Brain Aneurysms
Brain aneurysms are weak areas in blood vessels of the brain. While we don't know completely why they develop we do know some risk factors such as being female or smoking or certain kidney diseases or diseases involving connective tissues. Approximately 2% of adults in the U.S. have a brain aneurysm so they aren't common. Most brain aneurysms never cause trouble but all true brain aneurysms have a chance of rupturing and causing a serious, sometimes fatal, type of bleeding around the brain called a subarachnoid hemorrhage. Things like aneurysm size, aneurysm shape, aneurysm location, imaging characteristics and your medical history all influence how likely an aneurysm is to rupture. For low risk aneurysms observation with things like MRIs or CT scans is often the best course and some aneurysms never need to be repaired. For those aneurysms needing to be fixed Dr. Son has one of the busiest practices in south and central Texas. Many aneurysms that do need to be fixed can be done so minimally invasively from inside the blood vessels without an incision. Having the full breadth of experience and techniques and tools to treat aneurysms means patients get the individualized care they deserve.
Vascular Malformations
Broadly vascular malformations are abnormal connections between blood vessels. True arteriovenous malformations (AVMs) are a tangle of these abnormal connections that people are born with. Other types of vascular malformations including arteriovenous fistulas (AVFs). These malformations are often times asymptomatic but can pose a number of risks including bleeding in or around the brain or spine, venous strokes or seizures. Some of these risks can leave patients with serious deficits like weakness or numbness or trouble with memory or speech. Bleeding from these malformations can also sometimes be life threatening. The treatment of vascular malformations depends on many factors including your health and age, the type, its anatomy and the malformation's location. Options for treatment also depend on the same factors but sometimes include highly focused radiation called stereotactic radiosurgery/Gamma Knife, surgery to remove the malformation or embolization from inside the blood vessels. These full breadth of treatment options are available with Dr. Son and Neurosurgical Associates of San Antonio.
Carotid Stenosis
Carotid stenosis refers to narrowing of the major artery that supplies blood to the brain in your neck. The most common cause of this is a condition called atherosclerosis where plaque builds up within the blood vessel and narrows it. As the blood vessel narrows there is a chance of a stroke where the brain does not get enough blood and part of it goes on to die. For people with certain forms of carotid stenosis certain surgeries and procedures can help prevent a future stroke. These include surgery to remove the plaque - called a carotid endarterectomy (CEA) - or implantation of stents from inside the blood vessel under x-ray guidance to open up the space narrowed by the plaque - a transcarotid artery revascualrization (TCAR) or carotid artery stent (CAS). Dr. Son has experience in all techniques for carotid artery stenosis to help prevent future strokes.
Strokes
A stroke refers to a period where a portion of the brain does not get enough blood and oxygen. If this goes on long enough that area of brain will die. Strokes can have many causes but the most devestating causes are when large blood vessels to the brain get blocked, often from blood clots that form from carotid stenosis or irregular heart beats. When strokes are caused by a large vessel occlusion (LVO) Dr. Son is often able to go from inside the blood vessels emergently and suck out hte clot to reopen the vessel. Strokes are medical emergencies and if you suspect you or another are having a stroke you should immediately call 9 - 1 - 1.
Cavernous Malformations
Cavernous malformations, sometimes called cav mals, are abnormal collections of blood vessels like other vascular malformations. They are oftentimes acquired - that means they grow over time and most people are not born with them. We know certain risk factors for developing cav mals including certain mutations in genes and radiation exposure. They are prone to cause bleeding in the brain and/or irritation to the surrounding brain and seizures based on their location. The definitive treatment of cav mals that cause trouble is surgery to remove them. But decisions on which cav mals to resect is complex and should factor in your age, comorbidities, symptoms from the cav mal and its location in the brain amongst other things. Luckily Dr. Son has lengthy experience in helping patients make these kind of decisions and with surgery for cavernous malformations when appropriate.
Moya Moya
Moya Moya syndrome or disease is an extremely rare condition where the large blood vessels around the brain slowly close down. While some conditions - such as uncontrolled diabetes or exposure to radiation - can prompt Moya Moya, for many people with the disease it is idiopathic, meaning we don't completely understand why it happens. As these large blood vessels slowly close down it puts patients at risk of having strokes or bleeding in or around the brain. For patients who have had a stroke from Moya Moya surgery is almost always appropraite to help prevent future strokes. This surgery, called a bypass, typically takes blood vessels from the scalp and supplies them to the area of the brain where the blood vessels are closing. For those patients with Moya Moya without symptoms the exact treatment is often more nuanced.
Pseudotumor Cerebrii
Pseudotumor cerebrii is also known as idiopathic intracranial hypertension. While it can occur in anyone it most commonly occurs in young women. In this condition the pressure inside the head is too high. This may be because the body does not reabsorp the cerebrospinal fluid (CSF) everyone makes to bathe their brain very well back into the major veins of the brain. Or sometimes it is because the major veins that drain the brain are narrowed and not draining properly. The excess pressure inside the head can cause intense headaches. Sometimes the excess pressure can damage the nerves that go to the eyes and cause permanent vision damage. For most patients medications and weight loss can greatly control the increased pressure. For some patients these are not enough and certain procedures such as using a stent from inside the blood vessels to reopen the narrowed veins or a shunt to drain CSF can greatly help. Fortunately Dr. Son is well versed in all the treatment options for pseudotumor and here to help.
