What are the main diseases treated in neurosurgery?
Neurosurgery is one of the youngest, most complex and fastest growing disciplines in medicine. In 1879, Mac Ewen performed the first formal craniotomy in Glasgow, England, where he successfully removed a flattened meningioma from the left anterior cranial recess with good results. Neurosurgery as an independent discipline was born in England at the end of the 19th century based on the development of neurology, anesthesia, and asepsis, and its initial development and maturity came in the United States after the early 20th century. Neurosurgery mainly treats the following diseases.
1) Trauma to the head and spinal cord;
2) Tumors of the head and spinal cord;
3) Vascular diseases of the brain and spinal cord, such as intracranial aneurysms, cerebrospinal vascular malformations, cerebral hemorrhage and cerebral infarction;
4) Intracranial infectious diseases, such as brain abscess, brain tuberculoma, brain parasites, etc;
5) Congenital (birth) malformations of the head and spinal cord, such as craniosynostosis, submicrocephalic herniation, meningoencephalic bulge, spondylolisthesis, spina bifida, etc;
6) Functional neurological disorders, such as neuralgia, epilepsy, Parkinson’s disease, torsional spasm, facial spasm, spastic slant neck, cerebral palsy, etc.
What are the conditions that warrant a neurosurgical consultation?
Disorders of the central nervous system can present with a wide variety of symptoms, and a neurosurgical visit is usually indicated if the following symptoms are present.
Headache: This is one of the most common symptoms in neurosurgery. In fact, most of the headaches in daily life are functional and there is no organic brain lesion.
(1) Acute attack headache. (1) Acute attacks of headache. Patients who usually have no headache symptoms suddenly have severe headache or even vomiting, which can be caused by intracranial hemorrhage, acute inflammation, tumor stroke, etc;
(2) Recurrent paroxysmal headache. It is usually seen in vascular headache, epileptic headache, occipital neuralgia or cervical spondylosis;
(3) Gradually worsening headache. If there is a gradual loss of vision when the headache is aggravated, and if the headache is accompanied by vomiting in the form of jets, it is a typical “three main signs” of cranial hypertension, mostly caused by neurosurgical diseases, such as brain tumors, metastases, chronic subdural hematoma or hydrocephalus.
Facial pain: including pain in the face, eyes, nose, mouth and teeth.
(1) If there is a sudden onset of transient and severe pain on one side of the face that feels like a knife, electric shock, burning or pins and needles, and it tends to appear suddenly when washing the face, brushing the teeth, eating or talking, then the possibility of trigeminal neuralgia should be considered. In particular, trigeminal neuralgia is sometimes manifested as unbearable toothache. Patients often go to the stomatology department first and impatiently ask for tooth extraction, as a result, half of the big teeth are often extracted, and the pain is still not relieved in the slightest.
(2) If there is persistent vague, dull or swelling pain in the face without obvious intervals, then peri-trigeminal lesions should be considered and neurosurgery should be consulted.
(3) If there is transient severe pain at the root of the tongue, deep in the mouth, or deep in the external auditory canal, and the pain is often induced by swallowing, then it may be hyohypopharyngeal neuralgia, and a neurosurgical consultation should also be promptly sought.
Convulsions: Convulsions caused by brain diseases are characterized by suddenness, transience and recurrence. It is often characterized by sudden onset of limb convulsions, which may extend to the whole body and may be accompanied by impaired consciousness or urinary or fecal incontinence, lasting from a few seconds to several minutes each time, with completely normal interictal periods.
Limb weakness: can be gradually aggravated or appear suddenly. In milder cases, the early manifestations are often inflexible gripping of chopsticks, easy dropping, and difficulty in holding objects. In case of lower limb weakness, the manifestations are walking with dragging, knees tend to get weak and bend or even fall down, and the sole of the affected side is significantly more worn than that of the healthy side. If the hand or foot cannot be lifted or even consciously control the movement of the hand and foot, it is called “paralysis”.
Involuntary movements
(1) Twitching: Involuntary twitching of the limbs, face, or chest and abdominal muscles that occurs and stops suddenly, and may be accompanied by involuntary barking and grunting.
