Conditions Treated

Meningiomas are tumors that develop from the protective layers surrounding the brain rather than from the brain tissue itself. Most meningiomas are noncancerous and grow slowly. Some are discovered incidentally when imaging is performed for an unrelated reason.

Small tumors that are not growing or causing symptoms can often be monitored with periodic MRI scans. Surgery may be recommended when a tumor is growing, producing symptoms, or placing pressure on the brain, nerves, or nearby blood vessels. The goal of surgery is to remove as much of the tumor as can be safely achieved while protecting normal neurological function.

Depending on the tumor's location, the amount that can be safely removed, and its microscopic grade, radiation therapy or focused stereotactic radiosurgery may sometimes be recommended. Continued imaging is important even after treatment.

Gliomas are tumors that arise from cells within the brain. They vary significantly in how they behave and are classified according to their microscopic appearance and molecular features.

Gliomas may be assigned a grade from 1 through 4. Lower-grade tumors generally grow more slowly, while higher-grade tumors tend to grow and spread more aggressively. Glioblastoma is a grade 4 glioma and is the most aggressive form.

Treatment commonly begins with surgery to obtain a diagnosis and remove as much of the tumor as safely possible. The amount that can be removed depends heavily on the tumor's location. Tumors involving areas responsible for speech, movement, sensation, vision, or other critical functions may not be safely removable in their entirety.

Following surgery, treatment may include radiation therapy, chemotherapy, targeted therapy, or a combination of treatments. The treatment plan is based on the tumor's grade, molecular characteristics, location, and the patient's overall health. Regular MRI scans are used to monitor the tumor and evaluate its response to treatment.

Brain metastases are tumors that have spread to the brain from a cancer elsewhere in the body. In adults, metastatic cancer is the most common cause of a newly identified brain tumor. Common sources include cancers of the lung, breast, kidney, skin, and gastrointestinal system.

When imaging suggests that a brain tumor may represent metastatic disease, additional testing is usually performed to identify the original cancer. When possible, the diagnosis may be confirmed by obtaining a biopsy from the suspected primary tumor or another area of disease outside the brain. In some cases, the brain lesion itself must be biopsied or removed to establish the diagnosis.

When there is a single brain metastasis, surgical removal may be recommended if the tumor is accessible and can be removed without causing unacceptable injury to critical areas of the brain. Surgery can provide a diagnosis, relieve pressure on the brain, and reduce symptoms. Treatment is commonly followed by stereotactic radiosurgery to the surgical area and systemic treatment directed at the original cancer, such as chemotherapy, immunotherapy, or targeted therapy.

When multiple brain metastases are present, treatment often includes stereotactic radiosurgery to the brain lesions and systemic treatment for the underlying cancer. Surgery may still be considered for a larger lesion that is causing significant pressure, neurological symptoms, or uncertainty about the diagnosis.

Treatment is individualized based on the number, size, and location of the tumors, the type of primary cancer, the patient's symptoms, and their overall health. Follow-up MRI scans are used to monitor the response to treatment and identify any new areas of disease.

An epidural hematoma is a collection of blood between the inner surface of the skull and the dura, the tough protective covering surrounding the brain. It most often occurs after a significant head injury and is commonly caused by bleeding from an injured artery.

Because arterial bleeding can expand rapidly and place dangerous pressure on the brain, an epidural hematoma can be a life-threatening neurosurgical emergency. A person may initially appear relatively well but then develop a worsening headache, vomiting, confusion, weakness, increasing sleepiness, or loss of consciousness.

When the hematoma is large, expanding, or causing pressure on the brain, emergency surgery is frequently required. A craniotomy allows the surgeon to remove the blood clot, relieve pressure on the brain, and identify and control the bleeding vessel. Prompt diagnosis and treatment can be lifesaving.

A subdural hematoma is a collection of blood between the surface of the brain and the dura. These hematomas can develop rapidly after a serious injury or accumulate more gradually over days, weeks, or months. They are commonly described as acute, subacute, or chronic based on their age and appearance.

Acute subdural hematomas often contain a firm blood clot and may cause significant pressure on the brain. A large or symptomatic acute hematoma may require an urgent craniotomy to remove the clot and relieve pressure.

