Surgical Treatments

CRANIAL SURGERY

Craniotomy


WHAT IS IT

Craniotomy is a procedure where by a window of skull is removed usually to remove a brain tumour or remove a blood clot or treat a vascular problem such as an aneurysm. The location of the craniotomy depends on where the problem being treated is located.

THE PROCEDURE

Craniotomy is usually performed under general anaesthetic however in certain circumstances it can be performed awake, and this can be useful for removing tumours in critical areas of the brain. An incision is usually made behind the hairline. A Stealth navigation system is often used to help in planning the surgery. This works like a mini ‘GPS’ system in the operating theatre. Burr holes are drilled into the skull and a special drill is used to connect the burr holes and remove the bone. Deep to the bone is the dura. This is a membrane that covers and protects the brain. This has to be opened to perform the surgery. The condition requiring treatment is performed inside the skull. Once the surgery has been completed and any bleeding stopped the dural membrane is normally sutured. Sometimes a dural graft is required to repair the dura. The dural graft can be performed from some of your own tissue such as fascia although sometimes an artificial graft is also used. The bone flap is usually replaced with plates and screws. The scalp and skin are usually sutured and staples used for the skin.

RECOVERY

After surgery you may have some headaches but usually craniotomy is not a particularly painful type of surgery. You may have air in your head after surgery and be placed on oxygen. This air normally resorbs over a number of days.

Following a craniotomy, you will be managed in intensive care and when stable transferred to the ward. You will usually have a CT scan on day 1 postop operatively to check for any complications such as bleeding. You may also require further scans after this.

Your wound staples and normally removed on day 7. It is a good idea to keep the scalp dry for several days. It is also advisable not to pick at the wound to lessen the chance of infection.

You will be reviewed in Neurosurgery + Spine with Prof McDonald at 6 weeks. In some circumstances, you will require closer monitoring. This will be explained on discharge.

RISKS & COMPLICATIONS

Craniotomy is a common and routine procedure performed by neurosurgeons to treat many intracranial conditions. The intracranial condition may have specific risks associated with this. In general terms there is always a small risk of stroke with craniotomies. The risk of this may be around 5%, but it depends on what condition has been treated. After surgery there is a small risk of seizures. Your surgeon will discuss with you the period of no driving. This is typically between 3 and 6 months. You may be placed on antiseizure medication. There are other risks such as post-operative bleeding. If a blood clot forms within the brain this may need to be removed. Blood clots can also form between the skull and the dural membrane (extradural haematoma) or between the dura and the brain (subdural haematoma). If these post-operative blood clots are large, further surgery to remove the haematoma may be necessary. This is also one of the reasons you usually spend the first night after surgery in intensive care. You will stay there until your condition has stabilised. Another serious complication can infection of the brain. If the bone flap becomes infected it may need to be removed and then subsequently replaced after antibiotic treatment, with a titanium plate (titanium cranioplasty). There can also be problems with the spinal fluid leaking out, and this is more common with craniotomies involving the posterior fossa (cerebellar region). Sometimes the scalp can feel numb and there are always risks of wound healing problems. Every operation on the brain also carries the general risks of surgery including anaesthetic risk, medical complications and other complications such as deep vein thrombosis and pulmonary embolism.




Brain Tumour Biopsy


Details to come.​




Shunt


Details to come.​




Burr Holes


Details to come.​





SPINAL SURGERY

Anterior Cervical Discectomy and Fusion (ACDF)


