What is brachialgia?

Brachialgia, also known as cervical radiculopathy, is defined as compression or irritation of either both of the dorsal (sensory) and ventral (motor) roots of a cervical nerve at one or more vertebral levels. Put simply, it is a compressed or pinched nerve in the neck which leads to pain in the arms. It is described as the upper body equivalent of sciatica, and like sciatica, the onset can be sudden.

 What causes brachialgia?

The spinal cord and spinal nerves are contained within the spinal canal and intervertebral foramen. These protective passageways prevent spinal cord and spinal nerve damage. However, compression can result from; intervertebral disc herniation, osteophyte formation (bony lump) and spinal stenosis (narrowing). This leads to increased pressure on your cervical nerve roots which subsequently causes pain in your neck, shoulders and arms.

 Symptoms of brachialgia

Brachialgia is most prevalent in people aged 50 to 54 years old. Statistics reveal that annually 107 men out of 100,000 will be diagnosed with brachialgia whereas only 64 out of 100,000 women are diagnosed, therefore the condition is more common in men. Symptoms may vary but are likely to include;

  • Pins and needles (paraesthesia) in your arms, which may increase in discomfort as you stretch your neck or turn your head to one side

  • Pain in your neck, shoulder blade or arm

  • Tingling sensations

  • Weakness or numbness in your arm

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 Diagnosis of brachialgia

To diagnose this condition, you may need to have all or some of the following tests; CT scan, MRI scan, X-ray, ultrasound and nerve conduction study. Your consultant will first want to understand your symptoms, how long you have experienced these for and any relevant medical history. They may also need to do a physical examination of your neck to help determine what is causing the pain.

Potential treatment options

Many cases of brachialgia will resolve spontaneously and can initially be managed conservatively. Non-surgical treatment options include; physiotherapy, special exercises to stretch and strengthen your muscles and medication to reduce any inflammation. If symptoms persist then steroid injections may be recommended to reduce any swelling and pain. Alternatively, surgery may be considered, this might include; anterior cervical discectomy, spinal fusion or disc replacement. Your consultant will discuss the most suitable course of treatment with you, note that the treatment will depend on the nature and location of the pinched nerve.

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.

Arachnoiditis

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What is arachnoiditis?

Arachnoiditis is a painful condition of the spine. It is caused by the inflammation of the arachnoid lining which is the middle layer of three membranes that surround and protect the brain and nerves of the spinal cord. It is a debilitating condition that causes burning pain and stinging sensations, coupled with neurological problems.

What causes arachnoiditis?

The condition often starts after surgery, injury or epidural injection to the spine. Causes include:

  • Direct injury to the spine

  • Chemicals. Dye used in myelograms (diagnostic tests in which a dye called radiographic contrast media is injected into the area surrounding the spinal cord and nerves). The radiographic contrast media responsible for this is no longer used, however there is concern that the preservatives found in epidural steroid injections may cause arachnoiditis.

  • Infection from bacteria or viruses.

  • Chronic compression of spinal nerves. For example, chronic degenerative disc disease or advanced spinal stenosis.

  • Complications from spinal surgery or other invasive spinal procedures.

     

What are the symptoms of arachnoiditis?

Symptoms depend on which nerves or areas of the spinal cord are damaged by inflammation. Arachnoiditis often causes intense pain in the injured area, which can include the lower back, legs, buttocks or feet. In severe cases, it causes debilitating pain throughout the whole body. If left untreated, the symptoms can get worse and cause permanent disability. Symptoms include:

  • Tingling, numbness or weakness in the legs

  • A crawling sensation on the skin

  • Severe shooting pain

  • Muscle cramps, spasms and uncontrollable twitching

  • Bladder, bowel and possible sexual dysfunction

How is arachnoiditis diagnosed?

Arachnoiditis can be difficult to diagnose as the symptoms are similar to other nerve problems in the back. Knowing that you have recently had a spinal surgery, an injury or an epidural injection can help your consultant with the diagnosis. If a consultant suspects that you have this arachnoiditis they will carry out a CT scan and/ or an MRI scan. They will use the results from these to assess if there is any nerve damage and whether the nerve roots have clumped together which will confirm the diagnosis.

 

How is arachnoiditis treated?

There is no cure for arachnoiditis. Most treatments focus on relieving pain and improving symptoms to restore quality of life. Often, consultants will recommend physiotherapy and exercise which will help to regain movement in the affected parts of your body.

As arachnoiditis can cause serious disability and chronic pain, many people with the condition also experience depression. Therapy can help you to cope with the emotional and physical pain of the condition. Finally, surgical procedures are sometime recommended, these include decompression surgery and foraminoplasty.

  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. 

Brain Aneurysm (Intracranial aneurysm)

What is a brain aneurysm?

Aneurysms can develop in any blood vessel in your body but the brain (cerebral) arteries are affected in approximately 1% of the population. A brain aneurysm is a weak or thin spot on an artery in the brain that balloons or bulges out and fills with blood. As a result, the bulging aneurysm can put pressure on the nerves or brain tissue. It may also burst or rupture, spilling blood into the surrounding tissue, this is called a haemorrhage. A ruptured brain aneurysm can cause serious health problems such as haemorrhagic stroke, brain damage, coma, and even death.

However, not all brain aneurysms lead to major health problems, particularly those that are very small and there are treatments to prevent damage from both unruptured and ruptured aneurysms.

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 Causes and risk factors

Brain aneurysms are caused by a weakness in the walls of blood vessels in the brain. There are several reasons why this might happen, although an exact cause is not always clear. Some people may have an inherited tendency for weak blood vessels, which may lead to the development of aneurysms.

 Several risk factors contribute to the formation of aneurysms. Smoking and high blood pressure (hypertension) are two of the most significant factors that we can control. Other risk factors include;

  • Family history. Around 1 in 50 people with a family history of a ruptured brain aneurysm have a rupture themselves.

  • Age. Being over the age of 40

  • Gender. Brain aneurysms are more common in women than in men.

  • Pre-existing weakness in the blood vessels.

  • Autosomal dominant polycystic kidney disease (ADPKD). Around 1 in 20 people with ADPKD will develop an aneurysm in the brain.

  • Body tissue disorders. Your risk of developing a brain aneurysm can be higher if you have a condition that affects your body tissues, such as, Ehlers-Danlos syndrome and Marfan syndrome.

  • Coarctation of the aorta. A congenital heart disease that describes the narrowing of the main aorta (the main artery in the body).

  • Drug use, particularly cocaine.

  • Excessive alcohol consumption

  • Infection

  • Severe head trauma

What are the symptoms of a brain aneurysm?

Most brain aneurysms only cause symptoms if they rupture. Unruptured brain aneurysms occasionally cause symptoms, particularly if they are large or pressing against tissues or nerves in the brain. Symptoms of an unruptured brain aneurysm include; visual disturbances (loss of vision or double vision), pain above or around your eye, numbness or weakness on one side of your face, difficulty speaking, headaches, loss of balance and difficulty concentrating. You must see your Doctor as soon as possible if you are experiencing these symptoms. 

