospitals like The Harley Street Clinic, London Bridge Hospital and King’s College Hospital meaning we are well resourced to offer you the best possible treatment and care.

It is our duty to make sure you feel important, listened too, cared for, safe and understood.

If you would like further information then we would love to hear from you.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition. 

 

What is syringomyelia?

Mr Sanj Bassi explains what is syringomyelia:

Syringomyelia is a fluid filled cyst (syrinx) that has developed within the spinal cord. The syrinx will get larger over time and will start to compress and damage the spinal cord. 

The formation of the syrinx is when the cerebrospinal fluid that circulates and protects the brain, turns back on itself, towards the spine and collects tissue from the spinal cord which then causes a small cyst. Over time, the cerebrospinal fluid will gradually fill the cyst which causes the compression and damage to the spinal cord.

The causes of syringomyelia do include, damage and injury to the spinal cord, tumours and most commonly Chiari malformation.

Patients who have syringomyelia may experience symptoms like those listed below:

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  • Headache

  • Weakness, numbness and stiffness in the back, legs, arms and shoulders

  • Intense pain in the neck and shoulders and face

  • Difficulty walking

  • Muscle weakness and signs of wasting

  • Reduced sensitivity (unable to feel hot or cold)

  • Loss of pain sensation

  • Bladder and bowel dysfunction

  • Scoliosis (spinal curvature)

Although symptoms do vary from patient to patient so it is important to watch out for signs. Usually patients experience early symptoms of weakness in their back, neck, arms and legs and loss of reflexes first.

How is syringomyelia diagnosed?  

If a patient is presenting with the above symptoms associated with syringomyelia then their doctor talk through their medical history and perform a physical examination to look for signs of the condition. It will then be necessary to refer the patient for an MRI or CT scan of the spine. This scan will be able to produce detailed imaging of the patient’s spine and pick up any syrinx on the spinal cord.

What are the different causes of syringomyelia?  

Chiari 1 malformation is the main cause for syringomyelia. Chiari is a malformation where the bottom part of the brain protrudes the spinal canal. If you would like to read more about Chiari from our previous blogs then click here

Other causes may be injury to the spinal cord, spinal tumour, meningitis and a tethered cord which is a condition present at birth

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How is syringomyelia treated?

There are a few different ways to treat syringomyelia and it all depends on the severity and whether it is affecting the patient’s day to day life.

Watch and wait – this option would be for patients with a less disruptive syringomyelia and it may have been caught early on where the cyst is still very small. As this condition can be slow growing, it may not be necessary to go ahead with treatments just yet, especially if the patient is not presenting with any symptoms.

Medication – although syringomyelia cannot be treated through medication, it can help some of relieve some of the symptoms that it is causing.

Draining the syrinx (shunt) – this is a surgical procedure in which the consultant inserts a tube which drains the fluid in to another area of the body such as the abdomen and prevents backflow.

 Other surgical options can be removing the tumour or a growth which may be obstructing the spinal cord. If the patient has Chiari malformation then the surgeon will aim to free up and expand the base of the cerebellum and improve the flow of cerebrospinal fluid.

The patient will need consistent follow up care just in case the syrinx comes back. Your doctor will perform regular scans and follow up appointments to check whether there is any changes. 

The patient must be aware that a syrinx can cause permanent spinal damage even after surgery so it is important that the patient understands the risks with and without surgery.

If you have any of the above symptoms and/or are suffering from syringomyelia and would like diagnosis and treatment then please do not hesitate to contact us.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

What is microdiscectomy?

Mr Nicholas Thomas explains the procedure for a microdiscectomy.

A microdiscectomy is a minimally invasive surgical procedure used to treat patients who are suffering with a herniated lumbar disc. The aim of the surgery is to remove parts of the herniated disc from the lower back and alleviate their pain. It is a type of keyhole surgery and thanks to pioneering medical equipment and technologies we are able to perform such a procedure this way.

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What is a herniated disc?

A herniated disc is when the soft tissue that sits between the individual bones of the spine pushes out through the spinal canal through a tear or rupture in the annulus.

What symptoms require a microdiscectomy for a herniated disc?

  • Worsening sciatic pain

  • No improvement using treatments

  • Worsening muscle weakness and numbness

  • If a patient got a herniated disc after a serious accident

Depending on the patient’s symptoms and how serious the herniated disc is will decipher on whether the patient does need to go ahead with surgery. Other simpler and less invasive treatments can be recommended before surgery is decided as many do work and mostly surgery is not necessary. Remember – surgery is always a last resort.

What risks of having a microdiscectomy are involved?

As with every procedure, risks are involved but with microdiscectomies complications are rare.

