Goals of Brain Tumor Surgery

When it comes to brain tumor surgery, surgeons have two main goals:

• Remove as much of the tumor as possible.
• Protect important brain functions, especially those related to speech and movement.

To achieve this delicate balance, Dr. Rima Rindler, neurosurgeon with Sierra Neurosurgery Group, performs a special kind of operation called an awake craniotomy.

What is an Awake Craniotomy?

An awake craniotomy is a type of brain surgery where the patient is awake during part of the operation. This might sound scary, but it actually helps doctors ensure that they do not harm critical areas of the brain responsible for speech, movement, and other essential functions.

Why Choose an Awake Craniotomy?

Removing Brain Tumors Safely

Tumors can be located deep within the brain or near important regions such as the frontal or temporal lobes. These areas control vital functions such as speaking, moving, and thinking. During an awake craniotomy, doctors can directly interact with the patient to ensure these functions are not being affected or damaged while removing the tumor.

A Team Effort

Performing an awake craniotomy requires a team of specialists, including:

• Neurosurgeons
• Anesthesiologists
• Neuropsychologists
• Neurophysiologists
• Surgical technicians
• Nursing staff

This multidisciplinary team works together to ensure the patient’s safety and comfort throughout the surgery.

How Does an Awake Craniotomy Work?

Before Surgery

The patient is put under general anesthesia to make the initial steps of the surgery comfortable. The scalp is numbed with medication to prevent pain during the surgery. The patient is positioned comfortably with the head secured for safety. The surgeons then proceed to expose the brain and locate the tumor. “Preparing the patient to undergo this incredibly unique experience is something we take special pride in and pay special attention to, which has led to many successful operations,” confirms Dr. Rindler.

During Surgery

Once the brain is exposed, the patient is gently awakened. This is when the truly remarkable part of the surgery begins. The patient is asked to perform simple tasks, such as speaking, answering questions, or moving a hand or foot, while the neurosurgeons use tiny electrical impulses to stimulate different parts of the brain. This helps the doctors identify and avoid critical areas that control these functions.

The Patient Experience

“Overall patient feedback has been neutral to positive,” says Dr. Rindler. “Everyone is, understandably, nervous before surgery. We make sure that the patient is positioned comfortably and is not feeling any pain. Most people report a severe dry mouth as the most difficult part of it.” Most patients remember the parts of the surgery when they are awake, but have not noted that the experience was distressing. This speaks to the careful and considerate handling by the surgical team.

Benefits of Awake Craniotomies

Awake craniotomies have revolutionized brain surgery. According to Dr. Rindler, “Awake craniotomies increase the margin of safety of resecting brain tumors,” allowing for more precise surgeries. By directly interacting with the patient, surgeons can better navigate the complex landscape of the brain, minimizing the risk of damaging important functions.

Patient Stories and Feedback

Patient feedback has been generally positive. Despite initial fears, many find the experience less daunting than expected. The personalized attention and expertise of Dr. Rindler and her team play a crucial role in making patients feel cared for and secure. According to the National Institutes of Health, an awake craniotomy is well tolerated by patients.

Sierra Neurosurgery Group’s Expertise

Sierra Neurosurgery Group has been performing awake craniotomies for function mapping and placement of deep brain stimulators for movement disorders, over the last decade. The most current program for awake craniotomies for resection of intra-axial brain tumors began in the summer of 2023.

A Consistent, Multidisciplinary Approach

The goal of this new program is to develop an expert team that consistently provides high-quality care. This multidisciplinary team works together to seamlessly perform awake mapping of speech and motor areas during tumor resection, ensuring the best possible outcomes for patients.

A Brave Choice for Better Brain Surgery Outcomes

“Choosing to undergo brain surgery while awake is incredibly brave,” states Dr. Rindler. It offers the best chance to remove as much of the tumor as possible while preserving essential brain functions. Dr. Rindler and the team at Sierra Neurosurgery Group are dedicated to making this unique experience as positive and successful as possible.

If you or a loved one needs brain surgery or a second opinion, you can ask your doctor for a referral to Sierra Neurosurgery Group at (775) 323-2080.

A Surprising Diagnosis

It was a normal day for Kristopher Dahir. He was out on his usual run when his legs felt strange, again. He had been experiencing unusual leg spasms for a while. “The symptoms began by me having seizures in my legs and so I was running or doing whatever and all of a sudden, my leg would just start twitching and start doing some crazy things,” he recalls.

Kristopher consulted his doctor, which led him to a neurologist. An MRI image of his brain was ordered to find out what was causing his unusual symptoms. The results revealed a brain tumor. With this challenging diagnosis, Kristopher wrestled not only with the decision of whether to remove the tumor, but also with the key choice of selecting a surgeon.

Although some friends urged him to go out of state for his brain surgery, Kristopher set up an appointment with local board-certified neurosurgeon Dr. Christopher Demers, of Sierra Neurosurgery Group. During the office visit Kristopher asked, “What if I want to go somewhere else?” Dr. Demers told him, “If we get in there and there’s anything that does not look like something I know I can take care of we’ll just seal it back up, and we will help get you wherever we need to take you,” which put Kristopher at ease. Kristopher paused his duties as a Sparks City council member, ultimately deciding to trust the surgical skills of Dr. Demers and to stay in Northern Nevada for his complex brain tumor surgery.