If a brain aneurysm does rupture this will usually begin with a sudden, excruciating headache. Other symptoms that also tend to come on suddenly include; feeling nauseous or vomiting, a stiff neck or neck pain, sensitivity to light, blurred or double vision, sudden confusion, loss of consciousness, fits and weakness on one side of the body or any limbs. This is a medical emergency and you or those around you should call 999 immediately and ask for an ambulance.

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How is a brain aneurysm diagnosed?

Most brain aneurysms go unnoticed unless they rupture or are detected during medical imaging tests for another condition. Several tests are available to diagnose brain aneurysms and to help determine the best treatment. These include;

  • MRI scan. This is usually used to detect brain aneurysms that have not ruptured but is also used to look at the arteries in detail.

  • CT scan. This is usually the preferred type of scan if there is a history suggestive of a haemorrhage. CT scans within three days of a bleed are very reliable at detecting blood.

  • Angiography (digital subtraction – DSA). This involves injecting contrast into the arteries of your brain through a catheter (narrow tube) to give clear pictures of the brain arteries.

How is a brain aneurysm treated?

Not all brain aneurysms require treatment. Some very small (normally under 5mm in diameter), unruptured aneurysms that are not associated with any factors suggesting a higher risk of rupture, may be safely left alone and monitored with MRI scans.

If there is a high risk the brain aneurysm will rupture, then surgery is required. There are two surgical techniques called neurosurgical clipping and endovascular coiling. These both prevent ruptures by stopping blood flowing into the aneurysm. In an emergency when a brain aneurysm has ruptured, you will initially be given medicine to reduce the risk of the blood supply to the brain becoming severely disrupted, then have neurosurgical clipping or endovascular coiling to repair the ruptured brain aneurysm.

 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.

 

 

Pituitary tumours

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What is a pituitary tumour?

A pituitary tumour, also known as an adenoma, are benign (non-cancerous) growths that develop from the tissue of the pituitary gland. The pituitary gland controls many bodily functions by making and regulating the release of hormones into the bloodstream. For this reason, pituitary tumours can cause an over or under production of certain hormones which gives way to specific symptoms. Pituitary tumours are tumours of the endocrine system therefore they do not fall in the same category as tumours of the brain and central nervous system.

Where is the pituitary gland?

The pituitary gland lies in a small hollow, just behind the eyes where it is attached to the base of the brain. It works with parts of the brain, such as the hypothalamus, affecting their functions. Due to the positioning of the pituitary gland, as a pituitary tumour grows, it may go upwards which means it can press on other parts of the brain and its nerves. For example, the optic nerve which could lead headaches and vision problems.

 

Symptoms

As previously mentioned, there are two ways that a pituitary tumour can produce symptoms, either due to the over or under production of hormones.

Symptoms of over-production:

  • Loss of menstrual periods in women

  • Lowering of testosterone in men leading to loss of sexual appetite

  • Acromegaly in adults and gigantism in children

  • Unexpected weight gain

  • Easy bruising of the skin and muscle weakness

Symptoms of under-production:

  • Loss of sex drive in men and women, and infertility

  • Hypothyroidism, which can cause appetite loss, weight gain, fatigue and decreased mental function

  • Adrenal insufficiency which can cause fatigue, low blood pressure and electrolyte abnormalities

  • Growth hormone insufficiency which can cause delayed puberty and in adults tiredness and loss of muscle mass

 

Diagnosis

To diagnose a pituitary tumour the patient will be examined by their consultant and may require all or some of the following tests:

  • Brain scans – MRI and CT scans will show detailed images of the brain

  • Eye tests – to check the patient’s field of vision which may be impaired by a pituitary tumour

  • Blood tests – high levels of pituitary hormones may indicate a pituitary tumour.

 

Treatment Options

There are two surgical approaches to removing a pituitary tumour. The consultant will discuss the treatments options with you and take into consideration the size and growth rate of the tumour:

  • Through the nose, this is called trans-sphenoidal surgery. This is achievable as the pituitary gland is located just above the back of the nose, which gives the surgeon access to the tumour without making an incision.

  • Through the skull, this is a trans-cranial approach. If the tumour is growing into the brain this method might be suggested, although this is not common now.

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.

 

Parkinson’s disease, we all know a little something about this..

We all know a something about Parkinson’s disease, but do we know the facts? Let’s strip it back to basics…

Parkinson’s disease (PD) is a progressive neurological condition caused by a lack of dopamine in the substantia nigra. The substantia nigra, found in the mid-brain, is a group of nerve cells that are responsible for producing a large amount of dopamine in the body. The dopamine from the substantia nigra helps the body function properly, and is responsible for movement such as walking, talking and eating.

PD, named in 1817 after Dr James Parkinson, effects over 4.5 million people worldwide. Mostly PD develops in over 60 years olds; however, people under 50 can get it too. Behind Alzheimer’s, PD is the most common neurodegenerative condition.

What are the causes?

Currently, the cause of PD is unknown. There is plenty of ongoing research into PD and there is evidence to suggest it could be hereditary. Furthermore, pesticides, toxins and chemicals found in agricultural work have also been linked to PD.

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Symptoms of Parkinson’s disease

  • Tremors, mostly in the hands but other parts of the body too.

  • Stiffness in the body, sometimes causing chest pain.

  • Anxiety and depression

  • A short, shuffling walk.

  • slurred speech

  • Constipation

There are different stages of PD.

Stage 1

During the initial stage of PD, daily routine is mostly uninterrupted by symptoms. It’s common for loved ones and friends to notice a difference in movement, such as light tremors in the hand, before the individual does. At this point, medication can be effective to manage symptoms.

Stage 2

From stage 1, the progression to this point can take months or even years. Symptoms are much more noticeable by now. For instance, tremors in the hand become more severe and changes in facial expressions arise. Speech difficulty at this stage is also common and overall symptoms are on both sides at the body at this stage. Daily tasks become much tougher.

Stage 3

The severity of symptoms increase in Stage 3. As balance and co-ordination is very difficult by this point, stage 3 PD patients should be very careful as falls and trips arise more often. Part or full time care is recommended.

Stage 4

By this point, most individuals will need full time care, as mobility is very restricted. Daily tasks should be supervised and walking will be much slower and cause fatigue.  

Stage 5

By stage 5, patients are wheelchair bound. Full-time assistance is required to prevent injury when walking. Other side effects can include dementia, delusions and hallucinations.

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Treatment for PD is dependent on which stage the disease is diagnosed, meaning it’s important to have regular checks if you are fit the criteria of any of the above symptoms. PD also varies for each person, meaning it’s common to try a range of treatments.