Anterior cervical discectomy and fusion (ACDF) is a surgical procedure used in the management of spinal cord and nerve root compression secondary to certain disorders such as degenerative disc disease, herniated disc, spondylosis, and spinal stenosis. ACDF reduces the neck and arm pain and provides stability to the spine. Anterior: Front of the body Cervical: Neck Discectomy: Surgical removal of an intervertebral disc Fusion Join: (fuse) 2 or more vertebral bodies Before the surgery, the neurosurgeon explains the details of the procedure to the patient including the possible risks and complications such as infection, bleeding, nerve damage and reaction to anaesthesia. A minimally invasive approach may be employed in some individuals depending on their diagnosis, medical history, earlier treatments and other factors. A general health clearance from a general physician is essential for the surgery. This assessment may comprise of blood tests, X-rays or other imaging studies, along with special tests for the diagnosis of other medical problems such as diabetes and cardiac disease. Procedure Anterior cervical discectomy and fusion is performed under general anaesthesia. During the surgery, different gauges, monitors, and equipment are employed, which provides the visual and audio feedback to the surgeon. All the vital functions, including central nervous system are carefully monitored throughout the procedure. Image guidance such as real time x-ray or fluoroscopy helps the neurosurgeon to visualize the surgical field during the surgery. The essential steps involved in minimally invasive ACDF are as follows:

  • The patient is placed on a padded operation table, facing up
  • The cervical level of the patient is confirmed by real time X-ray
  • An incision is made in front of the neck through one of the natural folds to disguise scarring
  • Then muscle and other soft tissues are pulled aside to expose the intervertebral disc
  • A discectomy is carried out to remove the entire disc or a portion of it
  • A block of bone or cage (s) is placed in the disc space. A bone graft may be used to fill this space
Bone graft types Autograft: Bone from your body Allograft: Donor bone
  • The spinal cord and nerve roots are further decompressed by removing the bony outgrowths such as bone spurs, osteophytes, and thickened ligament or other tissues
  • The space between the upper and lower vertebral bodies is restored. This helps in decompression of the neural structures by enlarging the normal pathway of the nerve.
  • Extra bone graft is filled around the disc space.
  • The anterior portion of the spine is fixed with a cervical plate using bone screws to stabilize the neck.
  • Finally, the incision is sutured and dressed.
Post-operative care After the surgery the patient is brought to the recovery area, where the medical staff monitors the vitals and also manages post-operative pain. Patients may experience pain at the site of incision, spasms of the neck muscles, or other symptoms. After the surgery, a cervical brace is placed on the neck of the patient. Some of the common post-spine surgery instructions which the patient needs to remember are as follows:
  • Schedule a follow-up appointment
  • The incision should be kept clean and dry
  • While taking a shower the incision should be covered
  • Wear the cervical brace as instructed
  • Avoid tub baths, but can go for swimming, or sit in a hot tub or pool
  • Take rest as it helps rapid healing
  • Start physical therapy and exercises as per the instructions of the surgeon
  • Compliance to prescribed medications
  • Avoid heavy lifting
  • Encourage daily walking
  • Avoid driving until cleared by the neurosurgeon
  • Avoid smoking or the use of tobacco
  • Eat a healthy and nutritious diet
Call your neurosurgeon’s office for any of the following problems:
  • Rise in body temperature 101° F or higher
  • Excessive swelling or redness at the incision site
  • Increase in incision drainage or a change in its odour and appearance
  • Severe pain at the incision site
  • Bowel or bladder dysfunction
  • Development of numbness in the genital region




Anterior Cervical Discectomy and Disc Replacement


Details to come.​




Microdiscectomy


WHAT IS IT

Lumbar microdiscectomy is a common neurosurgical procedure used to treat a herniated, prolapsed or bulging lumbar disc. The goal of this procedure is to remove the portion of the disc that is compressing or pinching the nerve. It is principally used to treat sciatica or leg pain. It usually does not help with your back pain and in some cases can worsen your back pain after surgery. There are 2 types of lumbar microdiscectomy. The first is a standard microdiscectomy performed through an incision the middle of the back and typically treats disc bulges in the centre or slightly off centre. The alternative microdiscectomy is a far lateral microdiscectomy where the surgery is performed for a disc bulge out of the side of the spine. Usually, the incision for this is off the midline.