Subacute and chronic subdural hematomas contain blood that has gradually begun to liquefy. Depending on their size, symptoms, and imaging appearance, treatment may include close observation with serial CT scans, drainage through one or more small burr holes, or evacuation through a craniotomy.

In selected patients, middle meningeal artery embolization may be used to reduce the blood supply to the membranes contributing to the hematoma. This may help prevent the hematoma from continuing to grow or returning after treatment.

Treatment is individualized based on the patient's symptoms, neurological examination, use of blood-thinning medications, and the size and pressure caused by the hematoma.

Cervical spinal stenosis is narrowing of the space around the spinal cord or the nerves as they exit the neck. It commonly develops from a combination of disc degeneration, arthritis of the spinal joints, bone spur formation, and thickening of the ligaments that support the cervical spine.

When narrowing affects an individual nerve root, it may cause cervical radiculopathy. Symptoms can include pain, numbness, tingling, or weakness that travels from the neck into the shoulder, arm, or hand. The exact pattern of symptoms depends on which nerve is affected.

When narrowing places pressure on the spinal cord, it may cause cervical myelopathy, or spinal cord dysfunction. Myelopathy may occur with or without significant neck or arm pain. Symptoms can include difficulty with balance or walking, loss of coordination, difficulty with fine motor tasks such as buttoning clothing or writing, numbness in the hands, and weakness in the arms or legs.

Treatment depends on the severity, duration, and progression of symptoms, as well as the degree of narrowing seen on imaging. Options may include observation, medication, physical therapy, or targeted spinal injections. When symptoms are progressive, spinal cord function is affected, or nonsurgical treatment has not provided adequate relief, surgery may be recommended to decompress the spinal cord and nerves. The specific surgical approach depends on the location and extent of the stenosis and may involve an anterior, posterior, or combined procedure.

Lumbar spinal stenosis is narrowing around the nerves in the lower back. It commonly develops from a combination of disc degeneration, arthritis and enlargement of the spinal joints, bone spur formation, and thickening of the ligaments that support the lumbar spine. A lumbar disc herniation occurs when part of a spinal disc extends beyond its normal position and places pressure on a nearby nerve.

Both conditions can cause lumbar radiculopathy, commonly called sciatica. Symptoms may include pain, numbness, tingling, or weakness that travels from the lower back into the buttock, thigh, leg, or foot. The pattern of symptoms depends on which nerve is affected. Some patients have little back pain and primarily experience symptoms in the leg.

Lumbar spinal stenosis may also cause neurogenic claudication. This can include pain, heaviness, numbness, or weakness in the legs that becomes worse with standing or walking and often improves with sitting or leaning forward. The distance a person can comfortably walk may gradually decrease as the narrowing becomes more severe.

Treatment depends on the cause, severity, and duration of the symptoms, as well as the degree of nerve compression seen on imaging. Options may include observation, medication, activity modification, physical therapy, and targeted spinal injections. Many disc herniations improve without surgery.

Surgery may be recommended when pain remains disabling despite nonsurgical treatment, weakness is developing or progressing, or the narrowing significantly limits walking and daily activity. Procedures may include removal of the herniated portion of a disc, decompression of the affected nerves, or decompression combined with spinal fusion when instability or deformity is also present.

Rarely, severe nerve compression can cause loss of bowel or bladder control, numbness around the groin or inner thighs, or rapidly worsening leg weakness. These symptoms may represent cauda equina syndrome and require immediate medical evaluation.

The sacroiliac joints connect the lower spine, or sacrum, to the pelvis. These joints help transfer weight between the upper body and the legs while allowing a small amount of movement. Sacroiliitis refers to inflammation of one or both sacroiliac joints, while sacroiliac joint dysfunction occurs when the joint becomes painful because of abnormal movement, degeneration, injury, or instability.

Pain is typically felt in the lower back, buttock, or area near the back of the pelvis. It may spread into the hip, groin, or upper thigh and can sometimes resemble pain caused by a lumbar disc or compressed nerve. Symptoms are often worsened by prolonged sitting or standing, climbing stairs, walking, transitioning from sitting to standing, or placing weight on one leg.