In Expert Surgical Hands with Dr. Demers

“The most important thing in the doctor-patient relationship is trying to be honest with patients about what problems they’re having, about what the risks are of doing surgery,” says Dr. Demers. “If that’s something that I would recommend, but also what the risks are sometimes of not doing surgery.”

Every brain surgery is significant, and this was an intricate one. “Because this tumor involved the edge of the superior sagittal sinus that large draining vein, there was definitely a possibility that removing this tumor could take his life because of bleeding from this vein or from what we call an air embolism actually having air sucked into that sinus,” recalls Dr. Demers.

The option of not having surgery was not a reasonable one explains Dr. Demers, “If he didn’t have surgery we knew that we might be able to control he seizure symptoms with medications, but if he’s already presenting to me with weakness because that tumor is putting pressure on that motor strip then waiting to do surgery means that the tumor would have had an opportunity to get larger and when those tumors get larger they put more pressure on the brain and possibly cause irreversible damage to the brain.”

A Serious, but Hopeful Brain Surgery

Kristopher faced the surgery with a determination deeply rooted in his faith. The uncertainty of the brain surgery weighed heavily on him. “The week coming up to the night before (surgery) I sat and wrote letters to my kids and my wife saying goodbye,” he says. “The list of the potential problems that could come were very real. I believe I get to live a life of what it means to have hope and faith and all those things and so we really live his out in front of everybody.”

Implications of the surgery’s outcome also affected his wife, Melissa, “It was very scary; it was very disconcerting. My faith is strong and so I rely a lot on prayer,” she shares. “It also helped me just to focus on what a gift it is to have had this much time with this person that I love so much and if this is all that I could have… it was worth it,” she emotionally adds.

Clyde and the Community

To bring some humor into such an uncertain situation they named the brain tumor Clyde. Fortunately, after surgery, Kristopher retained his mental and motor functions, and they found out the brain tumor was not cancerous. Then the full focus turned to Kristopher’s recovery including physical therapy to restore the mind and muscle link.  “We like to look at our lives as a as a story. It’s been an adventure,” says Kristopher.

Because they chose to stay at home, during this challenging time Kristopher and Melissa felt the support of their friends, family, and community. “Being able to have those loved ones around to support us, and to be there at the hospital, and to say, ‘Are you okay?’ and ‘Can I bring you some food?’ that meant a whole lot,” says Melissa.
“And then even for recovery as soon as we were able to come home to just know that we could be here in our own surroundings with our support group network of humans to be there with us, I think that was really helpful,” she remembers.

Being close to loved ones gave Kristopher a strong support system, helping both his emotional and physical recovery. The convenience of local care also eliminated the stress and logistical challenges of long-distance travel, allowing him to focus on his healing journey in a familiar and comforting environment.

Getter Stronger Every Day

“Probably one of the most frustrating things for anybody who walks through something like this is that the things that you know you can do – you just can’t do them,” states Kristopher. As the months have passed, he feels an improvement in his energy and is resuming his pre-surgery activities and community service with vigor and determination.

This experience has made Melissa especially grateful to Dr. Demers, “Thank you so much for this. For giving me more time with this person that I love more than anything and giving our kids and our grandbaby the chance to have more time with him.”

Looking back, Melissa also says, “I’m so glad we stayed here, and I think it was the best option for us.”

Local Care Supports Recovery

Today, Kristopher Dahir is active and well. By opting for local care, he chose not just an excellent surgeon and medical team, but a community invested in his well-being. You can view Kristopher’s story on YouTube.

Sierra Neurosurgery Group is widely known in Northern Nevada for its exceptional surgical skills and a team of experienced neurosurgeons, pain management physicians, and sports medicine experts, providing top-notch care close to home.

Sciatica can be a painful and challenging condition, but understanding the sciatic nerve, its importance, and the causes of sciatic pain can help you take the first steps toward relief. Pain management doctors are experts in diagnosing and treating sciatica, offering a range of treatments from medications to injections. In this article, Christopher Woolley, M.D., D. ABA, discusses this condition and treatment options.

What is the Sciatic Nerve?

The sciatic nerve is one of the most important nerves in your body. It starts in your lower back as spinal nerve roots coming from the L4 to S3 level and runs all the way down to your feet. It’s the longest and largest nerve in your body and is responsible for connecting your spinal cord with your leg and foot muscles.

Why Is It Important?

The sciatic nerve plays a crucial role in your ability to walk, run, and even stand. Here is why:

Movement: It controls the muscles in the buttock, back of your leg, your knee and lower leg.

Sensation: It allows you to feel sensations in the back of your thigh, part of your lower leg, and the sole of your foot.

Reflexes: It helps with the reflexes in your lower body. If something goes wrong with your sciatic nerve, it can cause a lot of problems. That is why understanding this nerve is so important.

Causes of Sciatic Pain and Where the Pain Can Be Located

Sciatica is the name for pain caused by irritation or compression of the sciatic nerve. In fact, according to Harvard Health up to 40% of people will experience it in their lifetime, and the chances of experiencing this pain increases as people age. But what causes this pain, and where can you feel it?

