Department of Neurosurgery

Clinical Programs

Gamma Knife® Surgery

Kyphoplasty

Brain Topics

Spine Topics

Peripheral Nerve Topics

Testing

Hyperhidrosis (treatment for excessive sweating)

Developed over 30 years ago in Sweden, Gamma Knife® surgery is a unique, non-invasive method of operating on certain types of brain tumors.  Because the procedure is non-invasive, Gamma Knife® patients face little risk of infection or excessive inflammation, the two most significant issues with traditional surgery. Often patients do not require general anesthesia, leading to shorter recovery periods. Most surgeries can be performed in one day, with many patients returning to their homes the same evening.  The Gamma Knife® itself consists of a spherical housing in which 201 beams of cobalt radiation are arranged. Alone, each of these beams is relatively weak, but when all 201 beams intersect at the same time at a single point, the energy in that center point is very high. During surgery, the patient's head is restrained in a special frame and positioned so that the tumor is centered in the spot where all of the beams intersect. This way, the tumor receives a strong dose of radiation while the surrounding brain tissue receives very little radiation. The shape and dose of the radiation is optimized to hit only the target, without damaging surrounding healthy tissue.

When treatment is complete, the head frame is removed. If the patient has been given an angiogram, which involves an IV, they might be required to remain in a reclining position for several more hours so that the doctors can continue to monitor their recovery. Some patients experience a mild headache or minor swelling where the head frame was attached, but most report no discomfort following surgery.  Most patients are able to return to their normal routine within another day or two.

The effects of Gamma Knife® treatment will occur over time.  Radiation treatments are designed to stop the growth of tumors or lesions, which means that the effect will be seen over a period of weeks or months. The patient's physician will monitor and assess their progress, which may include follow-up MRI, CTs or angiography images.

To view the Temple Radiation Therapy web site, please go to:

http://radiationtherapy.temple.health.org

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The Condition: Spinal Fractures

Osteoporosis causes more than 700,000 spinal fractures each year in the U.S. According to the National Osteoporosis Foundation, this is more than twice the annual number of hip fractures.

Spinal fractures can also be caused by cancer, the most common being multiple myeloma.  According to the Multiple Myeloma Research Foundation, in the majority of patients with multiple myeloma, osteolytic lesions develop which weaken the bone, causing pain and increasing the risk of fractures.

Some spinal fractures may collapse acutely while others collapse more slowly. Left untreated, one fracture can lead to subsequent fractures, often resulting in a condition called kyphosis, or rounded back. Kyphosis, signified by the dowager’s hump, can compress the chest and abdominal cavity, which may result in negative health consequences.

Balloon Kyphoplasty is a minimally invasive, orthopaedic treatment that stabilizes the fracture, thereby reducing pain and providing for correction of the deformity.

Studies also report the following benefits:

• Correction of vertebral body deformity
• Significant reduction in back pain
• Significant improvement in quality of life
• Significant improvement in mobility, including the ability to perform daily activities such as walking, hobbies and work
• Significant reduction in the number of days per month that a patient remains in bed
• Low complication rate

About the Balloon Kyphoplasty Procedure

• The spine specialist creates a small pathway into the fractured bone. A small, orthopaedic balloon is guided through the instrument into the vertebra. The incision site is approximately 1 cm in length.
• The balloon is carefully inflated in an attempt to raise the collapsed vertebra and return it to its normal position. Inflation of the balloon creates a void (cavity) in the vertebral body.
• Once the vertebra is in the correct position, the balloon is deflated and removed.
• The cavity is filled with bone cement forming an “internal cast” to support the surrounding bone and prevent further collapse.
• Generally, the procedure is done on both sides of the vertebral body.

The Balloon Kyphoplasty procedure typically takes about one hour per fracture and may require an overnight hospital stay. The procedure can be done using either local or general anesthesia; the surgeon will determine the most appropriate method, based on the patient’s overall condition.

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We offer an extensive program for treatment of conditions of the brain including:

Arteriovenous malformations
Bell's palsy
Brain tumors
Cancer
Carotid disease
Epilepsy
Essential tremor
Head injury
Headaches
Hydrocephalus
Meniere's disease
Multiple sclerosis
Parkinson's disease
Pituitary tumor
Spasticity
Stroke
Trigeminal neuralgia

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We offer an extensive spinal surgery program treating a variety of conditions including:

Lumbar disk herniations
Lumbar spinal stenosis
Spasticity
Spinal tumor

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What is carpal tunnel syndrome?

Carpal tunnel syndrome is a common, painful disorder of the wrist and hand.

How does it occur?

Carpal tunnel syndrome is caused by pressure on the median nerve in your wrist. People who use their hands and wrists repeatedly in the same way (for example, illustrators, carpenters, and assembly-line workers) tend to develop carpal tunnel syndrome.