Diagnosis is based on the patient's symptoms, physical examination, and imaging when appropriate. Because sacroiliac joint pain can be difficult to distinguish from other causes of lower back and hip pain, a targeted injection of local anesthetic into the joint may be used to help confirm the diagnosis.

Treatment may include activity modification, anti-inflammatory medication, physical therapy, bracing, and image-guided sacroiliac joint injections. Radiofrequency treatment may be considered in selected patients to reduce pain signals from nerves surrounding the joint.

When symptoms remain severe despite appropriate nonsurgical treatment and diagnostic injections confirm the sacroiliac joint as the source of pain, minimally invasive sacroiliac joint fusion may be considered. This procedure is designed to stabilize the joint and reduce painful movement.

The multifidus muscles are small but important stabilizing muscles located along the back of the lumbar spine. They help control movement between the vertebrae and provide support during standing, walking, bending, and lifting.

Multifidus dysfunction occurs when these muscles do not activate or coordinate normally. This can reduce the spine's muscular stability and contribute to chronic mechanical low back pain. The condition may develop after a back injury, repeated strain, prolonged pain, or changes in the communication between the nerves and muscles.

Patients typically experience aching pain centered in the lower back. The pain may be worsened by prolonged sitting or standing, bending, lifting, or physical activity. Unlike pain caused by a compressed nerve, symptoms are usually concentrated in the back and may occur without significant pain, numbness, or weakness traveling down the leg.

Diagnosis is based on the patient's symptoms, physical examination, and review of imaging. Specialized examination maneuvers or physiological testing may also be used to determine whether the multifidus muscles are functioning properly.

Initial treatment commonly includes activity modification, medication, and physical therapy focused on strengthening the core and retraining the muscles that stabilize the spine. When chronic symptoms continue despite appropriate nonsurgical care, restorative neurostimulation may be considered in selected patients who have confirmed multifidus dysfunction and are not candidates for corrective spine surgery.

Restorative neurostimulation uses implanted leads to activate the nerves controlling the multifidus muscles. Unlike traditional spinal cord stimulation, which is primarily intended to interrupt pain signals, this treatment is designed to repeatedly activate and rehabilitate the muscles responsible for stabilizing the lower back. Improvement is generally expected to develop gradually as muscle control and spinal stability improve.

Lumbar spondylolisthesis occurs when one vertebra in the lower back slips forward or backward in relation to the vertebra next to it. This may develop from age-related degeneration of the discs and joints, a stress fracture in part of the vertebra, a congenital difference in spinal anatomy, trauma, or prior surgery.

Some patients have no symptoms, while others develop lower back pain, stiffness, or pain that worsens with standing, walking, bending, or lifting. If the slippage narrows the space around the nerves, it may also cause pain, numbness, tingling, or weakness that travels into the buttocks or legs. More significant narrowing can lead to heaviness or weakness in the legs with walking that improves with sitting or leaning forward.

Diagnosis usually includes a physical examination and imaging. Standing and bending X-rays can help show the amount of slippage and whether abnormal movement or instability is present. MRI may be used to evaluate the discs, spinal canal, and nerves.

Treatment depends on the severity of symptoms, the degree of nerve compression, and whether the spine is unstable. Options may include observation, medication, activity modification, physical therapy, and targeted spinal injections.

Surgery may be considered when symptoms remain disabling despite nonsurgical treatment, weakness is developing, walking is significantly limited, or imaging shows instability with nerve compression. Surgery may involve decompression of the affected nerves and spinal fusion to stabilize the slipped vertebra. The specific procedure is tailored to the patient's anatomy, symptoms, and degree of instability.

Carpal tunnel syndrome occurs when the median nerve is compressed as it passes through a narrow space in the wrist called the carpal tunnel. This nerve provides sensation to the thumb, index finger, middle finger, and part of the ring finger. It also helps control some of the muscles at the base of the thumb.

Symptoms commonly include numbness, tingling, burning, or pain in the hand and fingers. Symptoms are often worse at night and may wake patients from sleep. Some people notice hand weakness, difficulty gripping objects, or a tendency to drop items. In more advanced cases, there may be persistent numbness or loss of muscle bulk at the base of the thumb.

Diagnosis is based on the patient's symptoms and physical examination. Nerve conduction studies and electromyography may be used to confirm the diagnosis and determine the severity of the nerve compression.

