Cranial surgery includes surgery for tumors, vascular abnormalities (aneurysms, arteriovenous malformations, etc), blood clots, seizures, hydrocephalus, and Deep Brain Stimulation for neurologic diseases. Neurosurgeons work with other specialists in and outside of the operating room to get the best results possible. We often use minimally invasive or noninvasive techniques. Image guided, computer assisted and endoscopic surgery is also done in the brain.
Brain tumors include benign and more aggressive tumors, both of which often need surgical treatment or biopsy for diagnosis. Surgery for brain tumors ranges from minimally invasive biopsies or nearly non-invasive radiosurgery, to more aggressive surgical approaches. Some tumors require more than one modality for diagnosis and treatment.
Surgery for brain tumors is often done for resection or removal of accessible lesions. Modern techniques such as image-guided surgery, contact lasers and endoscopes have made the treatment of these tumors easier on the patient. Many types of brain tumors can be addressed surgically, including meningiomas, schwannomas, gliomas, metastatic tumors, pituitary adenomas, and others. Dr. Levine has published on the surgical treatment of meningiomas and has taught courses on resection of these tumors at the cranial base.
Open surgery also allows the use of other treatment during surgery. Chemotherapy and radiation can be delivered directly to the tumor during an open operation. This allows for higher concentrations of drug or radiation to be delivered to the site without exposing the rest of the body. Tumors at the base of the skull often require more extensive procedures and more lengthy operations. These tumors often involve the nerves and vessels that exit and enter the skull. Special procedures and monitoring are used during the surgery to increase the safety of the patient.
Deep Brain Stimulation
Deep Brain Stimulation (DBS) is used to treat movement disorders such as Parkinson’s Disease, Essential Tremor and Dystonia. Other disorders that are under investigation for treatment include: Tourette’s Syndrome, Obsessive Compulsive Disorder and Depression. Dr. Levine has extensive experience in DBS and has taught DBS nationally and internationally. He is a Key Opinion Leader in DBS. He has innovated the field with the propagation of frameless techniques for DBS and collaborates with the NIH.
Epilepsy is most commonly treated with medication. However, in some circumstances surgery is needed to eliminate the focus of seizures or a device may be implanted to decrease the number of seizures. Dr. Levine works with epileptologists and the epilepsy monitoring unit at Holy Cross Hospital to help screen and eventually treat surgically those patients that require this approach.
Is often associated with headaches, gait disturbance, nausea and difficulty with thinking. It is associated with abnormal flow of the cerebrospinal fluid. There are a number of procedures that can be used to treat this condition. Often a shunt is used to divert the fluid to the abdomen or heart. In some cases an endoscopic brain surgery can be used to treat the condition as well. This is called an endoscopic third ventriculostomy. Dr. Levine has experience with both forms of treatment and can determine which is appropriate with the history and imaging studies provided at consultation.
Radiosurgery is a technique used to treat tumors or vascular malformations of the brain without cutting the skin. Carefully designed radiation beams are delivered to the site, minimizing damage to surrounding structures. This is ideal for patients with multiple tumors of the brain. Radiosurgery is also used when conventional surgery might be too dangerous. Radiosurgery is not useful for every situation but plays a very important role in the surgical treatment of brain tumors. Stereotactic radiosurgery is a minimally invasive alternative to conventional brain surgery in some circumstances. This procedure allows safe and effective treatment for many types of intracranial tumors and vascular malformations. By using radiation sources with the aid of sophisticated dose planning software, radiosurgery can often treat conditions once considered inoperable. A linear accelerator delivers beams or X-rays that converge on and destroy tumor cells and abnormal blood vessels, such as arteriovenous malformations (AVMs).
BrainPath is a new and unique way to access deep areas of the brain using a minimally invasive technique. This allows the resection of deep seated tumors and evacuation of blood clots deep in the brain that were traditionally considered inaccessible. Dr. Levine is currently the first surgeon to do this procedure in the metropolitan DC area. Holy Cross Hospital has the first fully functional BrainPath center in the state of Maryland and the DC area! Dr. Levine is willing to consult on patients who may be candidates for this technique.
Blood flow to brain can be interrupted causing a stroke. This can result in a blood clot in the brain that might need to be removed. Also some strokes cause intense swelling in the brain and surgical decompression can be used to lower the pressure in the skull. Other patients have vascular abnormalities in the brain such as aneurysms, or arteriovenous malformations. These can often be treated with endovascular techniques. These too are serious and often require emergency surgery for treatment.