Service Areas

Last year alone, our neurosurgeons performed close to 500 neurosurgical procedures. We use state-of-the-art technologies and the most advanced procedures available, which enable us to address the full spectrum of brain and spine disorders while minimizing the risk of complications.

The experience, skill and compassion of our neurosurgeons and clinical and support staff are second to none, but we understand that a visit to a neurosurgeon can still be a frightening experience.

That’s why we’d like to explain to you some of the services and procedures we offer at the Brain & Spine Institute, so that you can learn more about treatment options available to you. This will provide you with general information on various procedures. Your surgeon will more fully explain your medical condition and the treatment options available to you.

Anterior Cervical Discectomy and Fusion
The anterior cervical discectomy and fusion procedure is performed to remove a diseased disc through an incision in the front of the neck. Once the disc is removed, the neurosurgeon uses pieces of bone from a bone bank or a piece of bone from your hip to place in the area of the removed disc. This is called a fusion, and it provides strength and stability in that area. This bone graft fuses over time. Usually this takes approximately three months. A titanium plate is used to keep the graft in place. 

To help stabilize the fusion, a collar is generally worn during this healing time.

Anterior cervical discectomy and fusion is an operation performed to relieve the pressure on the spinal cord or nerves that occurs for various reasons, such as:

• Herniated discs – the “cushions” between the vertebrae have been partially pushed out and press on the spinal cord
• Cervical spinal stenosis – a narrowing of the spinal canal in the area where the nerve root exits
• Radiculopathy – nerve root irritation caused by either compression from disc herniation or stenosis
• Cervical myelopathy – symptoms such as weak, clumsy or numb hands, difficulty walking, stiffness and weakness that occur due to compression

Anterior Lumbar Interbody Fusion
Anterior lumbar interbody fusion is a surgical procedure on the lower spine entering through the abdomen. A part of the diseased disc is removed and replaced with bone graft material or synthetic material such as a cage. The bone material can be from a bone bank or from a piece of bone from your hip. Once fusion is complete, the neurosurgeon may place a cage, screws or rods to improve stability in the area. This procedure is usually performed for those people suffering from chronic back or leg pain.

Anterior/Posterior Lumbar Fusion
An anterior/posterior lumbar fusion is primarily performed for those suffering from mechanical back pain and sciatica (irritation of the sciatic nerve resulting in pain or tingling running down the inside of the leg).

The anterior approach (through the abdomen) is performed first. During this stage, the disc material is removed and grafting is done with either a cage or bone graft. This is called fusion.

During the posterior approach (through the back), a laminectomy (surgical removal of the bony arches of one or more vertebrae) may be performed to alleviate some crowding of the nerve or nerve roots. The pressure is reduced by removing part of the spinal canal’s bony roof (lamina). Rods and screws will be placed to ensure stability of your back while your own bone fuses. This is called instrumented fusion.

This procedure is typically performed as a two-stage surgery. The anterior portion of the fusion is typically performed on the first day and the posterior portion on the follow day.

Brain Biopsy
A brain biopsy is performed when non-invasive studies like CT Scan and MRI are unable to definitively diagnose a tumor, infection or certain other diseases. Before the biopsy, a special set of images (CT or MRI) are taken, with special markers on the head to determine the precise position of the needle to remove the tissue.  During the biopsy, a small piece of diseased brain tissue is removed under computerized guidance. This is sent to a pathologist for examination.

Carotid Angioplasty and Stenting
Carotid angioplasty and stenting has emerged as an alternative treatment to open carotid endarterectomy surgery for some patients who have a narrowing of the carotid artery. The goal of this procedure is to prevent stroke. Vessels diseased by atherosclerosis (the hardening of the artery) are first opened with a balloon and then held open with an expandable stent. The risk of a stroke is reduced by the use of a distal protection device that prevents debris from flowing toward the brain. This procedure is generally done under local anesthetic with minimal sedation.   

This procedure, which is done through a small needle puncture in the groin area, is minimally invasive and poses less risk than traditional open surgery. The most common patients for this procedure are those who are older, those for whom an operation or general anesthetic is not safe or those who have had prior neck surgery or radiation treatment.

Carotid Endarterectomy
The carotid arteries provide the main blood supply to the front of the brain, and these arteries can become narrowed due to hardening. The narrowing may cause turbulence, which can form blood clots that can be carried up to the brain, blocking a vessel. This can decrease the amount of blood and oxygen to the brain, which may result in symptoms such as sudden weakness, numbness or tingling in the face, arm or leg; confusion; trouble speaking or seeing; or severe headache.

A carotid endarterectomy is performed to remove the plaque build up that narrows the arteries. The goal of this procedure is to prevent stroke.

Carpal Tunnel Release
Carpal tunnel syndrome is a specific group of symptoms that can include tingling; numbness; weakness; or pain in the fingers, thumb, hand and forearm. These symptoms occur when there is pressure on the median nerve at the wrist as the nerve passes through a tunnel made of bone and ligament. Nerve conduction studies are generally required to confirm the diagnosis and assess the severity. Carpal tunnel release surgery is performed when symptoms are still present after a period of nonsurgical treatment or when symptoms become so severe that they restrict daily activities. This surgery is usually done under local anesthetic, and the patient typically goes home the same day.

Cervical Laminectomy
The cervical laminectomy procedure is used to relieve pressure on one or more nerve roots in the neck by widening the spinal canal. The pressure is reduced by removing part of the spinal canal’s bony roof (lamina). This allows more space for the nerve roots, improving neck, arm and hand symptoms such as pain, weakness and numbness.  