  • Bleeding

  • Nerve root damage

  • Infection

  • Recurrent disc herniation

  • Bladder/bowel incontinence

  • Blood clot

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The surgery

A microdiscectomy is performed using general anaesthesia which means the patient will be fully unconscious during the operation. As stated above, the aim of the surgery is to improve the patient’s pain by removing the disc material that is putting pressure on the spinal cord.

A patient would have had MRI scans to discover and keep track of the herniated disc. Before surgery has taken place and new scan will be necessary to identify the area needed to operated and check for any changes.

The patient is positioned prone on the operating table. A microscope is used to enhance visualisation and see the affected area through a small tube clearly. X-ray is performed to locate the herniated disc and an incision is made to the skin. Retractors placed and fixated. X-ray and microscope used to visualise the spine. A burr is used to enter the spine and utilising microsurgical instruments, part of the ligamentum flavum is removed. The nerve root is gently mobilised using a ball tip probe and the nerve root is freed up and mobilised and retracted out of the way. Rongeurs are used to remove the herniated disc fragment. Retractors are removed and incision is closed with sutures.

Usually the patient will stay in hospital overnight and be discharged the following day. It takes a patient about 6 weeks to recover and during this time they will need to keep mobile without doing any heavy lifting or strenuous tasks. A follow up and scan with the surgeon will be necessary during a post-operative follow up to check all is ok.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

Managing your headache

Mr Sinan Barazi explains how to self-manage headaches

There are many options when it comes to managing headaches, it can almost seem quite daunting. But do not despair, we are here to help things make sense!

Headaches come in lots of different forms, from the most common tension, sinus and menstrual headache to the more severe being a cluster headache and migraine. The way you will manage your headache will depend on the type. Today I am going to be discussing tension, sinus and cluster headaches.

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Tension headache

Tension headaches usually last from several minutes to a couple hours but for most people, it should not stop them from carrying on their day. The symptoms for a tension headache can range from a constant ache on both sides of the head, you may feel your neck muscles tighten and even have a straining type feeling behind the eyes.

 Here are some self-management treatments to help your pain: Firstly, start with the simple ways of easing a headache like drinking plenty of water, getting lots of rest especially if you have a cold or the flu. It can help if you try some exercise if you feel up to it and also taking paracetamol or Ibuprofen and even aspirin usually makes the headache symptom subside.

The management for tension headaches can be quite simple because they do not tend to be too painful or serious and are very common. Following the instructions above should make your headache disappear.

Sinus headache

A Sinus headache is related to Sinusitis and it is one of its symptoms but it is quite an uncommon headache and many people who assume they have a sinus headache actually have a migraine or tension-type headache.

The cause for a sinus headache is when the upper airways and lining of the nose becomes infected. This causes the sinuses to swell and leads to a build-up of pressure due to it being blocked.

Some symptoms can include throbbing around the cheeks, forehead and eyes typically on one side, worsening of headache when your head is strained, leaning forward for example. Also your face may feel quite tender to touch, almost like its swollen.

Ways in which you can manage this headache can consist of taking over the counter painkillers such as, ibuprofen and paracetamol along with having lots of rest and keeping yourself hydrated. Purchasing a decongestant to clear the sinuses and help with the tension it is causing, it also may help holding a warm flannel to your nose to help with the congestion. You can also try medications in which can help reduce the swelling in the nose like decongesting and saline nasal sprays.

Cluster headache

Cluster headaches can be excruciating, start quickly and most times without any indication. They can be described as a piercing sensation at the side of the head along with burning or a sharp pain which radiates towards the eye temple. These types of headaches occur in a pattern and typically occur every day lasting up to several weeks or months each time before they disappear. There can be periods where you can go weeks, months or even years without this type of headache before it returns. They occur around the same time each day and at similar times of the year.

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There are ways in which you can manage and treat a cluster headache. The usual pain management like paracetamol and ibuprofen is likely not to help as they are not fast acting enough.

Here are the treatments you will want when suffering from a cluster headache:

Sumatriptan injections – you can give yourself up to twice a day

Sumatriptan or Zolmitriptan nasal spay

Oxygen therapy – where you breathe pure oxygen using a face mask

The above treatments can relieve the pain within 30 minutes.

It is important to see your GP or consultant if you are suffering with cluster headaches as they may give you medication and treatments specifically to treat this. 

if you would like to read more on cluster headache then this organisation is all about supporting and raising awareness for people suffering with cluster headaches. Ouchuk.org

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

Awake Brain Surgery (Craniotomy) – Answering the questions you need to know.