THE PROCEDURE

Standard microdiscectomy is performed under general anaesthesia. A small incision is made over the correct disc level after x-rays are taken to confirm the level. The spinal muscles are retracted and then the lamina which is the back part of the vertebrae is exposed. Then using a drill and punches, a small portion of the lamina and medial facet joint is removed to open up the spinal canal to allow room to perform the procedure. The ligaments surrounding the nerve root are removed and the nerve and disc bulge exposed. The bulging disc or disc herniation is removed and any loose fragments sitting within the disc space are also removed to reduce the chance of recurrent disc herniation. A surgical drain may be placed. The wound is closed with dissolving sutures.

RECOVERY

After surgery you will go through recovery for one to two hours and then back to the neurosurgery ward (Connery Ward). You will be given adequate pain relief. The incision site will be sore. Once you are comfortable you can get out of bed but will require some assistance. On the first post operative day after surgery your drain will be removed, if placed, and the physiotherapists help you mobilise and show you what exercises you need to start performing. On the second post operative day, it is not uncommon to have more lower back pain and you should take it easy. Typically, you will be discharged on day 3 post operatively. This does depend on how you are progressing. You may go home sooner if you wish. Your wound should be kept dry for several days. The dressing will be changed before you leave hospital and a new dressing should be left on for a week. When you are discharged you will be given pain relief. Typically, this will be a medication like Palexia. You should take some regular Panadol and anti-inflammatories if you are able to do so. Stronger pain relief such as Endone, or Oxycodone should be used sparingly. Once discharged you will be followed up in Neurosurgery + Spine by Rachel McAlister or Jo Twelftree spinal physiotherapist, around 3 weeks post operatively. You will see Professor McDonald and spinal physiotherapist at 6 weeks post operatively.

RISKS & COMPLICATIONS

Lumbar microdiscectomy is generally quite a successful surgery but there is always a small chance of a complication. There is a rare chance that surgery will make you worse. The most common complication after surgery is a recurrent disc herniation. This is where a fragment of disc re-herniates and compresses the nerve. This can occur in the immediate postoperative period up to years later. After surgery you do need to be careful with lifting and twisting to try and minimise the risk of this. A microdiscectomy may also increase the level of back pain. To minimise this, you will be given an exercise program. There are rare risks where the nerve root is injured. This can lead to more pain down the leg or numbness or weakness. It is also very rare to injure the sacral nerves that control the bowel and bladder function and this leads cauda equina syndrome. This condition is characterised by urinary incontinence or difficulty voiding and is associated with numbness around the anus or perineum. Should you have any difficulty urinating or using your bowels after surgery please discuss this immediately with the nurses or doctor. The dura or membrane surrounding the spinal nerves may also be punctured during surgery. This can cause the cerebrospinal fluid (CSF) to leak. If this happens the hole in the membrane is usually sutured or glued up. You may be required to lay flat after this occurs. This usually settles down. There is a small chance of infection following surgery. The wound should be kept clean and dry. Superficial wound infections may simply be treated with antibiotics but any deeper infection may require further surgery and more prolonged antibiotics. In some cases, you may need to be on intravenous antibiotics for a number of weeks and oral antibiotics for a number months. Post operative bleeding may also occur as well as intraoperative bleeding. This is uncommon but if a blood clot is pushing on the nerves this may require more surgery to remove. All operations also have other general risks, such as anaesthetic risks, allergies to medications, unforeseen risks such as heart attack, stroke, pneumonia, urinary tract infection or clots in the legs (deep vein thrombosis) and pulmonary emboli. During surgery you will wear thromboembolic stockings and also have calf compression devices. These will be kept on until you are mobile.

There is also rare complication of blindness with any spinal surgery because you are facedown for the procedure.

In the longer term there is a small chance that if you have ongoing back pain you may require a spinal fusion procedure.




Laminectomy


WHAT IS IT

A laminectomy is an operation where the lamina is removed to create more room around the spinal nerves or spinal cord. The lamina is the back part of the vertebrae. A laminectomy may be performed in the cervical, thoracic or lumbar spine. Some or all of the lamina may be removed depending on the area that needs to be decompressed. Single or multiple level laminectomy can be performed. Sometimes the procedure is also performed in combination with other procedures such as posterior spinal fusion. The most common reasons for performing a laminectomy are to relieve spinal cord compression or compression of the spinal nerves. In the lumbar spine this condition is called spinal stenosis where there is over growth of the bone and ligaments that may lead to nerve compression.