4 Common Causes

Herniated Disc: This is the most common cause of sciatica. A herniated disc occurs when one of the discs in your spine is damaged and presses on the roots of the sciatic nerve.
Spinal Stenosis: This condition involves the narrowing of the spinal canal, which can put pressure on the roots of the sciatic nerve.
Piriformis Syndrome: The piriformis muscle, located in the buttock region, can sometimes press down on the sciatic nerve if the muscle spasms or tightens.
Injury: A direct injury to the lower back or buttocks can damage the sciatic nerve.

Where Can You Feel Sciatic Pain?

The pain can be felt in various parts of your body, depending on where the nerve is affected.
Here is a breakdown:

• Lower Back: Often, the pain starts in the lower back.
• Buttocks: The pain can radiate from the lower back to the buttocks.
• Legs: You might feel pain down one or both legs, sometimes extending to the foot.
• Feet: In severe cases, the pain can reach your feet and toes.

The pain can be sharp, burning, or even feel like an electric shock. It can also cause numbness, tingling, or muscle weakness in the affected leg or foot.

How a Pain Management Doctor Can Help You

Dealing with sciatic pain can be a daily challenge. The good news is that a pain management doctor can help with diagnosing and treating all types of pain, including sciatica. “As a pain management physician, we have lots of options for treating leg pain like sciatica,” says Christopher Woolley, MD, D. ABA. “There are procedures such as epidural steroid injections that can be done in our office that are performed at the level of the spine that may be causing the problem. If someone has tried epidural steroid injections but has not found relief (or has only gotten short term relief with these), we have other non-surgical interventions like spinal cord stimulation that can help with sciatica symptoms. Aside from interventional options, we have many different nerve pain medications or types of physical therapy we can recommend that are helpful with sciatic nerve pain. “

What Does a Pain Management Doctor Do?

• Diagnosis: The first step is to find out what is causing your pain. The doctor will ask about your symptoms, perform a physical exam, and might order imaging tests such as an MRI or X-ray.
• Treatment Plan: Once they know the cause of your pain, they will create a treatment plan tailored to your needs.

Treatments for Sciatic Pain

Here are some common treatments that a pain management doctor might recommend:

Medications:

• Pain Relievers: Over-the-counter or prescription pain relievers can help reduce pain.
• Anti-inflammatory Drugs: These can help reduce inflammation around the sciatic nerve.
• Muscle Relaxants: If muscle spasms are causing the pain, these can help.

Physical Therapy:

• Exercises: Specific exercises can strengthen the muscles around your spine and improve flexibility.
• Stretches: Stretching exercises can help relieve pressure on the sciatic nerve.

Injections:

• Steroid Injections: These can reduce inflammation and provide relief from pain.
• Nerve Blocks: These injections can block pain signals from the affected nerve.

Lifestyle Changes:

• Weight Management: Maintaining a healthy weight can reduce pressure on your spine.
• Posture: Improving your posture can help prevent sciatic pain.
• Exercise: Regular exercise can keep your back strong and flexible.

In most cases, sciatica can be treated without surgery. However, if the pain is severe and does not improve with other treatments, surgery might be an option. A pain management doctor can refer you to a surgeon if needed.

By working with a pain management doctor, you can find the right treatment plan and get back to enjoying your life without pain. If you are dealing with sciatic pain, do not hesitate to set up an office visit with us at 775-323-2080.

Keep Your Active Lifestyle: Disc Replacement vs. Spinal Fusion 

We all want to lead an active lifestyle as we age, but sometimes, spinal disc issues can threaten to slow us down. If you’ve been offered spinal fusion to reduce your spine pain, consider a disc replacement to preserve the motion in your neck or back. Let’s explore the benefits of disc replacement surgery and why it might be the ideal choice for those with active lifestyles.

Understanding Disc Replacement and Spinal Fusion

Disc replacement surgery, also known as artificial disc replacement (ADR), is a leading-edge procedure that replaces your damaged spinal disc with an artificial one, maintaining the natural movement of your neck or back. On the other hand, spinal fusion surgery joins two or more vertebrae together to eliminate motion entirely in the affected area.

Leading-Edge Disc Replacement Surgery – The Gold Standard for Athletes
You may not know what it’s like to be an NHL player, but you have access to the same surgical innovation that allowed Vegas Golden Knights center Jack Eichel to hoist a Stanley Cup. Eichel had an artificial disc placed in his neck in 2021. Three months after his ADR surgery he was back on the ice, and he hasn’t stopped since. Other athletes such as six-time PGA Tour winner Rory Sabbatini and Chicago Blackhawks forward Tyler Johnson, have also benefited from ADR.

4 Benefits of Artificial Disc Replacement Surgery

1. Preserves Your Natural Spinal Flexibility

Your neck and lower back are designed for natural movement whether it’s hitting the perfect tee shot, returning a backhand on the court, or playing a game of catch. Disc replacement allows you to maintain your spine’s flexibility and range of motion, preventing stiffness and restrictions. You can continue to enjoy the activities you love without the fear of becoming a human statue.