(2) Tremor paralysis: involuntary rhythmic shaking of a part of the body or the whole body, accompanied by stiffness and slow movement of the muscles.
Sensory impairment: There are superficial sensations and deep sensations in the human body. The superficial senses are pain, heat and cold, light touch and pressure, while the deep senses are the sensation of the position of the limb, vibration and movement when the eyes are closed. Diseases of the nervous system may cause abnormalities in these senses. These include pain, hypersensitivity of sensation, and diminished or absent sensation. Different areas of the body are innervated by different sensory nerves, and there is a certain pattern in the distribution of these areas.
Sensory disorders due to sensory nerve problems are mostly confined to the area of distribution of that nerve, in a striped pattern. The location of sensory disorders caused by neurosurgical diseases is more fixed. If the location of sensory disorders is wandering, it is generally not a neurosurgical problem.
Visual field disorders: sudden or gradual decrease in visual acuity and reduced range of vision. If no ophthalmologic disease is found in the ophthalmologic examination or if edema is found in the fundus, neurosurgical consultation should be made, and these symptoms are often caused by intracranial lesions.
Polyuria: The daily urine volume is more than 4000 ml, the urine is light or colorless and transparent, and the patient feels thirsty and needs to drink a lot of water every day.
Aphasia: It mainly refers to acquired language dysfunction or loss, which means that there was no deafness or mute originally, but the problem of language function appeared later. Most of them are the result of lesions affecting the higher language centers of the left cerebral hemisphere. It can manifest itself in the following ways.
(1) Motor aphasia: It is manifested by the ability to hear others, to pronounce words, but not to speak or to utter individual single words and not to repeat them;
(2) Sensory aphasia: It is manifested as not understanding other people’s words and one’s own words, as if one has arrived at a place where one does not speak the same language as oneself. Therefore, although the pronunciation is normal and the speech is coherent, the words are often used incorrectly and the answer is not what is asked;
(3) Naming aphasia: The person knows the purpose of a thing but cannot name it, but when someone says the name of a thing, he or she can identify whether the other person is correct or not;
(4) Complete aphasia: Loss of both the ability to express and understand language, neither understanding what others say nor being able to say the words. Problems with reading, writing, naming, and repetition;
(5) Loss of reading: The person has normal vision and could read and write, but now has lost the ability to read even the simplest of words;
(6) Loss of writing: normal hand movement, but the ability to write or write in a very disorganized manner, while the ability to transcribe is not affected;
(7) Conductive aphasia: The patient is able to speak and understand language fairly well, but has difficulty with the words of others.
Menstrual abnormalities and lactation: irregular menstruation, irregular timing of each visit, low volume, or even no menstruation at all. Breast milk secretion occurs in the absence of childbirth, with small amounts requiring squeezing of the breast to overflow, and large amounts spontaneously overflowing mostly bilaterally, mostly due to pituitary tumors, and may be accompanied by vision loss.
Giantism in children, adult acromegaly, facial changes: pituitary growth hormone adenoma.
Abnormal growth and sexual development: Most of them are caused by anterior or posterior lesions of the three ventricles, such as craniopharyngioma, teratoma, germ cell tumor, pineal tumor, etc.
Unstable walking: skewing to one side, mostly due to cerebellar involvement.
Drowsiness, personality change, mental decline, etc.: lesions in the frontal lobe, temporal lobe or hypothalamus, etc.
Symptoms of meningeal irritation: sudden onset of headache, vomiting, and cervical tonicity are typical manifestations of subarachnoid hemorrhage. Acute intracranial infection
Somatic pain: radioactive, weakness and numbness of one or both limbs, gradually progressing upward or downward, and urinary and fecal disorders, as a manifestation of spinal cord lesions.
Symptoms of cranial nerve palsy: such as double vision, upper eyelids cannot be lifted, facial numbness, distorted mouth and eyes, drooling at the corners of the mouth, hearing loss, inability to swallow food, choking on water, abnormal pronunciation, hoarseness, etc., as a result of brainstem, cranial nerve tumors and lesions in adjacent parts of the skull base such as aneurysm, meningioma, chordoma, craniopharyngioma, pituitary tumor, nerve sheath tumor, etc.
Other symptoms: vertigo, sudden coma, memory and judgment loss, etc.