THE PROCEDURE

The procedure is performed under a general anaesthetic. A small incision is made over the correct level and the spinal muscles are retracted. The correct level is again checked with x-rays. The lamina is removed with drills and punches. The nerve roots or spinal cord are decompressed. The removed portions of bone are not replaced. The nerves or spinal cord are well protected by the muscles which are sutured back in place. A spinal drain may be placed and the wound is closed with dissolving stitches.

RECOVERY

After surgery you will go to recovery for 1-2 hours and then usually back to the neurosurgery ward. If you have any other medical conditions, you may also be managed in high dependency or intensive care overnight. If you have had a had a multilevel operation you may also have an indwelling catheter placed. The following day after surgery the physiotherapist will help you get you out of bed. Your drain and catheter will be removed and encouraged to mobilise. You will be given adequate pain relief. Depending on how many level laminectomies were performed, you will usually be in hospital for between 3 and 5 days. Sometimes you may require a period of rehabilitation. This will be assessed post operatively by your physiotherapist and treating team. Once discharged you will be followed up in Neurosurgery + Spine by Rachel McAlister or Jo Twelftree spinal physiotherapist, around 3 weeks post operatively. You will see Professor McDonald and spinal physiotherapist at 6 weeks post operatively.

RISKS & COMPLICATIONS

Laminectomy is a straight forward operation but there is always a small risk of being worse after surgery. The surgery does not treat back pain or neck pain and sometimes can make these symptoms worse. It is rare to injure a nerve or spinal cord. This can lead to worsening pain numbness or weakness in the leg. It is rare to damage the spinal cord but this obviously can lead to quadriplegia or paraplegia depending on the levels involved. Cauda equina syndrome is a rare complication where the spinal nerves that control bowel and bladder function are compressed or damaged. This can lead to incontinence of the bowel or bladder and is associated with numbness around the anus or perineum. If you have any difficulty using your bowel of bladder after surgery you should discuss this immediately with your nurse or doctor. There is also a small risk of a post-operative haematoma or a blood clot forming and putting pressure on the nerves or spinal cord. If this occurs this may be associated with increasing back or neck pain and may require further surgery to drain the haematoma. There is a small chance of infection following surgery. Superficial wound infections may be treated with antibiotics but deeper infections may require further surgery to wash out the wound and prolonged antibiotic therapy. A hole may also be made in the dura which is the membrane that surrounds the spinal cord or nerve. This may lead to leakage of the cerebrospinal fluid. This is usually repaired at the time of surgery however a postop CSF leak can occasionally occur as well. This may require further surgery or a spinal drain to treat. This may prolong your hospital stay and you may be required to lay flat for a period after surgery. Complications such as blindness are extremely rare but can occur because you are facedown for the surgery. We also take great care to make sure that there are no pressure areas that can lead to pressure sores or nerve damage. Particular care is taken to padding your elbows to make sure the ulnar nerves are not compressed during surgery. If this happens you can get numbness in the hand. This usually recovers.

Laminectomy is also associated with the general risks of surgery and anaesthesia. Complications such as heart attack, stroke and pneumonia can occur uncommonly. There are risks such as deep vein thrombosis and pulmonary embolism. You will be treated with thromboembolic stockings and calf compressors. You may have post-operative blood thinning medication given as well. You should discuss with your surgeon when is the optimum time to recommence any blood thinning medication that you have been on.