2. Prevents Future Disc Issues and Surgeries

Spinal fusion may alleviate pain in one area, but it can transfer stress to nearby segments, potentially causing future surgeries. Disc replacement minimizes this risk by preserving the spine’s natural biomechanics, reducing the chances of additional complications.

3.  Faster Recovery and Less Pain

Disc replacement offers a shorter recovery period compared to spinal fusion. Less pain and a shorter hospital stay means you can get back to the activities you enjoy sooner.

4. Long-Term Pain Relief and Motion Preservation

Disc replacement has shown remarkable long-term success rates, providing lasting relief for individuals with active lifestyles. Unlike some alternatives, it allows you to continue enjoying your favorite activities for years to come.

“If you’ve been offered a fusion, come in for a consultation to see if you are a candidate for disc replacement surgery,” says Chris Demers, MD, FAANS. Disc replacement is not only the preferred choice for athletes, but it can also help non-athletes return to the activities they enjoy. Disc replacement preserves natural motion, minimizes risks of more surgeries to adjacent discs, ensures a quicker recovery, and offers long-term success. Don’t let back pain limit your quality of life.  Call us at 775-323-2080 or email info@sierraneurosurgery.com to request a disc replacement consultation.

While the dangers of tobacco to lung health are well-known, its harmful effects on spine health are often overlooked. This blog post explores the link between smoking and back pain, how lighting up can worsen existing spine issues and even delay the healing process of surgery.

 Smoking and Back Pain: A Dangerous Duo

Research confirms a disturbing truth: smoking can significantly contribute to, and worsen, back pain. Studies have shown that smoking accelerates spondylosis, a condition characterized by the degeneration of spinal discs and facet joints. Additionally, nicotine and other harmful chemicals in tobacco smoke restrict blood flow to your spine, impairing the delivery of vital nutrients and oxygen to the affected area. This compromised circulation can lead to inflammation, tissue damage, and heightened sensitivity to pain, making everyday movements even worse for smokers battling back issues.

How Smoking Hinders Healing

“Beyond making your existing back pain even worse, smoking can be an obstacle to your recovery from spinal surgery,” says Jay Morgan, MD, FAANS, neurosurgeon at Sierra Neurosurgery Group. The process of tissue repair and fusion, crucial for healing fractured vertebrae or addressing spinal conditions such as pseudarthrosis (a disease that occurs when a broken bone fails to heal after a fracture), can be significantly reduced in smokers. Nicotine disrupts the body’s ability to form new blood vessels, vital for delivering nutrients to injured tissues and helping the healing process. Because of this, smokers may experience delayed wound healing, an increased risk of complications after surgery, and a greater likelihood of failed spinal fusion procedures. This highlights the importance of quitting smoking 4-6 weeks before undergoing spinal surgery, and remaining smoke free 4 weeks after surgery, to better the chances of a successful outcome and long-term relief.

Going Up in Smoke: The Threat to Bone Density

Besides its direct impact on spinal health, smoking can indirectly contribute to back pain by decreasing bone density. Osteoporosis, a condition causing  weak and brittle bones, is more common among smokers due to the harmful effects of tobacco on bone metabolism. Research suggests that smoking accelerates bone loss, heightening the risk of fractures in the spine and other bones. These fractures can trigger excruciating back pain, reduced mobility, and an increased risk of further injuries. By undermining bone strength, smoking not only aggravates existing back pain, but also sets the stage for future spinal complications.

Conclusion: The evidence is clear: smoking poses a significant threat to spine health, worsening back pain and slowing down the healing process for those struggling with spinal injuries or undergoing surgery. From accelerating spinal degeneration to weakening bone density, tobacco takes a negative toll on your spine. However, by embracing a smoke-free lifestyle, you can take proactive steps towards relieving your back pain, promoting healing, and ensuring the future health of your spine.

In the past, Nevada has gone through a crisis of losing physicians about every 20 years.

1975 – medical malpractice insurers pulled out of Nevada because of high litigation costs, and as a result, physicians could not obtain liability insurance. To fix this, the state created the Nevada Medical Liability Insurance Association to provide doctors with liability coverage. This company was subsequently sold after the medical malpractice insurance market stabilized.

Early 2000s – medical malpractice premiums again increased significantly. As a result, four insurance carriers stopped offering liability coverage to physicians, and for some doctors, premiums leaped from $40K to $200K per year.  This caused 30 OB-GYNs to leave Clark County, and physicians in other specialties, including neurosurgery and emergency medicine, to limit their practices. In addition, critical hospital services were at risk. Many other doctors were unable to purchase malpractice insurance because insurers had pulled out of Nevada.

The Nevada State Assembly Judiciary Committee is working on two critical bills AB 404 and AB 209. Both bills would be a major blow to the reasonable protections Nevada voters approved in 2004 to guard the health care community from outsize legal actions and safeguard patient’s rights to have access to a health care provider.

Nevada has a very fragile healthcare delivery system. The passing of AB209 and AB404 will likely worsen Nevada’s physician shortage due to the skyrocketing cost of malpractice insurance making it difficult to deliver key services.

We need to let our legislators know we oppose AB 209 and AB 404, as they threaten the delivery of medical care to Nevadans. Your voice is vital to keep doctors in Nevada and protect our community’s right to access health care how and when we need it.

