The human brain and spinal column are bathed in a fluid known as cerebrospinal fluid. Sometimes there may be an unnatural buildup of cerebrospinal fluid in the cavities (ventricles) of the brain. This can cause the pressure within the skull (known as intracranial pressure) to increase. This condition is known as hydrocephalus, taken from the Greek words hydro (water) and kephalos (head).
Hydrocephalus may occur at any age but it is most commonly found in infants and older adults. It can cause an increasing enlargement of the head which may be pronounced and clearly visible. The condition is serious and can result in brain damage and reduction in brain function.
There are a number of causes for hydrocephalus, both congenital (hereditary) and acquired (occurring due to external factors). Some of the congenital conditions which cause it are Arnold-Chiari malformation, Spina Bifida, craniosynostosis and so on. Among the acquired causes are trauma to the head, tumours, cysts, meningitis and haemorrhage.
Here at Sri Ramakrishna Hospital, we routinely perform surgery to treat hydrocephalus. The most complex but efficacious procedure for treatment of this condition is the endoscopic third ventriculostomy or EVP.
Craniosynostosis is a condition affecting infants. As you may very well know, a child’s skull is fairly soft. This is due to what are known as ‘sutures’ – a kind of fibrous joint occurring in the skull. The skull’s bones are not fused at birth and are in fact joined at these sutures which in turn allow for some movement. This allows the skull to grow with the child.
Typically the bones don’t fuse before the age of two. However, in some rare instances, the sutures of babies fuse prematurely and turn into bone. This leaves no room for the brain in which to expand with growth. What can then happen is that the brain may grow in a different direction such as laterally. This results in a child with a misshapen head. If the brain can’t grow enough in another direction, it can result in an increase in intracranial pressure. This in turn can lead to seizures, blindness and even death in some rare cases. Facial deformities can affect the breathing of child and the stunted brain development could lead to a host of issues ranging from language and speech defects to a low IQ.
Most forms of craniosynostosis are ‘non syndromic’, which is a fancy way of saying their causes are unknown. A few kinds are ‘syndromic’ and are caused by certain genetic conditions.
Not all misshapen heads are a result of craniosynostosis but if your baby seems to have an unusually shaped head, it is best to consult a paediatrician. If diagnosed, surgery might be the most effective course of treatment.
An aneurysm is a weak spot on an artery. The pressure of blood forces the weakened part of the wall of the artery to bulge outwards. If you’ve ever seen an inflated bicycle tube or balloon suddenly bulge out at one section, you will get the picture. Aneurysms may occur in any part of the body but it is only in the brain that it becomes lethal. Arteries feed oxygen to the brain constantly.
When this flow is limited, brain cells immediately begin to die, which is what happens in a stroke. When an aneurysm ruptures, it spills blood into the subarachnoid cavity and this is known as a subarachnoid haemorrhage. Depending on how fast (or not) the condition is addressed, the patient may survive and enjoy good quality of life, or die. Many people develop aneurysms at some point in their lives but, until they burst, they cause little to no symptoms and go undetected for the most part. Sometimes however an aneurysm may put pressure on a sensitive part of the brain causing a host of symptoms ranging from headaches to nausea to seizures and loss of consciousness. There are various surgical procedures to treat this condition.
Brain Tumours are classified into primary and secondary tumours. Primary tumours are those which originate in the brain. They could be benign or malignant and they are rarer. The most common tumours are secondary tumours, which originated in another part of the body and spread to the brain. They are all malignant as is indicated by the very fact that they have spread.
Primary brain tumours take their name from the kind of cells which cause them. Gliomas, for example, originate in the brain or spinal cord. There are several kinds of such as astrocytomas, glioblastomas, oligoastrocytomas, oligodendrogliomas and ependymomas. Then there are meningiomas which originate from the ‘meninges’ – the membranes surrounding the brain and spinal cord. They are largely benign. Medulloblastomas are the most commonly found brain tumours in children.
They are cancerous, starting in the lower part of the brain and spreading via spinal fluid. Schwannomas or acoustic neuromas are benign tumours which develop on nerves leading from the inner ear to the brain and control hearing and balance. Pituitary tumours are usually benign and, as the name indicates, develop in the pituitary gland. They can be surgically excised using the transsphenoidal approach.
Secondary brain tumours comprise the overwhelming majority of brain tumours. The types of cancer which ‘metastasise’ (spread) to the brain are lung, kidney, skin and breast cancer.
The spinal cord is wrapped within three layers of protective membranes called meninges, the outer most of which is known as the dura mater.
Thus, spinal tumours are named after their location relatively to the dura. Extradural tumours occur outside the meninges while Intramural tumours occur within. The former are the most common and comprise bone tumours such as the benign osteomas and osteoblastomas and the malignant osteosarcomas, chordomas, osteosarcomas and fibrosarcomas.
Intradural tumours are divided into Intramedullary and Extramedullary. Intramedullary tumours occur within the nerves of the spinal cord itself. There are many kinds of these, the most common being astrocytomas and ependymomas. Extramedullary tumours occur outside the spinal cord itself but lie within the meninges. Some of the most common are meningiomas and schwannomas.
Spine tumours can be excised using a variety of techniques