Posterior Lumbar Interbody Fusion (PLIF)


A posterior lumbar interbody fusion (PLIF) is a surgical technique that involves correction of the spinal problems at the base of the spine by placing bone graft between two vertebrae. Minimally invasive surgical techniques may be used to perform the procedure. Posterior lumbar interbody fusion (PLIF) is a spinal surgery that involves placement of bone graft material between two adjacent vertebrae from the back of the spine. The bone graft material works as a bridge or platform that binds or fuses two vertebrae together and promotes new bone growth. The ultimate purpose of the procedure is to re-establish the spinal stability. Now-a-days minimally invasive spine surgical techniques may be used to perform PLIF which permits the surgeon to make small incisions and gently separate the surrounding muscles of the spine rather than cutting. The aim of the minimally invasive approach is to preserves the surrounding muscular and vascular function for faster recovery and reduced scarring. Indications Patients with spinal instability in their lower back due to degenerative disc disease, spondylolisthesis or spinal stenosis that has not responded to other non-surgical treatment measures such as rest, physical therapy or medications may be recommended for surgical treatment of spinal fusion procedure such as PLIF. Patients with lumbar spinal instability may experience pain, numbness and muscle weakness in the lower back, hips and legs. Before prescribing the PLIF surgery your surgeon considers various factors such as the condition to be treated, your age, health, lifestyle and your expected level of activity after the surgery. Have a complete discussion with your spinal care provider regarding the available treatment options. Procedure In this procedure the surgeon makes a small incision in the lower back over the vertebra (e) to be treated. The size of the incision depends on the bone graft to be used and can be as small as approximately 3 centimetres. Usually 3- to 6- inches of incision is required in a traditional open PLIF surgical procedure. The surgeon dilates the surrounding muscles of the spine to access the section of the spine to be stabilized. Next, the lamina, the roof of the vertebra, is removed to visualize the nerve roots. The facet joints that are directly over the nerve roots are trimmed to provide the nerve roots with more space. Bone Graft Placement To place the bone graft the nerve roots are shifted to one side and disc material is removed from the front (anterior) of the spine. Now the bone graft is implemented into the disc space. Screws and rods are used to stabilize the spine for better healing and fusion. After the completion of the procedure the small incision is closed and leaving behind a minimal scar. Recovery period This minimally invasive procedure typically permits most of the patients to be discharged the day after surgery but some patients may require a longer hospitalization. Usually most of the patients observe immediate improvement of some or all of their symptoms but sometimes the improvement of the symptoms may be gradual. Contribution of a positive approach, realistic expectations and compliance with your doctor’s post-surgical instructions help bring a satisfactory outcome of the surgical procedure. Most patients can resume their regular activities within several weeks. Have a conversation with the doctor to determine if you are a candidate for minimally invasive PLIF surgery. Risks and complications Every patient has a particular treatment plan and outcome result. Sometimes outcome results vary from individual to individual. The complications associated with PLIF surgery include infection, nerve damage, blood clots or blood loss, bowel and bladder problems and problems associated with anaesthesia. The primary risk of spinal fusion surgery is failure of fusion of vertebral bone and bone graft which may require an additional surgery. Please refer to your physician to obtain an ample list of indications, warnings or adverse effects or precautions, clinical results and other significant medical information related to the minimally invasive PLIF surgical procedure.




Transforaminal Lumbar Interbody Fusion (TLIF)


Transforaminal lumbar interbody fusion (TLIF) is a type of spinal fusion procedure in which bone graft is placed between the affected lumbar vertebrae through a posterior incision on the patient’s back. The term Transforaminal lumbar interbody fusion itself indicates: Transforaminal: Through the foramen Lumbar: Lower back Interbody: Bone graft between vertebral bodies Fusion: Joining together Minimally invasive surgical techniques can be employed for TLIF. Minimally invasive spinal surgery is safe with more advantages than the traditional open spine surgery. Minimally invasive surgery requires a small incision (reduced scar) and employs muscle dilation for a more precise operation without affecting or cutting the surrounding muscular and vascular tissues. Consequently minimally invasive technique results in a faster recovery. TLIF is a modification of the posterior lumbar interbody fusion (PLIF) where anterior aspect of approaching the spine is not employed. This helps to overcome various complications such as alteration of neural structures, damage to related ligaments, excessive bone removal, biomechanical instability, and early mobilization problems. Indications Based on the spinal condition, age, health, degree of activity and complete medical history of the patient, the surgeon may recommend TLIF as a treatment option. Your surgeon will recommend this procedure only if you are not responding to the conservative treatment methods such as rest, physical therapy and medications. Your surgeon may endorse TLIF if you are suffering from any of the following spinal instability conditions:

  • Degenerative disc disease
  • Spondylolosthesis
  • Spinal stenosis
The common symptoms associated with lumbar spinal instability are pain, numbness, and muscle weakness in the low back, hips and legs. Therefore one should always consult their surgeon or spinal care provider before making any decision regarding surgery. Procedure The basic steps involved in a transforaminal lumbar interbody fusion are as follow: A small incision (3 cms) is made in the skin on your back over the affected vertebrae Muscles encircling the affected spine are retracted to make approach easy Lamina covering the vertebra is removed to view the nerve roots Facet joints (situated over nerve roots) may be undercut or trimmed to provide more space to the nerve roots Nerve roots are moved away to remove the disc material from the anterior region of the spine A bone graft is then inserted between the vertebrae Then screws and rods are fixed to stabilize the spine Finally incision is closed Recovery Patients who have undergone TLIF surgery are usually discharged on the same day, but in some cases, hospital stay may be extended. Patients may find correction in some symptoms soon after the surgery, and other symptoms may gradually recover with time. Your surgeon may recommend a few specific post-operative instructions for a fast and better recovery. Generally patients may return to their routine activities within weeks after surgery. Risks and complications Although transforaminal lumbar interbody fusion surgery is a safe procedure, some complication may arise under certain circumstances. The common and possible complications associated with TLIF surgery are as follows:
  • Infection
  • Nerve damage
  • Blood clots
  • Blood loss
  • Bowel or bladder problems
  • Incomplete fusion of the bone graft (spinal fusion)
In rare cases, if the bone graft does not fuse or regenerate properly then revision surgery may be required. Please consult your physician for a complete list of indications, warnings, precautions, adverse effects, clinical results and other important medical information that pertains to a TLIF procedure.




Extreme Lateral Interbody Fusion (XLIF)


Details to come.​




Alternative Treatments for Back Pain


Details to come.​




Bone Grafting Options


Details to come.​





MOVEMENT DISORDER SURGERY

Deep Brain Stimulation


Deep brain stimulation (DBS) is a surgical procedure used to treat a variety of disabling neurological symptoms—most commonly the debilitating symptoms of Parkinson’s disease (PD), such as tremor, rigidity, stiffness, slowed movement, and walking problems. The procedure is also used to treat essential tremor, a common neurological movement disorder. At present, the procedure is used only for patients whose symptoms cannot be adequately controlled with medications. Deep brain stimulation, or DBS, uses tiny electrodes surgically implanted into part of the brain. The electrodes are connected by a wire under the skin to a small electrical device called a pulse generator that is implanted in the chest beneath the collarbone. The pulse generator and electrodes painlessly stimulate the brain in a way that helps to stop many of the symptoms of PD. DBS is stereotactic surgery, meaning it uses a 3D coordinate mapping system to locate tiny areas in our bodies in order to perform surgery accurately. DBS usually reduces the need for levodopa and related drugs, which in turn decreases dyskinesias. It also helps to relieve on-off fluctuation of symptoms. People who initially responded well to treatment with levodopa tend to respond well to DBS. While the benefits of DBS can be substantial, it usually does not help with speech problems, “freezing,” posture, balance, anxiety, depression, or dementia. DBS is not a good solution for everyone. It is generally used only in people with advanced, levodopa-responsive Parkinsons Disease who have developed dyskinesias or other disabling “off” symptoms despite drug therapy. Deep Brain Stimulation surgery may be performed on one or both sides of the brain depending on the patient and their symptoms. Sometimes the surgery is done in two parts with the first surgery done to implant the electrodes in the brain, and a second surgery to implant the neurostimulator. Because each patient is different, your surgeon will discuss the options that are best for your particular situation. Deep Brain Stimulation surgery is performed by a Neurosurgeon under sterile conditions in an operating room with the patient initially awake but sedated. General anaesthesia is administered to finish the surgery once the electrodes have been placed in the brain. Prior to surgery the patient is sedated and with the use of local anaesthetic, a rigid stereotactic frame is placed around the skull. A stereotactic MRI scan is taken to identify and locate the exact target within the brain where electrical nerve signals generate the PD symptoms. The target area is mapped with coordinates on a computer. The patient is then taken to the operating room:

  • A small area of the head is shaved and numbed with local anaesthetic.
  • The surgeon makes an incision in your scalp behind the hairline.
  • A drill is then used to create a small hole in the skull bone about the size of a nickel.
  • At this point, the patient is taken off sedation medications and is awake while the surgical team “maps” the brain to ensure the precise location of electrode placement.
  • The surgeon then locates the precise area of the brain that the electrodes are to be implanted and places the tip of the electrodes within this targeted area.
  • Once the electrodes are placed and tested, the patient is again sedated and the scalp incision is closed with sutures and covered with sterile bandages.
  • The patient is then placed under general anaesthesia for the rest of the surgery.
  • The surgeon tunnels the thin wire attached to the electrode under the skin of the head, neck and shoulder.
  • The neurostimulator or pulse generator is a small box that is implanted in the chest beneath the collarbone, or elsewhere depending on your surgeon’s preference.
  • Your surgeon then connects the neurostimulator to the wire to enable pulses to be transmitted to the electrodes in the brain.
  • The surgeon then closes the chest incision with sutures and covers the area with sterile bandages
  • Once the system is in place, electrical impulses are sent from the neurostimulator up along the extension wire and the lead and into the brain. These impulses interfere with and block the electrical signals that cause PD symptoms.
Post-Operative Guidelines After surgery your surgeon will give you guidelines to follow depending on the type of surgery performed and the surgeon’s preference. Common Post-operative guidelines following Deep Brain Stimulation surgery include:
  • You will probably stay in the hospital a few days if no complications occur.
  • You will be given pain medications to keep you comfortable and antibiotics to prevent infection.
  • Keep the incisions clean and dry. You may shower once the stitches and/or staples are removed unless otherwise directed by your surgeon.
  • Your surgeon will give you activity restrictions to follow.
  • Do not scratch the incision areas as this can lead to infection.
  • If the incision areas become red, painful or draining, call your surgeon as these are signs of infection.
  • If you experience headache, vomiting, visual problems, confusion, fever, or increased lethargy, call your surgeon right away.
  • It is important to keep all your post-operative appointments with your surgeon to ensure a good outcome.
  • Eating a healthy diet and not smoking will promote healing
Follow Up Care Patients must return to the medical centre frequently for several months after DBS surgery in order to have the stimulation adjusted by trained doctors or other medical professionals. The pulse generator must be programmed very carefully to give the best results. Doctors also must supervise reductions in patients’ medications. After a few months, the number of medical visits usually decreases significantly, though patients may occasionally need to return to the centre to have their stimulator checked. If you have deep brain stimulation surgery performed, you must inform your dentist or surgeon if you should need dental work or surgery in the future. You must also inform any physician who may want to order an MRI scan on your brain or body due to the hardware components placed. Risks and Complications Specific complications of DBS surgery are rare but can include:
  • Bleeding
  • Stroke
  • Infection
  • Brain damage
  • Seizures
  • Death
Other complications that can occur, although rare, involve the hardware components that are placed inside the body. Complications involving hardware will usually require another surgery to repair or replace and can include:
  • Fracture or breakage of the wire or cable
  • Battery failure
  • Erosion of the cable or device through the skin
  • Migration of the electrode in the brain due to failure of the anchor