What you can do:

Sign the Online Petition

Submit Your Opinion

Your opinion does not need to be long. It can simply be:

1. I need my doctor to stay in Nevada! Passing this bill may drive doctors from the state.
2. Protect my right to the healthcare me and my family needs – oppose this bill.

Contact your Legislator

Tell your legislator you are a concerned citizen.
Who’s My Legislator?

Thank you for your support on this important issue,

The Physicians of Sierra Neurosurgery Group

There’s no way around it: being diagnosed with a brain tumor and experiencing the symptoms associated with a brain tumor is a life-changing experience. In medicine, knowledge is power, and working with the right team of experts to diagnose and treat your brain tumor is essential. As with most tumors, generally speaking, the earlier the diagnosis, the better the prognosis. Therefore, it’s important to know some specifics about brain tumors so that you can take care of yourself, get support and the medical interventions you need.

A brain tumor is an abnormal growth of cells in the brain. Approximately 700,000 Americans currently live with primary brain tumors, with 88,970 new primary brain tumor diagnoses estimated for 2022. Brain tumors are relatively rare, but they are disproportionately fatal and thus receive special attention in the healthcare fields and in medical literature.

There are many different varieties of brain tumors. Some are benign and noncancerous, while others are malignant and cancerous. Primary brain tumors originate in the brain, while secondary (or metastatic) brain tumors start from cancerous growths in other parts of the body and spread to the brain.

Brain tumors can have varied effects on the nervous system, depending on their points of origin, rates of growth, and other factors. These factors also influence recommended courses of treatment. When treating a brain tumor, it’s important to understand your symptoms and to work with a multidisciplinary team, typically radiation oncology, neurology, neurosurgery, and primary care physicians.

Symptoms of brain tumors

Common symptoms related to brain tumors can present themselves at different times and in different ways depending on the type of brain tumor, its location, its rate of growth, the patient’s overall health and lifestyle, and other factors.

Some common symptoms of brain tumors include:

• Headaches, particularly if they are increasing in frequency and severity
• New issues with vision: blurry vision, double vision, etc.
• Dizziness, nausea, vomiting, or vertigo without a known explanation
• Lessening sensation in an arm or leg, or decreasing ability to move your extremities
• Confusion, fatigue, and a decrease in normal cognitive function or environmental awareness
• Loss of ability to communicate, answer simple questions, or follow normal instructions
• Seizures with no other explanation
• Hearing loss

If you are experiencing one or more of these common symptoms of brain tumors, or you have other reasons to suspect you may be experiencing a brain tumor, you should consult with a qualified medical professional as soon as possible. A brain MRI is typically ordered before a diagnosis can be made.  Because early detection and diagnosis are so important, there is no reason to put off a discussion of your symptoms.

Types of brain tumors

There are many different types of brain tumors, but they all fall into two pairs of broad categories: primary and secondary, and cancerous and noncancerous.

Primary brain tumors originate within the brain or the meninges (membranes that surround the brain), the pineal gland, the pituitary gland, or the cranial nerves. When healthy cells in these areas mutate, or go through changes in the structure of their DNA, the cells may grow and split too rapidly for the body to manage, and a brain tumor may be the result.

There are over 100 distinct types of primary brain tumors, with some of the most common being:

• Gliomas, which originate in the brain or the spinal cord. These may include astrocytomas,  glioblastomas, oligoastrocytomas, and oligodendrogliomas, with glioblastomas being the most common form of malignant brain tumors
• Medulloblastomas, which start in the lower area of the brain and are most common in children
• Meningiomas, which originate in the membranes surrounding the brain or the spinal cord and are the most common form of primary brain tumors
• Pituitary adenomas, Craniopharyngiomas, which develop in the pituitary gland
• Schwannomas, which originate in the area between the brain and the inner ear and are usually benign but can affect hearing, balance, and motor function

Gliomas are classified by the World Health Organization under grades I-IV, with grade I being the least severe and grade IV being the most severe.

Secondary brain tumors are more common than primary brain tumors and originate in other parts of the body. Secondary brain tumors are also known as metastatic tumors, as they spread from elsewhere in the body and metastasize in the brain. Cancer of the breast, colon, kidneys, lungs, or other parts of the body can result in a secondary brain tumor.

Risk factors for brain tumors are complex and not fully understood but may include exposure to radiation or familial history of brain cancer.

Selecting your multidisciplinary healthcare team

Being diagnosed with a brain tumor is a frightening and emotionally challenging experience, but the good news is you don’t have to go through it alone. To reiterate, getting your diagnosis as early as possible is extremely important as it increases the odds of survival and recovery as well as the range of treatment options available. You should also have support from your family and loved ones, as well as a qualified multidisciplinary team.

The advantage of working with a multidisciplinary neurosurgery team, versus a single specialist, is that this range of clinical expertise can open you up to more treatment options. As molecular science becomes both more expansive and more specific, the way brain tumors are treated is changing. Many drugs are approved by the FDA for the treatment of primary and secondary brain tumors. Surgery and radiation are common treatments. Innovative new tools such as Cyberknife and Truebeam are creating new possibilities for the less invasive and painful treatment of brain tumors. You should work closely with your multidisciplinary team to make sure you understand all your available options.

