Overview of the Cranial Neurosurgery Program 

Cranial neurosurgery is a specialty that includes head surgeries in which the neurosurgeon has to make an opening in the skull to treat a medical issue. The multidisciplinary team at Cleveland Clinic Abu Dhabi’s Cranial Neurosurgery Program is experienced in a wide range of surgical approaches for treating patients who require cranial neurosurgery. 

As part of Cleveland Clinic Abu Dhabi’s Patients First approach to care, the Cranial Neurosurgery Program offers cutting-edge services that are unique in the region. Tools like medical navigation systems, endoscopic equipment, continuous electrophysiological intraoperative neuromonitoring (IOM), and fluorescence guided microsurgery are all available. These technologies make it possible to ensure that each surgical procedure is safe, and that the most appropriate course of action is taken for the individual patient. 

What we treat

There are a number of conditions of the brain that can potentially require surgery. In many cases, modern medicine reduces the need for surgical intervention with the help of highly specialized medical treatments. However, surgery may sometimes be necessary.

Brain tumors 

One condition that may require cranial neurosurgery is a brain tumor, which can be fast-growing or slow-growing. A cure for brain tumors is hard to achieve because they tend to infiltrate the surrounding, healthy tissue. This increases the risk of recurrence, even after the tumor has been completely removed.

Cancerous brain tumors typically arise within the tissue of the brain itself. This is referred to as a glial tumor. A glial tumor may originate in the brain or spinal cord, or may be a result of cancer originating in a different area of the body and spreading, with tumors occurring in the brain. While radiation therapy or chemotherapy are often used to control the growth of a brain tumor, a surgical approach is sometimes required. If the tumor is life threatening and easily accessible, safe removal with cranial neurosurgery is recommended. 

Benign tumors of the brain are most often located within the skull, but outside the brain. They grow very slowly, but over the course of years, they can reach a very large size, compressing the brain and growing around nerves and vessels at the base of the skull. Tumors can also compromise the hormonal balance of the body when they compress the pituitary gland (which controls the production and release of hormones). Surgeons need to work carefully to remove these benign brain tumors without causing disability or compromising quality of life. 

Pain syndromes

Some types of pain syndromes, such as trigeminal neuralgia (when even a light touch on the face causes pain) or hemifacial spasm (twitching of the face), are also treated in the Cranial Neurosurgery Program. In these conditions, one of the twelve cranial nerves, the nerves traveling out from the brain, may be compressed. Patients with these conditions may require a small craniotomy (a surgery in which a part of the skull needs to be removed to access the brain) to decompress the affected cranial nerve. Performed by Cleveland Clinic Abu Dhabi’s experienced neurosurgeons, this is a very low risk, highly successful procedure used to alleviate pain or spasm. 

Congenital malformations

Congenital malformations are issues that are present at birth, occurring when an organ did not develop properly during gestation. Several congenital malformations may be treated with cranial neurosurgery, including:

  • Chiari malformation: A structural issue in which a part of the brain extends into the upper spinal cord.
  • Neurofibromatosis: A hereditary condition in which tumors occur in brain, spinal cord, and nerve tissue.
  • Hippel-Lindau disease: A genetic condition in which tumors occur in the blood vessels of the eyes, brain, and spinal cord.
  • Tuberous sclerosis:  A hereditaury condition in which benign tumors occur in multiple organs. 

Individuals with these conditions may require a craniotomy at some point to address intracranial tumors or lesions.

Vascular conditions 

If weakness or rupture of intracranial vessels (blood vessels in the brain) is identified, a craniotomy (a surgery in which a small part of the skull is removed) is needed to repair the vessel or the vascular malformation. In some situations, this may require emergency surgery. Surgery may be performed for:
 
  • Intracranial aneurysm: A weakened blood vessel in the brain that causes a bulge that is at risk for rupturing, or breaking. A brain aneurysm is a medical emergency.
  • Arteriovenousa malformation: A condition present at birth in which a cluster of veins and arteries connect in an abnormal way. An AVM in the brain can result in headaches, bleeding in the brain, seizures, or bleeding in the brain.
  • Cavernoma: A blood vessel cluster characterized by a series of small bulges, occurring in the brain or spinal cord. Cavernomas may cause headaches, seizures, or bleeding in the brain.
  • Arteriovenous (AV) fistula: A direct connection between an artery and a vein, without capillaries that carry oxygen and nutrients to the tissue. AV fistulas can occur anywhere, including the brain, and they become problematic when they are large.​

Hydrocephalus

Hydrocephalus is an accumulation of cerebrospinal fluid (CSF, or the liquid around the brain). Sometimes CSF does not drain properly. Patients with this condition require a small craniotomy to place a shunt, a device that uses a thin tube to drain excess CSF into the abdomen.

Diagnosis & treatment with cranial neurosurgery

Diagnosis with cranial neurosurgery

Choosing the safest trajectory to the problem within the skull requires extremely careful pre-surgical planning. Whether this means a minimally invasive procedure with a small opening in the skull or a combined approach through the base of the skull (such as through the nose, the mouth, or behind the ear) depends on the underlying issue. A multidisciplinary approach is necessary for safe surgical preparation and treatment. For instance, patients with tumors involving the skull base are evaluated by a team of caregivers that includes otolaryngologists, endocrinologists, and ophthalmologists in addition to surgeons.

Because pre-operative planning is the mainstay of success, the expert Cranial Neurosurgery Program team makes extensive use of imaging technologies in preparation for surgery. Modern magnetic resonance imaging (MRI) and computed tomography (CT) scans provide invaluable information about the individual’s skull anatomy and the location and behavior of the tumor or other disorder. Sometimes, diagnosis also requires laboratory testing of the cerebrospinal fluid (CSF).

Treatment with cranial neurosurgery 

Expert surgeons and supporting caregivers at the Cranial Neurosurgery Program make use of a number of important technologies that maximize the safety and success of craniotomies. These include:

  • Imaging: Imaging technology is incorporated in the navigation system and the microscope during surgery to allow better visibility during the procedure.
  • Intraoperative neuromonitoring (IOM): This is a technology used to monitor the function of cranial nerves as well as overall body function during surgery. This approach can greatly increase success, leading to fewer side effects, better outcomes, and more complete removal of brain tumors.
  • Fluorescence guided surgery: This state-of-the-art method uses special dyes and lamps to distinguish tumor tissue from adjacent brain tissue.

For patients with vascular malformations that require cranial neurosurgery, caregivers may offer neuro-interventional (minimally invasive) treatment, surgical treatment, or a combination of both, focusing on what is best for the patient. 

Cranial Neurosurgery Program caregivers 

The Cranial Neurosurgery Program at Cleveland Clinic’s Neurological Institute is a multidisciplinary collaboration of highly trained medical professionals with broad expertise in planning and performing brain surgeries.

Caregivers involved in patient care for this program are:

  • Neurosurgeons
  • Ear, nose, and throat (ENT) surgeons
  • Vascular surgeons
  • Endocrinologist
  • Ophthalmologist
  • Oncologist
  • Neuro-anesthesiologists
  • Neuro-intensive care unit (ICU) physicians
  • Psychologists
  • Neuro-rehabilitation physicians
  • Physical therapists
  • Occupational therapists
  • Speech therapists
  • Social workers

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