Narrowing of the spinal canal can be caused by: 

• Calcification – ligaments of the spine thicken and harden with age 
• Osteophytes (bone spurs) –  formed when bones and joints enlarge
• Herniated discs – the “cushions” between the vertebrae have been partially pushed out and press on the spinal cord
• Spondylotisthesis – the slipping of one or more vertebrae onto each other

Aneurysm Coiling
Endovascular therapy (working through the blood vessels to treat vessel abnormalities) is a minimally invasive technique that can be used to treat aneurysms of the brain. (An aneurysm is a weak spot in a blood vessel that balloons out and can rupture, causing bleeding in the brain, which can be fatal).

A common endovascular therapy technique is called coiling, in which small, soft, metal coils are placed via catheters into the weakened part of the blood vessel to prevent bleeding into the brain. The aneurysm is gradually "filled up from the inside" rather than being "pinched off from the outside" as it is in traditional open surgery.

Sometimes, related tools such as stents (wire-mesh tubes) and balloons are used along with the coils to treat aneurysms in situations that previously would have been untreatable or very risky to treat. This procedure, which is done through a small needle puncture in the groin area, provides a minimally invasive option for patients with difficult-to-treat “wide neck” aneurysms, offering recovery that may be shorter than surgery.

Dr. Porter was the first physician in the area to treat brain aneurysms with a leading-edge procedure involving a stent combined with coiling. 

Craniotomy
A craniotomy is a temporary surgical opening of part of the skull. This procedure is performed to gain access to the disease or injury affecting the brain or its blood vessels. 

A craniotomy is performed to:

• Remove lesions such as tumors or cysts
• Remove blood clots (hematomas)
• Repair an aneurysm
• Remove an abnormal collection of blood vessels
• Drain an infection or abscess
• Repair fractures of the skull

Lumbar Laminectomy
The lumbar laminectomy procedure is used to relieve pressure on one or more nerve roots in the lower back by widening the spinal canal. The pressure is reduced by removing part of the spinal canal’s bony roof (lamina). This allows more space for the nerve roots thereby improving leg symptoms such as pain, weakness or numbness.  

Narrowing of the spinal canal can be caused by: 

• Calcification – ligaments of the spine thicken and harden with age  
• Osteophytes (bone spurs) –  formed when bones and joints enlarge
• Herniated discs – the “cushions” between the vertebrae have been partially pushed out and press on the spinal cord
• Spondylotisthesis – the slipping of one or more vertebrae onto each other

Microdiscectomy
The microdiscectomy procedure is performed with x-ray guidance to remove herniated or bulging disc material through a small incision in the lower back (lumbar region). An operating microscope or magnifying instrument is used to view the disc and nerves. The magnified view makes it possible for the surgeon to remove herniated disc material through a smaller incision, causing less damage to surrounding tissue.

The diseased disc causes pressure on a nerve or nerves. This pressure usually results in pain, weakness and tingling in the back and or lower extremity. Pain in the legs may improve immediately. However, regaining strength or sensation may take some time.

Tumor Embolization
Tumors of the brain and spine may be very vascular (having vessels or ducts) and therefore have a potential for significant bleeding during surgical removal. Prior to surgery, some tumors can undergo a procedure called embolization, in which large blood vessels supplying the tumor (but not healthy tissue) are blocked off by working through the vessels. This procedure, which is done through a small needle puncture in the groin area, is minimally invasive and may reduce the risk of surgery by decreasing blood loss and operative time.

Ventricular peritoneal shunt
A ventricular peritoneal shunt is small tubing that is placed inside the brain’s cavity and tunneled underneath the skin to the membrane that lines and protects the abdominal cavity, called the peritoneum. This procedure is typically performed on patients who suffer from hydrocephalus – a condition where there is an excessive build-up for cerebrospinal fluid in the cavities of the brain. Normally, there is a balance between the amount of cerebrospinal fluid made and the rate of absorption. Hydrocephalus occurs when cerebrospinal fluid is not reabsorbed as fast as it is produced or if there is blockage along the path where cerebrospinal fluid flows. The ventricular peritoneal shunt reduces the amount of cerebral spinal fluid in the brain.

X-Stop
The X-stop is a minimally invasive surgical alternative for patients suffering from mild to moderate lumbar spinal stenosis (a narrowing of the spinal canal). Spinal stenosis is the most common reason for back surgery in people over age 50.

X-stop is a titanium spacer inserted between the spinous processes, which are located at the back of the vertebrae. Approved by the U.S. Food and Drug Administration in 2005, the device is designed to keep the space between the spinous processes open, so that when the patient stands upright, the nerves in his/her back will not be pinched or cause pain. The procedure can relieve leg symptoms such as pain, numbness or weakness and can enable the patient to stand upright without severe pain.

Candidates for this procedure are patients who are 50 and older and who have undergone at least six months of non-surgical treatment with limited success. The X-stop procedure is reversible and does not limit a patient’s surgical options in the future. Insertion of the X-stop typically takes less than an hour and can be done under local anesthesia. In most cases, the patient can return home the same day. 

In addition to the procedures and services listed above, our neurosurgeons also treat the following conditions:

Brain

• Arterialvenous Malformations
• Brain Tumors
• Head Injuries
• Epidural Hematomas
• Hydrocephalus
• Intracerebral/Intraparenchamal Hemorrhages
• Intraventricular Hemorrhages
• Pituitary Tumors
• Skull Fractures
• Subarachnoid Hemorrhages
• Subdural Hematomas

Spine

• Degenerative Disc Disease
• Disc Herniation
• Myelopathy
• Radiculopathy
• Sciatica
• Stenosis