What are Cyberknife and Truebeam?

Cyberknife and Truebeam are among a new class of exciting and innovative tools for the non-surgical treatment of brain tumors.

These robotic machines are used to perform stereotactic radiosurgery (SRS), which allows your neurosurgeon to zoom in on cancerous cells in the brain with greater accuracy than ever before. While older forms of radiation therapy affected larger areas surrounding the brain, SRS treatments tend to be easier on patients, take less time overall, and more accurately target tumor cells, effectively treating the brain tumor.

Because it is noninvasive, SRS is less risky, less painful, and less damaging than traditional radiation treatments. They don’t require anesthesia, and patients can usually recover and resume their normal lives more quickly and easily.

The effective use of SRS requires the interconnected knowledge and skills of a full multidisciplinary team, including neurology, oncology, radiation specialization, and the ability to empathize, educate, and effectively guide patients through the process of treatment.  Currently, both Cyberknife and Truebeam treatments are performed locally in our area.

Other treatment options for brain tumors

While stereotactic radiosurgery is an appropriate choice for more and more patients with brain tumors, it may not be the best choice for all patients.

Other treatment options include:

• Brain surgery, which can work in cases where the tumor is easily accessible and can be surgically separated without damaging other areas of the brain
• Chemotherapy, which uses drugs (in intravenous or pill form) to kill cancerous brain tumor cells
• Targeted drug treatments, which block certain abnormalities in tumors and are currently under investigation in clinical trials

Before your appointment: what you should know

If a medical professional suspects you may have a brain tumor, they will attempt to diagnose you through a number of procedures or tests.

These may include:

• A full neurological exam
• Lab work and/or possible biopsy (taking a tissue sample)
• Imaging

The results of the diagnosis, as well as other factors in a patient’s life, will help determine the appropriate course of treatment. In order to make the most of your options, it is important that you share any information with your clinician that may be relevant. You should also have support from your family and others in your life and practice self-care to prepare yourself for treatment, which can be challenging both physically and psychologically.

Understanding your condition and your options for treatment starts with asking the right questions to help you and your doctor gather the information that will be most useful.

Questions to ask your multidisciplinary team after diagnosis

• Where is the tumor located in my brain?
• What type or grade of brain tumor is it?
• Is the brain tumor malignant or benign?
• Is the brain tumor primary or secondary?
• What forms of treatment for my kind of brain tumor is available?
• What form of treatment do you recommend for my brain tumor?
• How long can I expect my treatment(s) to take?
• How will my treatment affect my overall health and functioning?
• What clinicians and experts will be participating in my treatment, and what skills and experience do they bring to the table?

A brain tumor diagnosis is a frightening event in anyone’s life, but with the right support from loved ones and medical experts, many treatment options are available and a full recovery is possible. If you are seeking out useful information about brain tumors, you are already on the right track. A qualified multidisciplinary team should be able to answer any specific questions you may have and help you understand your condition, your available options for treatment, and how to best proceed.

Sources:

• “Brain and Other Central Nervous System Statistics.” CA: A Cancer Journal for Clinicians, American Cancer Society, 24 Aug. 2021, https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21693
• “Brain Tumor.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 2022, https://www.mayoclinic.org/diseases-conditions/brain-tumor/symptoms-causes/syc-20350084#:~:text=A%20brain%20tumor%20can%20form,headaches%2C%20nausea%20and%20balance%20problems.
• “Brain Tumors – Patient Version.” National Cancer Institute, 2022, https://www.cancer.gov/types/brain

Spinal discs become worn out and weaker as we age.  About 40% of adults over age 40 have at least one degenerated vertebral disc. As adults reach the age of 80, this percentage doubles, which means most people will likely have to deal with disc disease at some point in their lives. 

If you or someone you know have been diagnosed with chronic pain due to degenerative disc disease, treatments are available to address your symptoms and improve your quality of life. Some of the most current and effective pain management solutions for disc degeneration are physical therapy, NSAIDs (such as Advil) and epidural steroid injections.  If pain management treatments do not provide adequate relief, surgery may be indicated based on your medical history, physical exam(s) and imaging studies such as an MRI.

Your Low Back is Complex

Your spine is an intricate system of working parts.  It is made up of vertebrae, which are bones that stack like building blocks and are separated by discs, which serve as cushions between the vertebrae.  The components of the vertebrae form a protective case around the spinal canal, which houses a fluid-filled sac containing spinal nerves. These nerves have the important job of carrying signals between the brain and body. Small openings in the vertebrae, called the foramen, are formed by the stacked vertebrae, which provide a way for the nerve to leave the spinal canal.  The lumbar spine contains the five bottom vertebrae in the back. These vertebrae are named L1-L5.

The Causes of Degenerative Disc Disease

The constant wear and tear of daily life can weaken vertebral discs over time, making it more prone to damage from sudden movement or injury.  If the disc’s soft center begins to bulge, or the outside of the disc tears and the soft center squeezes through, a nerve may become irritated or pinched.  This can cause pain, burning, tingling or numbness in the leg.  Pressure on a nerve that connects to the sciatic nerve may cause pain in the buttock and down the leg.