There is a variety of treatments for Parkinson’s disease; as mentioned earlier, there’s no cure for PD, but there are solutions which can help symptoms and enhance wellbeing.

Occupational Therapy

Parkinson’s disease can restrict your everyday wellbeing. Occupational therapy can help implement independence back into the lives of patients through the management and planning of practical issues, such as walking, eating, drinking and building a healthy routine.

Physiotherapy

It’s important to stay as active as feasibly possible during PD. A physiotherapist can advise on how best to maintain movement, good posture and stamina. This also becomes beneficial in avoiding issues or problems that may arise in the future.

Medication

Medication is the most popular means of treatment. There is a diverse selection of medication for Parkinson’s. Most medication aims to increase dopamine to the brain whilst also stopping the breakdown of dopamine. It’s best to speak to your doctor to find the best medication which will work for you.

Surgery

Deep Brain Stimulation is the most common type of surgery for PD. The procedure involves thin wires inserted to the area of the brain that controls movement. Once the wires are positioned correctly, they are connected to a battery operated neuro-stimulator placed under the skin. The aim of the surgery is to send electronic signals to the area of the brain related to Parkinson’s to help control motor symptoms.

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. 

 VISUALASE™: Minimally invasive treatment of brain tumours and epilepsy

Professor Ashkan and Mr Bhangoo are currently the only surgeons in the UK able to perform the Visualase® procedure for brain tumours. In this blog post they explain exactly how it works and how it is different from other treatments available.

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Visualase® is a minimally invasive technique. These types of procedures are generally associated with reduced risk of infection to the patient as well as faster recovery times - although it is important to note that every patient is different. The procedure involves a very small incision, just a centimetre or two. The surgeons, using MRI-guidance, insert a fine narrow tube into the tumour, before a laser is beamed down it. This laser gradually heats up to about 70 degrees celsius to break down and destroy the cancerous cells.

Real-time MRI showing the temperature of the brain as the laser ablates the tissue.

Real-time MRI showing the temperature of the brain as the laser ablates the tissue.

Prof Ashkan explains: “We are able to provide MRI-guided laser ablation to our patients using the Visualase® system, which helps us to treat tumours that were previously thought to be inoperable due to their location.”

The term ablation refers to the destruction of soft tissue (in this case the tumour) by heat and can be used to treat brain tumours as well as epilepsy. The Visualase™ system allows Prof Ashkan and Mr Bhangoo to monitor the tissue ablation in real-time.

This technique has also been developed as a very successful treatment for epilepsy. The same process is used to ablate/heat brain tissue which is causing epileptic seizures. This procedure provides epileptic patients with a more immediate, alternative treatment option to traditional medication and surgery and brain tumour patients an option where previously there was no treatment.

One of our patients, Pablo Casasbuenas, 36, had an aggressive and deep-seated tumour which we treated with the Visualase™ procedure in October 2018, after being told he had only a year to live. He has agreed that we can discuss his story to date.

Mr Casasbuenas, a PhD student from Richmond in London, was initially diagnosed with glioblastoma in 2014. He had radiotherapy to shrink the tumour and he also needed chemotherapy. However a scan in early 2017 showed that the tumour on the left frontal lobe had grown and there was a tiny speck in the right lobe too. He had a craniotomy on the left sided tumour and radiotherapy to target the right side. Unfortunately, the right side continued to grow. To read more about Pablo’s story click here: https://www.dailymail.co.uk/health/article-6499739/Pioneering-precision-laser-beam-zaps-impossible-treat-brain-tumours.html

Have a look at the video to see exactly how the Visualase™ procedure works:

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.

Craniotomy for glioma

What is a glioma?

Gliomas are brain tumours which start in the glial cells, the supportive tissue of the brain. There are three main types of glioma:

·       Astrocytoma – from astrocyte cells which regulate electrical impulses in the brain

·       Oligodendroglioma – from oligodendrocyte cells which insulate nerve cells to help send nerve signals

·       Ependymoma – from ependymal cells which line the cavities of the brain (ventricles)

Astrocytoma is the most common type of glioma brain tumour in adults and children. They can appear in any part of the brain and nervous system, which includes the spinal cord. There are four different grades of gliomas and the type of treatment will depend on this grade.

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What is a craniotomy?

A craniotomy is the most common type of operation to remove a brain tumour. To access the tumour, the surgeon will cut out an area of bone from the skull which is referred to as a ‘flap’. The surgeon will use scans done prior to the operation to accurately locate and remove as much of the tumour as possible, without taking any healthy tissue. The ‘flap’ is then replaced and secured with small permanent metal brackets. The scalp is stitched back into place, and in most cases, this will be covered by the patient’s hair.

Depending on the location of the brain tumour, the surgeon might suggest an ‘awake craniotomy’. If the tumour is close to part of the brain that controls an important function eg, speech, the surgeon may want to ask the patient to do tasks eg., speak, whilst checking the function of the brain. There may be the option to have general anaesthetic for part of the operation which will be discussed with your surgeon. Either way, a local anaesthetic will be used for any parts of the surgery when the patient is awake so they will not feel any pain.  An interesting fact about the brain is that it does not feel pain, therefore although an awake craniotomy may seem daunting, the team around you will ensure you are not in any pain.

Minimally invasive technique: Neuroendoscopy

Neuroendoscopy is a minimally invasive technique, sometimes referred to as keyhole, which requires a much smaller opening in the skull. An endoscope which is made up of a long tube, camera and small surgical instruments is passed through this small opening. The camera projects the image inside the brain on to a TV screen, the surgeon will use this as a guide to remove the tumour. The benefit of this method is that it is less invasive and allows for a faster recovery. This type of surgery is particularly useful for removing ependymoma’s in the ventricles (the fluid filled spaces of 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.



Schwannomas - what is it and how we diagnose!

A schwannoma is a tumour which develops in the peripheral nervous system (the nerve system relating to systems other than the spine and brain). Schwannomas develop from Schwann cells; these are cells which form a myelin sheath for myelinated nerves. The myelin sheath acts as a protective layer for nerve fibres. These Schwann cells can grow from this protective later into a tumour called a schwannoma. Once they start to grow, they form a lump under the skin.

Schwannomas can start anywhere in the body. Their severity depends on whether they are benign (non-cancerous) or malignant (cancerous). In most cases, schwannomas are benign.

 If benign schwannomas are small and are not affecting nearby nerves, they are not considered serious. However, malignant schwannomas can put pressure on nerves and require treatment.

A vestibular schwannoma is one of the most common types. The vestibular nerve is the nerve responsible for balance. However, this type of schwannoma doesn’t just affect balance, it can also cause deafness.

 Did you know? Schwann cells were coined by Theodor Schwann, who discovered them in the 19th century.