Pressure on the nerve may also be caused by a fracture or other injury, which may cause inflammation and swelling. In addition, pressure may be caused by inflammation and swelling associated with arthritis, diabetes, and hypothyroidism. Carpal tunnel syndrome can also occur during pregnancy.

What are the symptoms?

The symptoms include:

• Pain, numbness, or tingling in your hand and wrist, especially in the thumb and index and middle fingers; pain may radiate up into the forearm
  Increased pain with increased use of your hand, such as when you are driving or reading the newspaper
• Increased pain at night
• Weak grip and tendency to drop objects held in the hand
  Sensitivity to cold
• Muscle deterioration especially in the thumb (in later stages).

How is it treated?

If you have a disease that is causing carpal tunnel syndrome (such as rheumatoid arthritis), treatment of the disease may relieve your symptoms. Other treatment focuses on relieving irritation and pressure on the nerve in your wrist.

To relieve pressure your doctor may suggest:

• Restricting use of your hand or changing the way you use it
• Wearing a wrist splint during sleep and physical activity involving the wrist
• Exercises.
  

Your doctor may prescribe a cortisonelike medicine or a nonsteroidal anti-inflammatory medicine, such as ibuprofen. Your doctor may recommend an injection of a cortisonelike medicine into the carpal tunnel area. In some cases surgery may be necessary.

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What is CT scanning?

Computed tomography or CT scanning is a radiographic procedure used for diagnosis. X-rays are taken from a series of different angles and assembled to show a cross-sectional view of internal organs. In this procedure your body is exposed to a very small amount of radiation.

When is it used?

CT scanning is used when your doctor needs more detailed information than regular x-rays provide, particularly to look for head injuries, brain disease, and tumors.

How do I prepare for CT scanning?

No preparation is necessary unless your doctor gives you special instructions.

What happens during the procedure?

CT scanning can be done in a hospital. You are put in a reclining position on a moving table that can change your position inside the scanner. The scanner itself can move around you to change the angles of the x-rays. Contrast media may be injected into your blood vessels or you may be asked to swallow the contrast media, which will show any abnormalities as it passes through the body. This process is called enhancement.

Inside the scanning machine, multiple x-ray beams are passed very quickly through your body at different angles. The images are projected onto a TV screen and prepared for the doctor to examine.

What happens after the procedure?

Generally, there are no special measures to take after the procedure.

What are the benefits of this procedure?

A CT scan may help the doctor diagnose your problem.

What are the risks associated with this procedure?

Exposure to radiation is considered unhealthy if you are exposed to it frequently or in large amounts. However, the amount of radiation you receive in a CT scan is not considered threatening.

Pregnant women should not have a CT scan without first discussing the possible risks with their doctor.

There is a small risk that you will have an allergic reaction to the contrast media. Be sure to tell your doctor if you know you are allergic to any medications.
When should I call the doctor?

Call the doctor immediately if you have any change or worsening of pain or symptoms.

Call the doctor during office hours if:

• You have questions about the procedure or its result.
• You want to make another appointment.

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Up to one percent of the population suffers from hyperhidrosis, a neurological condition caused by an overactive sympathetic nervous system. The condition causes excessive sweating, usually of the hands, armpits and feet, making it very difficult to perform even simple acts such as shaking hands or writing on paper or on a keyboard. This problem is much more than cosmetic; the embarrassment associated with it often leads to social avoidance and can greatly impact on one's career and personal life. In severe cases, medical therapies for this condition are not very effective, or have unacceptable side-effects.

Temple neurosurgeons treat hyperhidrosis with an elegant surgical procedure called endoscopic transthoracic sympathectomy (ETS). This minimally-invasive procedure is done through two very small incisions on the side of the chest. Using an endoscope, tiny silver clips are placed across the upper thoracic sympathetic chain inside the chest. Sweating in the hands is usually immediately and permanently eliminated.

"People who have hyperhidrosis have often given up on leading a normal life," says Jack Jallo, M.D. "After the surgery, patients find their hands warm and dry for the first time in many years. To people who have never experienced the problem it might seem trivial, but to those who suffer from hyperhidrosis, it is an intensely emotional issue-one that they cannot easily discuss, often even with their close friends or family.

According to Dr. Jallo, patients are usually sent home the day after surgery, normal activities can be resumed within a couple of days and the quarter inch incisions on both sides of the chest are barely noticeable within a few weeks.

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Contact Information:

Department of Neurosurgery

Temple University School of Medicine

3401 N. Broad Street

Suite C540

Philadelphia, PA  19140

T: 215-707-7200

F: 215-707-3831