Also, as a disc wears out, the vertebrae above and below the disc begin to touch and abnormal bone, called bone spurs, grow.  The foramen or the spinal canal can then narrow, causing irritation of a nerve.

Vertebral discs are predominantly made up of water, and as we age the core of the discs gradually lose some water, reducing their ability to provide a cushion to absorb shock. The loss of water in your discs lead to disc space collapse, which can cause increased back pain and nerve pressure.

Diagnosis and Symptoms of Back Pain

One of the primary reasons degenerative disc disease often goes undiagnosed is that the pain is not constant and often comes in waves, causing pain in your neck and back that can last for months at a time and then subside for months at a time. One nearly-universal symptom associated with degenerative disc disease is numbness or tingling in your arms or legs that extends down to your buttock and lower back. Also, if your back and neck pain intensifies when you sit, bend or lift, it may indicate you have degenerative disc disease.

Selecting Your Pain Management Specialist and Spine Surgeon

The diagnosis and treatment for degenerative disc disease can be emotionally and physically challenging for you and your family. The selection of a pain management team, or even a surgical team, is an important part of your treatment plan. Many patients seek a specialist with exceptional clinical training and years of experience. Accessibility, location, insurance, and convenience and comfort for both you and your family are also key considerations. Do not hesitate to ask questions when selecting a pain management specialist. Here are a few questions to ask potential pain management specialists that may help guide your decision.

1. What is the clinician’s and team’s overall approach to treatment?
2. What experience and training does the clinician have in the diagnosis of degenerative disc disease?
3. How is the diagnosis made?
4. How is a treatment plan developed and who is involved?
5. Where can patients read genuine reviews about the clinician(s)?

Treatment Options for Degenerative Disc Disease

The first course of action for treating degenerative disc disease is implementing conservative measures.  Only if these prove unsuccessful is surgery then considered.

NSAIDs are either over-the-counter or prescription strength. Common examples include ibuprofen (such as Advil or Motrin), naproxen (such as Aleve), and aspirin. NSAIDs reduce the body’s production of chemicals called prostaglandins, which trigger inflammation and pain.  NSAIDs can have both positive and negative effects and should only be taken under the guidance of a physician.  If you are on blood thinners, have kidney disease or other medical conditions, consult with your physician before taking NSAIDs.

Physical therapy and movement changes involve a specific series of stretching and flexibility exercises, strengthening exercises, low-impact aerobic exercises and key movement changes. Physical therapy might sound intense if you are suffering from chronic pain, but good physical therapists know how create an exercise routine that is manageable. Key protective movements that can help protect your vertebrae include:

• Tightening the muscles in your stomach to support your spine.
• Keeping your ears, shoulders and hips in a line.
• Bending at the hips and knees, not your waist.
• Moving your body as a unit and avoid twisting at your shoulders or waist.

Epidural steroid injections are intended to calm the problematic nerve that is affected by the diseased disc. This minimally invasive and low-risk procedure does not correct the structural damage to your spine but can improve inflammation, will usually ease your chronic pain, and improve your quality of life.

Facet joint injections may be effective in relieving pain and inflammation.  This procedure involves injecting a soothing mixture of numbing anesthetic and anti-inflammatory steroid medication into the joints on the side of your spine.  This non-surgical option may provide pain relief for a span ranging from several days to several months.  Up to three injections may be given per year.

Lumbar medial branch blocks are another minimally invasive procedure, used to help identify if your pain is originating from the facet joints. If this is the case, long lasting relief can be provided with a radiofrequency ablation (RFA) of irritated nerves overlying these joints.  First, anesthetic medicine is injected around the nerves.  If the injection/block provides pain relief, results are considered “positive” and the radiofrequency ablation procedure may be considered.  RFA uses an electric current to heat up a small area of nerve tissue to stop it from sending pain signals to the brain.

Spinal Cord Stimulation, also called SCS, uses electrical impulses to relieve chronic pain.  It is the belief that electrical pulses prevent pain signals from being received by the brain. The treatment starts with a trial implantation to determine if a SCS is effective for you.  If the amount of pain relief is acceptable, a permanent implant is placed and the electric impulses are controlled with an external wireless programmer.

Surgery may be an option if conservative and interventional treatments fail and the pain continues for an extended period.  There are many factors taken into consideration when discussing surgical options, which are customized for each patient’s unique needs.

One surgery commonly used for degenerative disc disease is a laminectomy, in which some or all of the lamina is removed from the affected vertebrae.  The opening created may be enough to take pressure off the nerve.  If needed, the surgeon can also remove any bone spurs or disc material still pressing on the nerve.

Another surgical option is an anterior cervical discectomy fusion (ACDF).  In this procedure, the affected intervertebral disc and adjacent bone, if necessary, is removed to take pressure off the nerves and align the spine.  This surgery is performed less frequently than a laminectomy.

For the best outcomes, treatment is a partnership between the clinical experts, the care team supporting the physician(s), and you and your family.  Patient education videos on degenerative disc disease and information on Sierra Neurosurgery’s conservative and effective approach to treatment can be found at www.sierraneurosurgery.com/surgical-procedures.