 Symptoms

 As mentioned above, once a schwannoma is putting pressure on the nerve, a bump under the skin can appear. Depending on which limb the schwannoma is located, and it’s whereabouts and size, other symptoms include…

  • Weak muscles

  • Tinnitus

  • Numbness

  • Difficulty swallowing

  • Co-ordination difficulties

  • Back or neck pain at night

Despite the signs above, there are some schwannoma’s which do not produce any symptoms.

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Diagnosing

Diagnosing schwannoma’s can occur through a variety of different ways by a doctor. Once a general health check has been done, and sometimes a blood test, methods for identifying schwannoma’s are… 

  • CT Scan

  • MRI Scan

  • Nerve Conduction Study

  • Tumor Biopsy

  • Nerve Biopsy

 Causes

Schwannoma’s can be inherited from conditions such as Neurofibromatosis II (NF2). NF2 is a condition which causes tumours to grow along your nerves, usually the ones responsible for hearing and balance.

Despite this, most schwannoma’s are not inherited and it’s unknown why they develop.

Treatment

Depending on whether a schwannoma is malignant or benign, there are different options for treatment.

If they are small, benign, and not putting pressure on nerves, it’s possible they can be observed by a doctor or specialist over time with MRI scans. Benign tumours can also be surgically removed with the aim of keeping the nerve fully intact.

However, if the schwannoma is malignant, growing in size and causing discomfort to the individual, treatment such as surgery, radiotherapy or chemotherapy can be used.

Following successful surgery, recurrences of schwannomas are rare.

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.



Foramen magnum decompression

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At the base of the skull is an oval shaped opening known as the foramen magnum. This opening is where the spinal cord links to the brain.

Foramen magnum decompression (FMD) is a procedure used to treat Chiari malformation. Chiari malformation occurs when the spinal cord is under pressure from a lower part of the brain called the cerebellum. The process of FMD involves removing small parts of the base of the skull and sometimes the top of the spine to alleviate pressure on the cerebellum.

The cerebellum, translated in Latin as ‘little brain’, is responsible for a range of voluntary movements and mostly all physical ones, such as walking or cycling.

Chiari Malformation

There are different types of Chiari malformation; however, FMD is used to treat Chiari I Malformation

As mentioned above, Chiari I malformation occurs when the cerebellum pushes into the spinal cord and brainstem. This can cause discomfort such as headaches and neck pain.

Cerebrospinal fluid (CSF) is found within the brain and central spinal canal. CSF acts as a cushion between the brain and skull and aids basic mechanical and immunological function within the brain. Chiari I malformation can stop the flow of CSF to the brain causing a build-up of fluid – when that occurs, this cyst like obstruction is known as a syringomyelia. This can cause discomfort, stiffness and other symptoms.

Chiari malformation can be caused by structural malfunctions in the spinal cord and brain during foetal growth. A poor maternal diet during pregnancy can also be a factor. If the skull is not large enough for the brain, this can also be responsible for lots of diagnosed Chiari malformations.

Symptoms

Despite the risks, many people who are diagnosed with Chiari malformation do not display symptoms and will not need treatment.

However, symptoms of Chiari Malformation can be…

  • Balance and coordination issues

  • Blurred vision

  • Headaches, usually at the back of the head 

  • Neck Pain

  • Muscle weakness

  • Depression

Diagnosing and identifying Chiari Malformation can be done through different means, such as X-Rays, CT scans or MRI scans (the most common method).

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Surgery and recovery

As with any surgery, there are risks involved; however, for FMD, serious complications are uncommon. Patients will need to provide a full and thorough medical history and will be run through the benefits and risks of the procedure. Pre-surgical tests are also required.

During FMD, patients will undergo a general anaesthetic. The head is usually clamped in place for precision. At the back of the head, a small section of hair is shaved to make way for a 5-10cm cut, depending on the patient. Small sections of the base of the skull, and sometimes the top of the spine, are removed by the surgeon to lighten pressure. The process takes roughly 3 hours.

Following surgery, patients will be prescribed medication and painkillers to aid recovery. Pain in the head and neck is common after surgery. Eventually, the surgery should show a reduction in symptoms, especially headaches.

if you would like more information on Chiari Malformation or a foramen magnum decompression then please do not hesitate to contact Mr Sanj Bassi for a consultation who has a subspecialty in the diagnosis and treatment of this condition.

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.




Paediatric Brain Tumours

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Brain tumours are a swelling within the brain caused by a collection of cells that grow abnormally due to an incapability of the body being able to moderate cell growth and division. Due to the restricted space within the skull, brain tumours can be very problematic. Although more rare, there are still around 400 paediatric brain tumours diagnosed in the UK each year.

 There are many different types of paediatric brain tumours. These can be either non-cancerous (benign) or cancerous (malignant).

Symptoms of paediatric brain tumours can be very diverse and depend on the location, size and growth of the tumour. These can include:

-   Sickness, especially in the morning.

-   Visual disturbances

-   Seizures

-   Headaches

-   Behavioural changes

-   Abnormal eye movements

-   Balance issues

-   Excessive thirst leading to increased urination

From ages 0-4, the most likely symptoms are visual disturbances and cranial pressure leading to nausea and vomiting whilst beyond this age, the most highly reported symptom is a continuous headache. Due to vague indicators and a child’s reduced ability to communicate these symptoms, diagnosing a paediatric brain tumour can take time. However, this delay can impact the treatment options available and therefore the prognosis, making it important to identify warning signs early on.

Diagnosing paediatric brain tumours is best done through a neurologist. There are many different methods to determine whether a child has a brain humour. However, the most popular ones are an MRI scan, X-ray or CT scan.

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Following diagnosis, there is a variety of options for treatment, including…

Surgery
During the operation, a doctor will try to extract as much of the tumour mass as possible. Surgery can also be used to remove small portions of the tumour for testing (biopsy). It’s also possible to install a device which can help alleviate symptoms, such as a shunt.

Radiotherapy

Using high energy radiation, the aim of radiotherapy is to eliminate cancer cells. Radiation is popular if it’s deemed the tumour cannot be operated on. It’s also used to remove any remaining tumour cells following surgery. As healthy cells are damaged during radiotherapy, side effects such as fatigue, hair loss and nausea are common. The process has been around for over 100 years.

Chemotherapy

Mostly used for fast growing brain tumours, chemotherapy uses drugs to combat cancer cells. There are several types of drugs depending on the type and stage of the tumour. These drugs are sometimes used in different combinations. Chemotherapy can be used alongside other treatments, such as surgery and radiotherapy. Some side effects can be anaemia, fever and hair loss.

Recovery

Complete recuperation of health from paediatric brain tumours can be possible. A variety of therapy options can also aid recovery, such as physiotherapy, occupational therapy and speech therapy.

Brain tumours for children and their loved ones are a traumatic experience. However, thanks to advances in modern medicine and science, more children than ever are fully recovering.

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.