Professor Ashkan explains what’s what with awake brain surgery. An awake craniotomy is a type of surgical procedure performed on the brain whilst the patient is awake. Surgery like this is necessary because the patient may have a tumour near the speech/motor parts of the brain.  

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Why does the patient need to be awake?

It is important the patient is awake because it allows us to continually check the patients function throughout the procedure. We may need to talk to the patient and ask them questions to monitor the activity in their brain before anything is incised or removed.

What are the risks?

Craniotomies do carry risks, but so does all surgeries. Here are some general risks when performing this surgery, although it does differ from patient to patient and some risks will be greater than others depending on the patients’ health.

  • Seizures

  • Speech and learning difficulty

  • Impaired coordination and balance

  • Visual changes

  • Swelling to the brain

  • Infection

  • CSF leak

  • Memory loss

  • Meningitis

 

What happens during surgery?

Here is a common example of a craniotomy: Firstly the patient will be given some drugs to make them feel relaxed and numb around the area of incision. A small part of the hair will be shaved and the incision will be marked out using high quality neuronavigation equipment. The patients head will be in a fixed position to ensure accuracy but they are still able to move their arms and legs during the procedure. Drapes will be placed around the patient but they will still be able to see and speak to the surgical team.

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During the first part of the procedure, the anaesthetist will make sedate the patient whilst we drill and open the skull. Once opened, the sedation will stop being administered so the patient is awake during the craniotomy.

Using pioneering brain mapping which sends tiny electrical probes to the brain surface. We will map out the important areas of the brain by stimulating the motor, sensory and speech regions so we can avoid and preserve them during surgery. We will continually test these regions while we remove the tumour from the brain.

Once the tumour has been removed and bleeding stopped then sutures will be applied to close the dura and the scalp will be closed. Staples to close the skin together and a wound dressing applied. 

How long will my hospital stay be and what is the recovery process?

Depending on how straight forward the surgery went, the patient may only need to stay in hospital for a couple of days if not less. The first night will be in ITU so they can be closely monitored. The patient will be able to mobilise as soon as possible and eat and drink as normal. A post-operative scan is likely to take place before discharge to check the operation site.

The recovery does take a couple of weeks and patients are advised to take some time of work. Upon discharge you will be given some medication as some pain may occur, like a headache for example. A lot of rest is needed as the patient will feel more tired than usual.

The patient will have another postoperative scan and follow up to check the progress and operation site.

 This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

 

Spelling out Spondylolisthesis

Many of our patients are diagnosed with spondylolisthesis, but they have no idea what it is. Today Mr David Bell, one of the London Neurosurgery Partnership’s Complex Spine surgeons, is going to help explain what spondylolisthesis really means, the symptoms it causes and how we can treat it.

Spondylolisthesis is simply when a bone in the spine (vertebra) slips out of place, usually forwards relative the one below it. There is often a misconception that spondylolisthesis relates to or is a slipped disc, this is not true. A slipped disc is a rupture of the spinal disc between the vertebrae.

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There are five major types of spondylolisthesis which are:

  1. Dysplastic spondylolisthesis – a congenital defect where part of the vertebra called the facet causes it to slip forward.

  2. Isthmic spondylolisthesis – a defect in the vertebra which can cause it to slip

  3. Degenerative spondylolisthesis – due to ageing and arthritic changes in the joints

  4. Traumatic spondylolisthesis – a sudden injury or trauma such as fracture to the spine

  5. Pathologic spondylolisthesis – a weakness in the spine, possibly caused by a tumour or disease

So, what are the typical causes of spondylolisthesis?

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Well, the causes do vary, some people are born with a defective vertebra and if no symptoms, it may not be identified until later in life. Other causes are more identifiable such as:

  • Sports injury such as gymnastics

  • Degeneration (ageing or overuse)

  • Tumour or illness

  • Sudden injury or trauma

  • Birth defect

  • Surgery

Spondylolisthesis can carry quite common symptoms and which is why many people do not realise they have this condition.

Although some people do not have any symptoms, here are the symptoms you may notice:

  • Lower back pain

  • Pain and/or weakness in one or both legs or thighs

  • A tingling sensation that radiates from lower back down to the legs.

  • Tenderness or stiffness in the back

  • Tight hamstring and buttock muscles

  • Excessive curving of the spine known as lordosis

  • Difficulty walking or running 

Treatments and surgical options

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There are many ways to treat spondylolisthesis. Initial treatment could be simply avoiding back straining activities such as lifting, bending or sports, this can give your back a chance to get back to normal. If that does not work or show much progress when an introduction of anti-inflammatory painkillers such as Ibuprofen or stronger may be required to help reduce the pain and inflammation.