An estimated 50 million Americans, or 20% of the entire population¹, are living with chronic pain. In fact, chronic or acute pain is the most common reason adults seek medical care. Unfortunately, acute and chronic pain can lead to a decreased quality of life, opioid dependence, and diminished mental health in the form of anxiety and depression. 

Most often, the pain is felt in soft tissue areas, such as the lower back, neck and shoulders, hips, legs and buttock area. If you or a loved one are experiencing chronic pain, Sierra Neurosurgery Group offers treatments to address your symptoms.  

There are many options for interventional chronic pain treatment. These include trigger point injections, epidural steroid injections, nerve blocks, radio-frequency ablations (RFA), facet joint injections, spinal cord stimulation, and intrathecal pump placement.

Symptoms of Chronic Pain

Chronic pain is defined as pain that has been present for at least 12 weeks. The pain varies and may feel dull or sharp and may cause a burning or an aching sensation in the back, neck, limbs or feet. It may occur on one side or both. Other symptoms of chronic pain include throbbing, stabbing pain, tingling, weakness, and numbness. The intensity and presence of severe chronic pain may also lead to psychological symptoms such as depression, anxiety and fear. 

Types of Chronic Pain

Chronic pain may be caused by a variety of different stressors including spinal injury or stenosis, headaches, post-surgical pain, post-trauma pain, lower back pain, cancer pain, arthritis pain, neurogenic pain (caused by damaged or compressed nerves in the spine or neck), and psychogenic pain⁵. Two very common types of chronic pain that are treated by trigger point injections are fibromyalgia and tension headaches.

Fibromyalgia is a disorder indicated by universal musculoskeletal pain accompanied by fatigue, sleep, memory, and mood issues. Researchers believe that fibromyalgia increases pain by compromising the manner in which your brain and spinal cord process painful and non-painful signals.²

Tension Headaches typically range from mild to moderate pain that’s often described as a tight band around the head. Tension headaches are the most common type of headache, but the research behind the cause of the headaches is murky at best. The two types of tension headaches are episodic tension-type headaches and chronic tension-type headaches. ³

Selecting Your Interventional Pain Management Specialist 

The diagnosis and treatment of chronic pain can be emotionally and physically challenging. The selection of a pain management team is an important part of your treatment. We recommend you seek a specialist with Board Certification in Anesthesiology, followed by additional fellowship training in Pain Management. Interventional Pain Management specialists focus on treatments vs. medications, which merely mask the pain. Location, insurance coverage, nurse support and your patient experience are also key considerations.  Do not hesitate to ask questions and address concerns when selecting an interventional pain management specialist.  Here are a few questions to ask:

1. What is the physician and nursing team’s overall approach to treatment?
2. What experience does the clinician have in the treatment of chronic pain?  How big a part of his/her practice is it?
3. Does the physician have any board certifications?  If so, in what?
4. How is the diagnosis made?
5. How is a treatment plan developed?  Who is involved?
6. Where are procedures like Trigger Point Injections or Facet Joint injections done?
7. Where can I read reviews from your verified patients?

Treatment Options for Chronic Pain

Treatment options differ based on the type and location of the chronic pain, duration of your symptoms, your age and overall health, and other therapies that may have been tried. Treatments may include trigger point injections, medications, lifestyle changes, and supportive physical therapy. 

Common medications to treat chronic pain are non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin, Aleve, etc.) and acetaminophen (Tylenol, etc.). For severe cases of arthritis, COX-2 inhibitors such as Celecoxib are commonly used. Antidepressants and anti-seizure medications have been found to help patients who also experience psychological symptoms.¹ The strongest pain medication is also potentially the most detrimental to your long term health: Opioids such as hydrocodone, oxycodone, or fentanyl.  Interventional pain management specialists will work with you to try to reduce or eliminate this category of medications. 

During a Trigger Point Injection, the board-certified anesthesiologist carefully inserts a thin needle through the skin into sensitive portions of the muscle. The insertion of the needle into a trigger point area causes the muscle to relax. Then an anesthetic mixture is injected which causes the trigger point to relax. If the trigger point does not relax completely after the first injection, the physician may adjust the needle’s position and give additional injections.⁴

For the best outcomes, treatment is a partnership between the clinical expert, the clinical care team, you and your support system, including family and friends. Patient education videos on Trigger Point Injections and many other pain management procedures can be viewed at sierraneurosurgery.com/pain-management-video-library.

Sources:

1. “Products – Data Briefs – Number 390 – November 2020.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 4 Nov. 2020, https://www.cdc.gov/nchs/products/databriefs/db390.htm.
2. “Fibromyalgia.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 26 Oct. 2021, https://www.mayoclinic.org/diseases-conditions/fibromyalgia/symptoms-causes/syc-20354780.
3. “Tension Headache.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 29 Sept. 2021, https://www.mayoclinic.org/diseases-conditions/tension-headache/symptoms-causes/syc-20353977.
4. “Trigger Point Injection (TPI) for Muscle Pain Relief.” WebMD, WebMD, https://www.webmd.com/pain-management/guide/trigger-point-injection.
5. “Chronic Pain: What Is It, Causes, Symptoms & Treatment.” Cleveland Clinic,          https://my.clevelandclinic.org/health/diseases/4798-chronic-pain.