10 interesting facts about London Neurosurgery Partnership

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1.     LNP was originally founded by Mr Sanj Bassi. After practising for 15 years in the NHS, Sanj decided to take a leap and form a partnership of 11 neurosurgeons in the private sector and call it London Neurosurgery Partnership. In 2008 Sanj sought 10 surgeons from King’s College Hospital as they all worked there together on an NHS basis and still work there together on the NHS to this day! They are all great friends inside and outside work and often get together to play a spot of cricket or go for some dinner. As LNP is a partnership there is no competition or divide and they all work closely and in-sync with each other, that’s what makes them so unique! 

2.     Interesting fact about Professor Ashkan: At age 5 Professor Ashkan learned how doctors could relieve pain and suffering from a family friend who was then a trainee doctor and it defined his whole life and it is what made him become a neurosurgeon. Alongside his medical degree he also has a music degree and diploma and LOVES playing, listening and dancing to all music! 

3.     After 8 years of success with LNP the partners felt it was the right time to take a new direction and in 2016, London Neuroscience Academy was born. As you may already know LNA prides itself on delivering the best educational courses for continuing professional development with CPD awarded classes and world-renowned international speakers. LNP often speak at these events which are held almost every month, it’s a great opportunity for GP’s and all health professionals to get up-close and personal with the LNP team and really pick their brains! 

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4.     Even though you hear a lot about the surgeons at LNP you don’t necessarily hear about their medical secretaries. They have secretaries in various locations like Spire, Blackheath and The Shard but also at their practice base in Harley Street. Practice manager Mary has been working with Sanj Bassi since before LNP was ever formed and actually played a part in getting it off the ground. Some of our secretaries have been PA’s to the same surgeons for years and could run their clinics in their sleep! It’s really quite special what these women do on a daily basis and are a massive part of the practice. LNP are continually thankful and to show this, every year they host a fantastic summer and Christmas party where all the PA’s and surgeons get together for some fun and team bonding. Did someone say gin o’clock!

5.     Mr Christos Tolias served for two years as a Medical Officer in the Greek Air Force (1990-1992). He was also awarded an Action Research Fellowship in 1996 which was presented to him by its patron Prince Philip in a ceremony at Buckingham Palace! And that’s not all – it’s all pretty cool that he also writes poetry.

6.     The surgeons at London Neurosurgery Partnership have over 315 years’ worth of experience between them!  

7.     LNP are expanding and growing across London and Kent, they also are looking to increase consulting numbers in the near future. Watch This Space!

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8.     Mr Ranj Bhangoo is a secret pastry chef, so secret we have never even tried one of his cakes! Another interesting fact is when he was at medical school, he co-founded a Classical Music Society that has gone on to become the largest festival of Indian Classical Music outside of India! It is held annually at Southbank.

9.     Throughout Richard Selway’s career he has been asked to speak at many events, news articles and publications but the most memorable time is when he appeared on Richard and Judy as an expert to discuss the female orgasm!

10.  Finally, you may find it interesting (we did!) to know that the surgeons at LNP have roots all the round the world from America to Iran to India and Denmark! Combined they can speak a total of 10 different languages, of which you can find on each consultant bio! 

An image-guided brain biopsy

Mr Ranjeev Bhangoo explains what happens during an image-guided brain biopsy.

Here at LNP it’s common for us to perform a brain biopsy for patients who have a lesion on the brain. A biopsy is performed by removing a small sample of tissue and sending it to a lab where it can be determined exactly what type of lesion it is and therefore how it can be treated. 

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Undergoing an MRI scan is a fantastic and innovative way of producing clear-cut images of the brain and spinal cord in specific sequences. This will be able to initially pick up a lesion protruding on the brain and supply layered images.

The patient will be asleep during the procedure which means the they will not be able to feel a thing. There are different types of brain biopsies and the surgeon will be able to decipher which one is best for the patients’ lesion.

  • a biopsy as part of the operation to remove the tumour

  • image-guided biopsy

  • an open biopsy

  • a neuroendoscopy

Open biopsy: Some lesions can lay near the surface of the skull, using image-guidance a small incision will be made in the skull and a piece of the tissue  is take to be examined under the microscope.

Image-guided Biopsy: A small hole will be made and a small needle will be guided in to the tumour to take a sample.

Neuroendoscopy: A endoscope will be used to take tissue from in or around the ventricles of the brain. The ventricles are fluid-filled spaces in the brain.

Robotic technology for brain tumour biopsy – ROSA Robot

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 We currently use a new type of robotic surgery called ROSA Robot, it is a highly specialised stereotatic technique and is used for lesions that are in a sensitive part of the brain. ROSA has a robotic arm that reproduces the movements of a human arm but without the ‘tremor’ a human hand may give and can perform precise surgical gestures. The robot will follow the exact instruction from the controlling surgeon and will be about to provide high-definition 3D images of the surgical site on a screen in the theatre

It provides increased safety and precision for the patients and is a lot less invasive, hosting a quicker recovery time and reduced risk of infection and pain.

Once a small piece of the lesion has been removed, the sample will be taken to the labs where it will be put under a microscope. As mentioned, this will tell us exactly what this is and how we can treat it going forward.

The patient will be called back in for a consultation with the surgeon so he/she can check the wound is healing ok and go through the biopsy results, this will happen 5-7 days after the procedure. The surgeon will then discuss the treatment options in the MDT in collaboration with the oncologists and radiotherapists in order to determine the ideal treatment which may include a combination of surgery, chemotherapy, radiotherapy, immunotherapy or entering into a trial. 

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.

Sacroiliac Joint Pain

What are sacroiliac (SI) joints?

You have two sacroiliac bones in the lower part of your spine, one on the left and one on the right. They are located directly below your lumbar spine and connect to your pelvis. The SI joints do not need to move like the other parts of your spine as their job is to support and provide stability to the weight of your upper body.

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What are the causes of sacroiliac joint dysfunction?

Your SI joints are covered in a protective layer called cartilage and when this wears down, usually caused by ageing, it can cause the bones to rub on each other which can cause degenerative arthritis.

Pregnancy can also cause SI joint dysfunction; this is because the body is relaxing the muscles and joints ready for childbirth. Increased movement and changes of the joints will result in extra stress on those SI joints and can cause pain.

SI joint pain can occur when there are changes in the ligaments, this means if they become too loose or even too tight it can become painful and inflamed. Changes like a fall or injury, surgery, ageing, altered walking pattern and other medical conditions can all become factors in SI joint dysfunction.

What are the symptoms?

 SI joint pain starts in the lower back, it will then radiate down to your hips, legs, buttocks and thighs. The pain is usually felt on one side and will worsen during physical activities like walking, running, climbing stars or standing for long periods of time. The pain can feel sharp and a dull-like ache, you may also experience a tingling or numbness sensation.

 Diagnosis

During a consultation, a full medical history will be taken as well as a physical examination which will entail testing your reflexes and applying pressure to your joints to find a pain source.