PERIPHERAL NERVE SURGERY

Carpal Tunnel Release


What is a carpal tunnel release? A Carpal Tunnel release is a procedure to free the median nerve which runs through the carpal tunnel in the wrist. It involves making a small cut down the front of the wrist and palm of the hand and dividing the band of tissue which is pressing on the median nerve. Once the nerve is completely free, the skin is closed with stitches. My Anaesthetic This procedure will require a Local anaesthetic. See Local Anaesthetic for Your Procedure patient information sheet for information about the anaesthetic and the risks involved. If you have any concerns, talk these over with your doctor. If you have not been given an information sheet, please ask for one. What are the risks of this specific procedure? There are some risks/complications with this procedure. Uncommon risks include:

  • Infection. This will need antibiotics.
  • Bleeding. Bleeding is more common if you have been taking blood thinning drugs such as Warfarin, Asprin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).
  • Numbness and tingling in the fingers and thumb may persist.
  • The operation occasionally does not work and needs to be done again.
  • Damage to the tendons, which may require surgical repair of the tendons.
  • Damage to the median nerve. This may require re-operation and nerve repair.
  • Pain at the wrist when making a fist of leaning on the wrist.
  • The surgical cut may cause changes to the sensation and colour of the limb.
  • In some people, healing of the wound can become thickened and red and the scar may be painful.
Rare risks include:
  • Increased risk in obese people of wound infection, chest infection, heart and lung complications and thrombosis.
  • Death as a result of this procedure is very rare.




Ulnar Nerve Decompression


What is a ulnar nerve decompression at the elbow? The Ulnar nerve is a nerve which supplies feeling and strength to a portion of the hand and forearm. It may become compressed or trapped as it passes past the elbow. Ulnar nerve decompression at the elbow is performed to free up the nerve. It involves a small cut around the elbow, to free up the compressed nerve. My Anaesthetic This procedure will require an anaesthetic. See About your Anaesthetic information sheet for information about the anaesthetic and the risks involved. If you have any concerns, talk these over with your doctor. If you have not been given an information sheet, please ask for one. What are the risks of this specific procedure? There are some risks/complications with this procedure. Common risks include:

  • Infection. This will need antibiotics.
  • Bleeding. Bleeding is more common if you have been taking blood thinning drugs such as Warfarin, Asprin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).
  • Failure of the symptoms to improve.
Uncommon risks include:
  • Injury to the ulnar nerve resulting in a weak/numb hand.
  • Persistent numbness in the hand/forearm which may be temporary or permanent
  • Damage to the median nerve. This may need re-operation and nerve repair.
  • Damage to the tendons. This may require repair of the tendons.
  • Scar tenderness. This may be permanent.
  • A heart attack because of the stain on the heart or a stroke.
  • Clots in the leg (deep vein thrombosis or DVT) with pain and swelling. Rarely part of this clot may break off and go into the lungs.
  • Small areas of the lung may collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
  • Increase risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis.
Rare risks include:
  • Death as a result of this procedure is very rare.




Lateral Femoral Cutaneous Nerve of Thigh Decompression


Details to come.​




Common Peroneal Nerve Decompression


Details to come.​




Muscle Biopsy


Details to come.​




Nerve Biopsy


What is a nerve biopsy? The purpose for doing a Nerve Biopsy is to diagnose nerve disease. The surgeon will make a small cut over the nerve of interest. A small segment of the nerve will be cut and sent to pathology. The surgeon will then close the skin with sutures or staples. My Anaesthetic This procedure will require a Local anaesthetic. See Local Anaesthetic for Your Procedure patient information sheet for information about the anaesthetic and the risks involved. If you have any concerns, talk these over with your doctor.
If you have not been given an information sheet, please ask for one. What are the risks of this specific procedure? There are some risks/complications with this procedure. Uncommon risks include:

  • Infection. This will need antibiotics.
  • Bleeding. Bleeding is more common if you have been taking blood thinning drugs such as Warfarin, Asprin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).
  • A result may not be able to be obtained from the biopsy.
  • An area of numbness may occur or possible weakness which could be temporary or permanent.
  • Increase risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis.
Rare risks include:
  • An area of numbness may occur or possible weakness which could be temporary or permanent.
  • Bleeding. May require further surgery.
Death as a result of this procedure is very rare.