If the above is of no use or not proactive enough then your doctor may recommend some physiotherapy, stretching out those hamstring and the lower back may really help strengthen and increase the motion in the back.

Another non-surgical method is corticosteroid injections. This will be used for patients who are suffering from symptoms of numbness, pain and tingling. The injection will be placed around the compressed nerve and into the spinal canal.

Surgery is the last resort. If the above non-surgical treatments are ineffective and the patient is still suffering with symptoms or the spondylolisthesis is severe and persistent, then your doctor may take you down this route. Another reason for surgical intervention would be because of a trauma like spinal damage.

Depending on what type of spondylolisthesis the patient has will decipher which surgical procedure is needed. Usually a decompression (laminectomy) and a spinal fusion with pedicle screw instrumentation is needed. This can be discussed in detail with your doctor as the surgery will be tailored to you.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

 

The pros and cons of minimally invasive spine surgery

Mr Irfan Malik talks about his knowledge and experiences of the pros and cons of minimally invasive spine surgery.

As a neurosurgeon, I am always looking for ways to improve the surgical procedures and outcomes for my patients. I have spent much of my career as a neurosurgeon working to improve understanding and the scope of many minimally invasive and complex spinal surgeries as well as pioneering procedures such as endoscopic and keyhole spinal surgery.

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Firstly, let me lightly explain what minimally invasive spine surgery (MISS) is.

It is advanced technology that uses innovative techniques to treat neck and back pain. We use specialised instruments along with excellent imaging to access the spine. Rather than traditional open spine surgery where we would make a 5-6 inch incision, minimally invasive uses an incision as little as 1 inch to access the intended location of injury.

Let’s talk about some the pros and cons of minimally invasive surgery.

Pros of Endoscopic Spine Surgery

  • Reduced risk of infection when compared to open back surgery

  • There is minimal loss of blood due to the tiny incision

  • Less scarring

  • Less soft tissue and muscle damage

  • Minimal pain involved during and post operatively

  • Rapid recovery time (post patients will be able to go home the same day as the procedure)

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Cons of Endoscopic Spine Surgery

  • Unfortunately, only a handful of surgeons have the expertise to perform these procedures

  • Not all patients meet the criteria for this type of surgery. More challenging spinal injuries sometimes have to be operated on by open back surgery because of difficulty visualising the surgical field.

  • Minimally invasive is more technical and can sometimes prove difficult for your surgeon to perform for multiple level procedures.

As with any type of surgery, minimally invasive spine surgery does carry risks such as; bleeding, stroke, infection and need for additional surgeries. Even though the risks are small, they are still there and it is worth weighing up the options.

After having minimally invasive surgery it is common for patients to have some type of post-operative instructions to follow. These usually include light physiotherapy and to mobilise within the first couple of days. You will need post-operative follow ups and possibly more scans to make sure the operation is a success but after that patients usually have an easy recovery.

Minimally invasive surgery does not mean that it is any more efficient or better than traditional open back surgery, it is simply different technique and being able to offer this to patients means that they get best care for their injury and also what they are most comfortable with.

If you are suffering with a back injury or pain then it is always worth getting it checked, and if surgery is the route for you then your surgeon will be able to tell you the risks, benefits, complications and limitations to all the approaches of surgery that they could take. My advice is to make sure you always voice your concerns and make sure you completely understand what is going to happen before any type of surgery or treatment has taken place.

What is meningioma?

Chris Chandler explains to us what Meningiomas are and what the treatment options are.

Meningioma is a brain tumour which develops within the meninges of the brain. Meninges are layers of body tissue that cover and protect the brain and spinal cord. Meningiomas are graded from 1-3, while most meningiomas are slow-growing with a low potential to spread (grade 1), some can be faster spreading and more likely to return after treatment, these are called atypical (grade 2). Lastly (grade 3) meningiomas are most uncommon and are malignant, they are fast growing and have a high chance of returning.  

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What are the symptoms?

While some meningiomas do not present with any obvious symptoms and can be stumbled upon during tests for other conditions, others do show symptoms of the brain being affected and some of the most common symptoms can be:

  • Headaches

  • Seizures

  • Memory loss and confusion

  • Weakness in arms of legs

  • Changes in vision

  • Vomiting

If a patient presents with these types of symptoms then it is common to undergo tests like MRI and CT scans to effectively detect and diagnose a meningioma. Once diagnosed and assessed then treatment can be undertaken.

Treatment for meningioma

There are a number of different treatments that can be undertaken for a meningioma and there are many different factors to consider when doing so. Firstly, the decision has to be right for the patient and it is something that should be discussed in length with the treating doctor. Depending on the grading of the meningioma, either management, treatment or surgery can be considered.