An MRI scan, CT or X-ray will be performed to view detailed images of the SI joints and surrounding bones, this will ultimately confirm the diagnosis of SI joint dysfunction.

If imaging does not confirm a diagnosis then a injection containing corticosteroid and local anaesthetic will be placed at the SI joint. This will numb the area, if the pain continues after the injection then it would be unlikely that the SI joints are the source of your pain.

 

Treatments

It is always best to start with non-surgical treatment like physical therapy and stretching. Some anti-inflammatory medications may also be able to help such as ibuprofen, naproxen, creams, patches and salves

Steroid injections are a good way to target the pain without surgical intervention. They can reduce the swelling and inflammation but they are only temporary and may need repeating.  Nerve blocks are also useful in delivering an electrical current to stop the nerve fibres from sending pain signals to the brain.

Surgery will be a last option which can involve a fusion of the SI joints where titanium plates and screws are placed with the joints and fused together and promote bone growth which will stop all movement from the SI joints and stop the pain. If you would like to know more about fusion surgery please click here.

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.

Talk to me about Tarlov cysts.

Talk to me about Tarlov cysts.  

What are they?

Tarlov cysts are sacs filled with cerebrospinal fluid that are found in the spinal cord. They commonly affect the nerve roots in the sacrum. The exact cause for these cysts is unknown and can typically cause no symptoms and are found when undergoing diagnostic investigations for other health conditions.

Generally, the larger the cyst grows the more likely you are to experience symptoms as the cyst will be compressing the nerve root. This can cause pain when sitting, standing, walking and laying down. The pain may feel sharp and sudden or burning, usually at the lower back and hip area and it may start to radiate down towards the buttocks and legs. The symptoms associated with Tarlov cysts are:

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Pain from the affected area by the cysts

Weakness and numbness

Incontinence

Sexual dysfunction

Constipation

Headaches due to CSF pressure

Difficulty walking and sitting for period

General pain and deterioration  

Tarlov cysts can easily mimic other conditions and sometimes this can make it difficult to diagnose, especially if the doctor has not come across this type of cyst before. The best form of diagnosis is having an MRI scan as this will take real-time images of the spine in a specific sequence and will be able to show any cysts protruding the nerves and spinal cord.

If a Tarlov cyst is not causing any symptoms and is small in size then the best option will be to watch and wait, it is not always necessary to begin surgical intervention if the patient is not in pain or at risk. Simple monitoring will be used to check the state of cyst and to see if it is growing in size, it will also give the patient an opportunity to speak with the doctor if any symptoms have arisen since the diagnosis.

Medications like NSAIDS can be prescribed to control any inflammation or irritation affecting the nerve root. A TENS machine or electrical nerve stimulation are also used to help pain.

Draining or shunting the cyst is a treatment option to relieve pressure that has been affecting the nerve roots but there is still a chance of recurrence. Injecting the Tarlov cyst at its source with fibrin glue will help with pain and symptoms it is causing. Fibrin glue can also be used to seal or close the cyst and prevent it from filling back up again.

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Treatment and surgical routes all depend on how symptomatic the patient is, the size of the cyst and whether it is responding to conservative methods well. For some, the above treatment will work wonders and a patient will feel relief and less symptomatic almost immediately and some may not respond well at all.

 Surgical options may vary and the doctor will choose a treatment route specifically tailored to the patient.  

Drainage of Tarlov cyst is a surgical option where the cyst can be drained and removed from the spine. This option usually comes in to effect when more conservative treatments have not worked and the cyst is reoccurring.

If you have a Tarlov cyst and would like to discuss your options in more detail then please do not hesitate to contact our office for a non-obligatory 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.

Vagus Nerve Stimulation (VNS)

What is VNS?

 Vagus nerve stimulation is a type of neuromodulation. The aim of the treatment is to help children above the age of 4 and adults control their epilepsy. The neurostimulator is surgically implanted in to the chest with a wire connecting to the left vagus nerve. The vagus nerve is the 10th cranial nerve and runs from the brainstem right down towards the abdomen. The stimulator uses pulses of electricity that sends signals to your brain to ultimately prevent or lessen seizures. Having regular pulses of electricity sent to the brain can help people who are not aware seizures are going to happen or if they occur at night. VNS will not help patients who have non-epileptic seizures, this is because it is not associated with electrical activity in the brain.

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This treatment is extremely helpful for patients that have not achieved control on anti-seizure medication and other techniques. Vagus nerve stimulation is also helpful to patients suffering from depression and have not responded to anti-depressant medication and other treatments such as counselling.

There are different models of VNS and your consultant will point you in the direction of the correct one for you.

VNS insertion

As with all surgical procedures there are common risks and side effects attached to this procedure:

 Risks

  • Infection

  • Difficulty swallowing

  • Pain in the location where the cut was made

  • Loss of speech


Side effects

  •  Hoarseness and voice changes

  • Headache

  • Difficulty swallowing and throat pain

  • Shortness of breath

  • Sleep apnea or insomnia

  • Tinging of the skin  

Some people may get no side effects whatsoever, but if you do experience any of the above then it should be tolerable and get better over time. If it is affecting your day to day activities then consult your doctor.

Before your procedure it is important for you to be fully informed of all the pros and cons and your consultant will go through, in detail exactly what will happen and answer any questions you may have. Remember, no question is a silly question and your doctor will want you to have all the information possible to process.

You will be advised on what medications to stop prior to surgery and when to fast, which is usually 6-8 hours before.

Patients can be awake or asleep during surgery, the area will be numbed with local anaesthetic if awake.

Two incisions will be made, one in your chest or armpit and the other on the left side of the neck. The VNS will be implanted on the left side of your chest and a wire is guided under your skin from your chest and attached to the left vagus nerve where the neck incision was made.

After surgery you will be offered a follow up consultation where the doctor will turn on the VNS and test the frequency and duration correct for you, it will then be able to deliver electrical pulses to your vagus nerve. The VNS is not able to detect an impending seizure but your doctor would have set on and off cycles tailored to you. There is also a hand held magnet for people who can feel seizures about to happen or know their triggers and are about to initiate stimulation themselves. The magnet can also turn off the VNS.

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

Facet Joint Syndrome

Facet joint syndrome is caused by the degenerative changes in your spine. Your spine is made up of 33 individual bones that provides support for your body and the facet joints sit in-between the vertebrae of your spine. The facet joints provide mobility and strength to your spine and help limit movement.

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 Facet joints are synovial joints that sit in synovial fluid and are lined with cartilage. They are protected by a joint capsule that work and slide together providing mobility to your back.  Degenerative changes in your spine can sometimes cause your facet joints to become strained from wear and tear. The joint capsules that protect the facet joints can thin and the cartilage inside that is usually smooth will become harder and irregular. Facet joint syndrome can be described as an arthritis like pain as the joints become irritated and inflamed where they are unable to move together smoothly.