Initial treatment may include activity modification, nighttime wrist splinting, anti-inflammatory medication, or a corticosteroid injection. When symptoms persist, weakness develops, or testing shows significant nerve damage, carpal tunnel release may be recommended. This procedure relieves pressure on the median nerve by opening the ligament that forms the roof of the carpal tunnel.

Ulnar nerve entrapment occurs when the ulnar nerve is compressed or irritated, most commonly at the elbow in an area known as the cubital tunnel. The ulnar nerve provides sensation to the small finger and part of the ring finger. It also helps control many of the small muscles responsible for hand strength and coordination.

Symptoms may include numbness, tingling, or burning in the small and ring fingers. Symptoms are often worsened by bending the elbow, leaning on the elbow, driving, or sleeping with the arm bent. Patients may also notice reduced grip strength, difficulty with fine hand movements, hand clumsiness, or weakness when spreading the fingers apart.

Diagnosis is based on the patient's history, physical examination, and often nerve conduction studies with electromyography. These tests can help identify the location and severity of the nerve compression.

Nonsurgical treatment may include avoiding prolonged elbow flexion or pressure on the elbow, using a nighttime brace, and modifying activities. When symptoms continue, weakness progresses, or testing shows significant nerve damage, surgery may be recommended to decompress the nerve. In some cases, the nerve is also moved to a new position in front of the elbow to reduce tension and irritation.

Peripheral neuropathy refers to damage or dysfunction involving nerves outside the brain and spinal cord. It may affect a single nerve or many nerves throughout the body. Possible causes include diabetes, autoimmune or inflammatory disorders, vitamin deficiencies, infections, inherited conditions, exposure to certain medications or toxins, and other medical illnesses.

Symptoms vary depending on the nerves involved. Patients may experience numbness, tingling, burning pain, unusual sensitivity, weakness, loss of coordination, or difficulty with balance. Symptoms commonly begin in the feet or hands and may gradually spread.

Evaluation may include a neurological examination, blood testing, nerve conduction studies, electromyography, genetic testing, or a skin biopsy. In selected cases, the cause remains uncertain and examination of a small piece of nerve tissue may help establish the diagnosis.

A sural nerve biopsy removes a short segment of a sensory nerve near the outer ankle for examination under a microscope. Because this nerve primarily provides sensation to a small area of the foot, it is often selected when a nerve biopsy is necessary. The procedure may help identify certain inflammatory, vascular, infectious, infiltrative, or degenerative nerve disorders.

A sural nerve biopsy is not required for most patients with neuropathy. It is generally reserved for carefully selected cases in which the results are likely to clarify the diagnosis or change treatment. Because removing part of the nerve causes permanent numbness in its sensory area and can occasionally result in persistent nerve pain, the potential benefits and risks are reviewed carefully before proceeding.

Chronic pain is pain that continues beyond the expected period of healing and may persist for months or years. It can develop after an injury, surgery, nerve damage, or degenerative changes in the spine. In some patients, pain continues even after the original problem has been treated.

Symptoms may include persistent back, neck, arm, or leg pain, as well as burning, tingling, sensitivity, or electric shock-like sensations. Chronic pain can interfere with sleep, mobility, work, and daily activities.

Treatment is individualized and may include medication, physical therapy, activity modification, injections, behavioral pain-management strategies, and treatment of any correctable structural problem. When pain remains severe despite appropriate nonsurgical care and there is no additional surgery likely to provide meaningful relief, neurostimulation may be considered.

Spinal cord stimulation uses small implanted leads to deliver mild electrical signals near the spinal cord. These signals are designed to modify how pain messages are transmitted and perceived. It may be considered for conditions such as persistent pain after spine surgery, chronic nerve pain, complex regional pain syndrome, or certain forms of back and leg pain.

Before a permanent device is implanted, patients usually undergo a temporary stimulation trial. This allows them to evaluate whether the treatment provides meaningful pain relief and improves function. If the trial is successful, a permanent system may then be placed.

Neurostimulation does not cure the underlying condition and does not eliminate pain in every patient. Its goal is to reduce pain, improve activity and quality of life, and potentially decrease reliance on pain medication.