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

In this article, Naomi Albertson, M.D., reviews some of the commonly used, FDA approved medications for the treatment of osteoporosis and their major risks and benefits.

If I need medications for osteoporosis, what are my choices?

First, the reason to use medications at all is to decrease your risk of fractures (broken bones) and fracture associated morbidity and mortality. Remember, the Bone Health & Osteoporosis Foundation reported that 25% of women and 30-35% of men who sustain an osteoporotic hip fracture will DIE within one year of their diagnosis. An additional 25% of men and women will be unable to continue independent living due to their inability to complete regular activities of daily living…that means you live in a nursing home for the rest of your life!  Treating osteoporosis WILL affect your life expectancy and your QUALITY of life.

The medications used to treat osteoporosis can be broken into two large groups: medications that decrease bone reabsorption (anti-resorptive) and those that build bone (anabolic). There are a few others, but their utility is very specific and beyond the scope of this discussion. In general, if you have low risk osteoporosis you will be counselled regarding use of an anti-resorptive medication. And, if you have high risk (due to use of current bone destructive medications, underlying bone disease or you have already suffered a low velocity fracture) you will likely be counselled regarding use of an anabolic medication (Forteo, teriparatide).  

Anti-resorptive Medications for Osteoporosis and Their Risks

Anti-resorptive medications include the bisphosphonates (i.e. Actonel, Fosamax, alendronate, Boniva, Reclast), and denosumab (Prolia). These medications work by either slowing down or inhibiting development of the cells that resorb bone, osteoclasts. Use of these medications will decrease the risk of fracture in both the hip and vertebrae and increase bone density by up to 7% over 3 years of use. Unfortunately, the entire category carries the same risks which include esophagitis, severe joint/bone aching (more common with intravenous medication options), worsened kidney failure (except denosumab), and atypical fractures of the jaw (ONJ = osteonecrosis of the jaw) and femur (thigh bone). The method of delivery of these medications can be oral taken weekly, or monthly, as an injection every 6 months or as an intravenous infusion every 3 months or annually. These medications are NOT to be used in individuals who have kidney disease, severe esophageal disease or low blood levels of calcium.

Anabolic Medications for Osteoporosis and Their Risks

Currently, there are 2 anabolic medications (teriparatide analogs). These medications are hormone-like and increase bone formation and calcium and phosphate absorption from the intestine and kidneys. In clinical studies they have been shown to decrease vertebral and hip fractures and increase bone density up to 22% over 2 years of use. Both medications are only available as a self-administered injection and are used for 2 years only, due to a potential risk of bone cancer called osteosarcoma. Although osteosarcoma is a very scary side effect, it has not been shown to occur in humans (osteosarcoma was only reported in rats when obtaining FDA approval). These medications, however, are contraindicated for use in anyone with prior bone/skeletal cancer, metabolic bone disease, high blood levels of calcium, Paget’s disease, or prior bone/skeletal radiation for any reason.

If you would like to discuss osteoporosis, or any other sports medicine concerns, injuries, or preventive methods for improved sports performance contact Dr. Albertson at (775) 323-2080.