Symptoms can be triggered by an injury or pressure on the spinal cord. Pain signals will be sent from the medial branch nerves to your brain that the facet joint is irritated and therefore may react in spasms.  

Symptoms of facet joint syndrome do include:

  • Loss of spinal flexibility

  • Discomfort when leaning backwards, forwards or sideways

  • Radiation of pain into other parts of the spinal cord, neck, shoulders, arms, legs and fingers.

  • Tenderness of the back

  • Aching of the back

  • Pain when standing or sitting for a period of time

Degeneration basically means aging of the joints and as we get older our bones and joints do too, which causes wear and tear. Other possible causes can include obesity, posture and day to day repetitive activities like sitting for long periods. Both men and women can get facet joint syndrome but it usually occurs in people 40+ when the bones start to degenerate and ultimately rub together and become irritated.

If a patient is experiencing symptoms of possible facet joint syndrome then a trip to your doctor will be necessary. Your doctor will go through your medical history and symptoms then perform a physical examination like testing your reflexes, muscle tone and sensory function. Imaging is always a very good option when trying to diagnose a condition a doctor can not physically see. Studies like MRI, CT, and X-ray will be able to take pictures of your spinal cord and pin-point the irritated facet joints and any other problem affecting the spine.

There are a couple treatments available for facet joint syndrome and this doesn’t mean surgical intervention.

Simple solutions like self-care is sometimes the best way to start if your symptoms are not extremely painful or chronic. Correcting poor posture, exercise and better management and being mindful of your back are all effective ways of improving your back pain.

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Physiotherapists are specially trained in understanding how the body works and work hard to provide patients with effective care in the best way. They help you gain strength with exercises and show you techniques on how to walk, lift and stand properly.

Medications are also beneficial for patients with inflamed facets or who are suffering with muscle spasms. Anti-inflammatory medication and creams are just some of the options.

 Steroid joint injections are probably the most effective and quickest form of pain relief for patient suffering from a lot of pain on a daily basis. It is a minimally invasive procedure that injects corticosteroid and numbing agent in to the irritated joint. The steroid injection reduces swelling and irritation from the facet joints. Pain relief can begin straight away and can last from days to years and if the pain returns then the injections can be repeated.

Radiofrequency ablation is a treatment an x-ray guided electrical current is used to produce heat to burn areas of nerve tissue that sends pain signals to the brain, ultimately reducing the pain. It is minimally invasive and helps patients suffering from chronic pain like facet joint syndrome.

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


Children with Trigonocephaly

Mr Sanj Bassi one of our leading paediatric neurosurgeons explains to us what trigonocephaly is.

Trigonocephaly also known as metopic craniosynostosis is a condition where the baby’s skull has fused together before birth. This causes a triangular shape or ridge to the forehead. The skull is not a single bone and is actually made up of several bony plates. In between those plates are sutures. These sutures gradually get closer together and stick as the child gets older. Premature fusing of the sutures is called craniosynostosis.

This condition is present at birth but it can sometimes take some time to be more prominent.  There are other similar conditions related to craniosynostosis that can be confused with trigonocephaly so it is very important to get a correct diagnosis.

The cause for trigonocephaly is not yet known, but possibilities could include genetics, types of medication the mother takes while pregnant and the position of the baby in the womb.

The signs and symptoms vary from baby to baby because each case is different and severity can widen.

Here are some signs of Trigonocephaly:

  •  A ridge across the forehead

  • A triangular shape to the top of the head with a pointed shaped forehead. This can make the eyes closer together.

  • Difficulties with vision and developmental milestones.

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Because trigonocephaly is very visible and prominent it is not always necessary to get perform further tests to get a diagnosis. Monitoring scans such as X-rays and MRI can be used to see how the skull grows over time.

Sometimes treatment may not even be necessary if the trigonocephaly is mild and is not causing the baby any developmental or physical issues.

A multidisciplinary team of doctors will discuss each case in detail and decide on a dedicated treatment plan specifically tailored to the individual. The multidisciplinary team will include a neurosurgeon, craniofacial surgeons, ophthalmologists, speech and language therapists and more if needed.

Surgical intervention will be needed to correct the facial and skull deformities. As stated, each case is very different but surgery is usually best performed in the baby’s first year. This is because the bone is still soft so it makes it easier to manoeuvre. As the child gets older the surgery will become more complex and may have to be performed more than once.

Your surgeon will explain the best possible way to treat your child and make sure they receive the best possible outcome. You will be told the risks, complications and benefits for the treatment and able to ask as many questions as you like.

It can be extremely scary for a parent when a child goes for surgery even when in specialist hands. It is important that you talk to your doctor about your worries and are very well informed.

The types of surgery offered for patients with trigonocephaly do include endoscopic surgery and reconstructive surgery.

If your child has trigonocephaly and you would like to discuss the diagnosis and treatment options further, please do not hesitate to contact our specialist paediatric neurosurgeons, myself and Mr Christopher Chandler on +44 (0) 207 034 8709

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


Radiofrequency ablation for pain

Radiofrequency ablation (RFA) is a minimally invasive procedure performed to reduce pain. An x-ray guided electrical current is used to produce heat to burn areas of nerve tissue that sends pain signals to the brain, ultimately reducing pain.

This type of treatment is usually performed on patients suffering from chronic pain in their spine and other parts of the body. It can help relieve the pain of arthritis and neck, pelvic, back and peripheral nerve pain.

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Is it safe?

RFA is a safe procedure and has minimal risks. It is an effective and for some, a life changing procedure that has few complications and the benefits far outweigh the risks. Here are some of the possible risks:

  • Infection

  • Numbness

  • Neuritis

  • Bleeding

  • Neuroma

Your consultant will discuss the risks with you in detail before the procedure and will inform you of all the risks, complications and benefits of RFA.

 Preparing for the procedure  

Your consultant will give you a guide on how to prepare of the procedure. Here are a few tips:

You must be very clear with your doctor what medication you are on as some can cause complications and anaesthetic effectiveness during the procedure. You will be directed on which medications you will need to adjust for the procedure.

Do not eat six hours before the procedure. Drinking water is fine.  

Bring comfy clothes and someone with you to help you home after the procedure. You should not drive for at least 24 hours after the procedure.

What happens during radiofrequency ablation?

Your doctor will once again go through the procedure with you beforehand and ask you to sign consent forms 

You will be taken to theatres and local anaesthetic will be applied to numb the area where you are experiencing pain. A low dose of sedative may be used but you will be awake during the procedure but you will not feel any pain.

During the procedure a thin needle is guided by x-ray towards the area of pain. A microelectrode is passed through the needle towards the targeted nerve tissue. The microelectrode will burn off the nerve tissue that transmits the pain and destroys the signal. The procedure can take up to 45 minutes or longer if there are more areas of pain to cover.