The factors include:

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  • Your general health

  • Symptoms

  • Location of tumour

  • Size of tumour

  • Grade of tumour

Watch and wait

As meningiomas are often slow-growing and only increasing in size by 1-2mm per year, there may be no need for any immediate treatment but just simply watching and waiting. By this we mean that a patient will have a scan every six months to a year along with a check-up to see if the meningioma has increased in size and if it has not then no further treatment will be needed.

Surgery

Surgery can be required if the tumour is affecting the patients’ day to day abilities and poses a risk to life. The treating doctor will run through all the risks, possible complications and benefits of the operations with the patient. Meningioma surgery is usually relatively straight forward but there can be complications and it is important for the patient to be aware of this prior to the operation.

Depending on the size, accessibility and grade of the meningioma the surgeon will do what is necessary to remove the tumour without causing any further risk to quality of life. The type of process this could be is:

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  • Confirm diagnosis by obtaining scans and tissue and classify grade.

  • Check to see if tumour is invading any arteries, large veins or on the underside of the brain.

  • Remove sufficient or if safe all the tumour to restore normal pressure of the normal brain tissue and to make sure the tumour will not grow back.

  • Preserve or improve neurological function

Once surgery has taken place the patient will need to stay in hospital to recover for a couple of days and thereafter may need physiotherapy to restore function and gain strength.

Radiotherapy

Radiotherapy is another option to treat a meningiomas but it is less common, this is because it is only used for inaccessible or irremovable meningiomas. This type of treatment uses high-energy rays to destroy the tumour cells and stop them from coming back. There are many ways to treat a meningioma with radiotherapy and the treating doctor will tailor this specific to the patient’s tumour. Gamma Knife and Cyber Knife treatment can also be used.

As with most types of treatment, radiotherapy does carry side effects and it is important that the patient understands this as it can sometimes take months or years for the side effects to happen.

Chemotherapy

Lastly, Chemotherapy is rarely used to treat meningiomas but is used in some circumstances to treat high grade meningiomas reoccurring after surgery and radiotherapy.

Regular post-operative follow ups and MRI scans with your surgeons will be necessary to keep an eye on the remaining tumour or simply to check if it is returned.

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.

Carpal tunnel syndrome

Mr Bassi tells us all about what happens if you suffer from carpal tunnel syndrome.

Carpal tunnel syndrome is a condition whereby compression of the median nerve at the wrist causes pain, numbness and tingling in the thumb, middle finger and thumb side of the ring finger.

The carpal tunnel itself is a narrow space covered by a fibrous strip of tissue on the palm side of the wrist bone. The median nerve as well as the tendons which bend the fingers run through this space. As the space is limited, if there is any swelling in the area the nerve often gets squashed which means that it doesn’t work as well. This is then known as carpal tunnel syndrome.

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Symptoms of carpal tunnel syndrome include:

  • Pins and needles and numbness in the thumb, middle finger and half of the ring finger nearest the thumb

  • Pain and aching in the hand and thumb, middle finger and half of the ring finger nearest the thumb. This pain can on occasion travel up the arm

  • A weakened grip

Why does carpal tunnel syndrome occur?

In many cases there is no clear reason why carpal tunnel syndrome starts but it is clear that it is associated with pressure on the median nerve. This can be associated with:

  • Pregnancy – the fluid retention associated with pregnancy can cause swelling around the carpal tunnel, compressing the median nerve.

  • Wrist dislocations and fractures can put pressure on the median nerve.

  • Bone or arthritic conditions of the wrist such a rheumatoid arthritis – these conditions can be associated with thickening of the ligament at the carpal tunnel, narrowing the space.

  • Side effects of some medicines for example the combined oral contraceptive pill can disrupt the hormonal balance enough the cause carpal tunnel syndrome.

  • Other conditions including obesity, diabetes or menopause can increase water retention resulting in compression on the median nerve.

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When would surgery be needed?

If symptoms persist and are not relieved by medication or exercises then surgery may be an option.

Surgery involves either local anaesthetic to numb the wrist area during surgery or general anaesthetic. During the surgery, the surgeon will cut the ligament over the front of the wrist with the aim of relieving pressure on the median nerve.

After surgery, in most cases, patients can return home on the same day as the procedure. To help prevent swelling in the fingers raise the arm can stay on pillow when resting, wiggling the fingers and make a fist regularly. Most individuals (depending on their job of course) return to work and most daily activities in approximately 2 weeks. 

This article is intended to inform and give insight but not treat, diagnose or replace the advice of a doctor. Always seek medical advice with any questions regarding a medical condition.