Chiari Malformation
In Chiari malformations there is not enough room within the skull for a portion of the brain at the back called the cerebellum. This part of the brain is thus pushed through the narrow opening at the base of the skull and down around the spinal cord. The most common type of Chiari malformation is a type I and while, if particularly severe, these can be symptomatic soon after birth or in childhood for many people with milder forms it may not cause problems until later in life. Sometimes symptoms are triggered by trauma or other conditions. Symptoms can range for mild headaches to damage to the spinal cord and weakness or numbness. Not all Chiari malformations needs to be treated and such decisions can be influenced by symptoms and appearance on imaging. For those that are treated the most common treatment involves removing bone at the back of the skull to give the cerebellum more room.
Spinal Fluid Leak
A spinal fluid leak occurs when the normal cerebrospinal fluid (CSF) our body makes to cushion our brain and spine leaks out. Too little spinal fluid, as happens during a leak, can lead to intense symptoms with the most common being a debilitating headache which improves at least some when patients are lying down. While sometimes spinal fluid leaks can happen after surgery on the brain or spine or after trauma, often times they happen spontaneously and the cause is unclear. The most common location for these spontaneous spinal fluid leaks is around the spine. Subtle spinal fluid leaks can sometimes be difficult to locate but advanced techniques like digital subtraction myelography (DSM), as used by Dr. Son, can help. In addition some spinal fluid leaks - namely those caused by an abnormal connection with a vein - can be treated minimally invasively without surgery.
Normal Pressure Hydrocpehalus
Normal hydrocephalus (NPH) is a disease in the elderly where the normal flow of cerebrospinal fluid (CSF) that our brain makes to cushion it and the spine is impaired. This causes a build up of the fluid which we call hydrocpehalus. The exact cause of normal pressure hydrocpehalus is not completely understood. The common symptoms are memory trouble, trouble walking and accidents where patients lose control of their bladder. It is easy to confuse normal pressure hydrocpehalus with other forms of dementia like Alzheimer's. However, NPH is one of the rare causes of dementia for which we have a relatively good treatment and so it is important to diagnose it. The treatment typically consists of a small tube, called a shunt, which drains the excess CSF from the brain, runs under the skin and deposits the fluid in the patient's belly where the body can reabsorb it. Diagnosing NPH may consist of special brain scans and a lumbar puncture or drain to see if patient's get better when spinal fluid is temporarily drained.
Brain Tumors
A brain tumor is an abnormal growth of tissue in or around the brain. Not all brain tumors are cancer but some are. Sometimes these tumors can come from cancers in other areas of the body and metastasis to the brain. Some are non cancerous tumors that start up around the brain. Yet others are forms of cancer that start in the brain itself. There is no uniform treatment for a brain tumor. Options depend on whether the tumor is cancerous or not, patient's other medical conditions, the tumor location and symptoms amongst many others. Treatment options may range from just watching the tumor to surgery to radiation. The neurosurgeons at Neurosurgical Associates of San Antonio, including Dr. Son, can walk you through complex decisions such as these if you've been diagnosed with a brain tumor.
Spinal Stenosis
Spinal stenosis is a condition wherein the spinal cord or the nerves to the arms and legs are pinched. This pinch can occur because of the build up of arthritis or herniated discs or other conditions. Symptoms can include pain - especially when standing or walking - numbness or even weakness. When surgery is right for spinal stenosis Dr. Son's endoscopic and ultra minimally invasive techniques can often aid with a quick recovery and get patient's back on their feet..
Herniated Discs
The vertebral column around the spinal cord is made up of bones that are seperated by, and sit on top of, discs that act as shock absorbers. Sometimes these discs can herniate, or slip out and push on the spinal cord or nerves going to the arms and legs. This can cause intense pain, numbness or even weakness. While many herniated discs will get better with time not all do. When they continue to cause problems surgery to remove the part of the disc that has herniated out can provide immense pain relief and allow patients to recovery. Endoscopic surgery for such, as done by Dr. Son, is the most minimally invasive way to remove the painful herniated disk and allows for a much better patient experience and recovery.
Sciatica
Sciatica is a nerve type pain into the legs. It is often times caused by a pinch on a nerve to the leg either from arthritis or a herniated disc. Many bouts of sciatrica will improve with time and conservative management including physical therapy, medications and injections. When that fails often times minimally invasive surgery can aid in relieving the pain. Find out how Dr. Son can help if you're suffering from sciatica.
Vertebral Fracture
Vertebral compression fractures, also called insufficiency fractures, are painful fractures that can occur because of osteoporosis (weakening of the bones) or infection or tumors. They happen when parts of the vertebrae - the boney rings that surround the spinal cord and nerves - collapses or pancakes down. Despite not looking impressive on x-rays they can cause debilitating pain. For these fractures there is often time minimally invasive procedures that Dr. Son can use to dramatically help patient's pain and allow a return to functionality.