 After the procedure you will be taken to a ward to recover. Some observations may take place and you will be able to walk after the anaesthetic has worn off. You will be able to go home the same day, but you must not drive. A follow-up consultation will be made for you to review the procedure and your symptoms.

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How long does the pain relief last?

 The pain relief can be different for each person because it depends on the location and how bad the pain is. Usually it will last from 9 months onwards, sometimes it can be years. It is effective in 70% of people and the treatment can be repeated is need be.

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 Chordoma?

Mr Nicholas Thomas explains what a chordoma is and the types of treatment available.

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A chordoma is a rare type of cancerous tumour that grows within the skull base and spine. Usually, chordomas are diagnosed in people over 50, although it can affect any one. According to the Chordoma Foundation, just one in one million people per year are diagnosed with this tumour.

Chordomas start in the notochord which helps the development of a growing baby when it is still inside the womb. Only a small amount of notochord cells is left once the bones of the spine have grown. It is those cells that can turn in to chordoma. 

This type of cancer can occur anywhere along the spine but in 50 percent of cases the chordoma is usually found in the sacrum.

Symptoms

The symptoms for this type of tumour do depend on where it is growing and what parts of the body it is affecting. Here are some symptoms a patient may experience if the tumour is growing in the spine:

  • Pain and numbness

  • Radiating back pain to other parts of the body

  • Difficulty walking, feeling unsteady or off balance

  • Bladder and bowel changes or problems

  • Worsening back pain at night

Symptoms if the tumour is in the skull:

  • Headache

  • Facial pain, tingling or numbness

  • Hearing changes

  • Feeling dizzy or unsteady

  • Double vision

  • Changes in hearing

There is no exact cause of chordoma known, research in to this is taking place but so far there are no known environmental or lifestyle causes for this cancer. There have been only a small handful of causes where members of the same family have been affected but it is extremely rare for chordoma to run in families.

 Diagnosis

It is important when diagnosing this chordoma that it is with a specialist consultant neurosurgeon, neurologist or team that has had experience with this cancer before. This is because chordoma is easily mistaken for other types of cancer like a schwannoma or other spine or skull-based tumours.

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After a consultation discussing in detail your medical history and current signs and symptoms, the best way to diagnose a chordoma is through an MRI scan. A T2 weighted MRI scan will have a specific sequence where it will be able pick up detailed images of your skull and spine and is able to locate this cancer. The MRI scan will be able to see the tumour, tissue surrounding, how it is being affected and further issues. A CT scan can be held in addition to an MRI scan if there is need for clarification.

Depending on where the tumour is, for a true definitive diagnosis, a biopsy will take place where the tissue will be placed under a microscope and examined by a pathologist.

Treatment

 Your treatment will depend on three important aspects:

  1. Age

  2. General health

  3. Size and position of your tumour

Sometimes just observation may be needed if the tumour is slow growing and not compressing or causing any harm to the surrounding tissue. The consultant may want to watch and wait if it is small. During this time, regular scans and reviews will be necessary.

Surgery is an option to completely remove or debulk the cancer from the spine or skull. Sometimes the tumour can only be part removed as the risk of further damage outweighs the risk of remaining tumour. Other treatments are available if surgery the chordoma is inoperable or if the surgeon was not able remove the whole tumour, such as radiotherapy.

Radiotherapy is a type of therapy where beams of radiation are directed to destroy the cancer. Chemotherapy is also another type of treatment that kills cancer cells and can be used for patients with chordoma. All treatment will come with side effects, risks, benefits and complications and it is important that the patient completely understands what is happening and why every step of the way.

If you have a chordoma or are worried about your symptoms and would like a consultation 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

Glossopharyngeal neuralgia

 What is glossopharyngeal neuralgia and what are the causes?

 Glossopharyngeal neuralgia (GPN) is an extreme stabbing, burning or electric shock type of intense pain in the tongue, throat, ear, and tonsils. The attacks can last from a few seconds up to a couple of minutes. The pain is connected to the ninth cranial nerve which is also called the glossopharyngeal nerve. This nerve is connected to the brainstem at the upper medulla and travels through the back of the throat, tongue, tonsil and ear, hence why such intense pain is felt in these areas.

GPN usually affects people over the age of 50. Often, the cause for GPN is unknown and diagnosed as irritation. This is because abnormalities may occur where the nerve signal is disrupted and causes abnormal signals to pass through the nerve which ultimately causes pain. Other possible causes may be a tumour or infection in the mouth area which affects the glossopharyngeal nerve. Blood vessels or growths compressing the nerve and sometimes multiple sclerosis are also causes.

Symptoms and triggers  

The symptoms of GPN is extremely intense pain in the ear, tonsil area, back of the tongue and nose and usually only one side of the throat. It is intermittent and sporadic, as mentioned it can last from a few seconds up to a couple minutes. It can also get more frequent and painful over time. Some people describe the pain as the worst pain they have ever experienced. Sometimes people who experience this pain are able to notice certain triggers that bring on the pain. This is an extremely helpful way to help manage the pain by avoiding the triggers. Some of the triggers may be:

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  • Chewing

  • Swallowing

  • Talking

  • Yawning

  • Laughing

  • Coughing

  • Sneezing

 

Diagnosis and treatment

 To diagnose GPN a doctor will begin by going through your medical history and current symptoms you are experiencing. A physical examination may also take place where a cotton tipped swab will touch the back of your throat. This is performed to see you experience any pain, if there is pain then some local anaesthetic will be applied and the doctor will try again, if the anaesthetic works and you cannot feel the pain then it is likely you have GPN.

Other ways of diagnosing glossopharyngeal neuralgia is by performing an MRI or sometimes a CT scan.

To treat GPN your doctor may want to try a conservative route first of call. Anti-convalescent drugs like carbamazepine, oxcarbazepine, gabapentin, or phenytoin may be prescribed to see if they help neutralise the pain.

A microvascular decompression is an option for more permanent relief, but usually a last resort if other methods have not worked.

A microvascular decompression is performed to stop the compression between the blood vessel and the nerve root. This is done by placing a sponge between them. Firstly a craniotomy will be performed by making a small incision behind the ear and drilling a 1-inch opening in the occipital bone. The dura is exposed which is a protective sheet or covering of the brain. The dura is moved to expose the brain. Once the glossopharyngeal nerve is found, a Teflon sponge is permanently placed in-between the glossopharyngeal nerve and blood vessel to stop the compression. The dura is then closed with sutures and a small titanium plate will cover the skull opening with small screws in place, this is because the bone from the skull is not replaced. The skin is then sutured together and dressing is placed.

You will spend a couple of days in hospital recovering and will be assessed by your surgeon and nurses before discharge. Recovery will take a couple of weeks but this can be in the comfort of your own home. A follow-up appointment will be made to check your wound and see if the surgery has worked.

 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.