Prof. Christopher Robert Mascott, M.D.

No reason for large head shave. Have been doing minimal head shaves for over 25 years with no issues I usually shave about the width of a little finger just to avoid hair tangling in sutures. There is no increased infection risk for minimal or even no shaves as you may have seen. I have always felt that patients recover better psychologically if they leave the hospital looking normal.

Most discs resolve over time. Managing symptoms with steroids, injections, physio, traction etc can help avoid surgery. Risks of surgery are not great but for me the main and rarely discussed surgical risk is that surgical scar tissue can lead to a greater pain problems down the road than the initial problem. Also if someone suggests a fusion, that can lead to a greater problem down The road than the initial problem. I have found that very few “herniated” discs actually need surgery. Symptom recovery may or may not be faster with surgery but with the risk of further problems down the road.

Sounds like a seizure. Nocturnal only seizure activity does not necessarily preclude driving depending on where you live. An EEG may be reasonable, but a normal EEG does not preclude a seizure. An MRI may be reasonable to rule out a visible underlying cause for seizures. A trial of a contemporary seizure medication to see if episodes resolve may be reasonable.

In the US spine surgery is about 80% of what neurosurgeons do.... higher in private practice. In the rest of the world neurosurgeons usually do more brain surgery than spine surgery.

I presume a scan did not show any problems in the head. Scalp injury can look pretty dramatic but will heal. Fluid under the scalp is no big deal and can go away in days but sometimes can take months. Draining the fluid With a needle is usually not a great idea because of a small risk of introducing germs

If you have back problems from being overweight avoid spine surgery like the plague. Losing weight can be difficult if you need to lose a lot.... bariatric surgery is the only thing I would consider.

It usually isn’t a question of doing something as much as finding out what they are. Tumor spreading to bone can do that but other things can too. First step is to do imaging of bone elsewhere in the body, imaging of the body looking for a cause or source. Eventually a nuclear medicine scan (bone scan) and possibly a biopsy if there is no obvious diagnosis

The standard investigation for a brain tumor is an MRI unless you have something like a pacemaker that precludes having an MRI. Many things can be done with an MRI including 3D acquisition in order to plan treatment or accurately follow possible growth or treatment response. MR Spectroscopy done in the MRI machine to measure chemicals in the tumor to help determine what it might be. Functional MRI can test for speech or movement function near the tumor. Diffusion Tensor Imaging (DTI) can help show brain connections and how they may be displaced by the tumor. Not all of these MR I tests are usually done in one sitting since it would take too long. CT is a much more rudimentary test. CT angiography (CTA) can help show tumor blood supply and nearby blood vessels. If I am ordering an exam to rule out or follow a brain tumor I would usually go straight to MRI. MRI usually gives you a pretty reliable idea of what a tumor is but tissue may be needed to be sure. Personally I do not favor biopsies very much which I view as surgical risk without surgical benefit and usually advocate removal if at all possible. Some tumors such as benign appearing meningiomas can be observed over time on imaging without intervention if not symptomatic.

"Not talking" requires some further explanation. There are speech areas in the brain (usually on the left side in right handed people) which are speech related. Interference with these can lead to a variety of temporary or permanent speech problems ranging from problems naming things, to difficulty with fluency to totally garbled speech. There are other areas of the brain that can lead to mutism (no speech at all, notably in an area called the supplementary motor area or in the cerebellum). Fortunately mutism from surgery in these areas is almost always reversible although this may take weeks to months. In primary speech areas we can do awake surgery and stimulate the brain to see where speech is to avoid trouble. This is necessary because no two people are alike with regard to where speech is although usually in the same general area.

There are lingering effects from long anesthesia for up to a week but with regard to the tumor, it very much depends on location, size and tumor type. A small superficial tumor will have much faster recovery than larger and deeper ones. It also depends what functional brain areas are nearby. Is it close to movement areas, speech areas, coordination areas etc ? Having nearby functional brain areas will affect function and recovery after surgery.

There are specific areas in the brain needed for speech (usually on the left side of the brain in right handlers and also on the left in most left handlers but with a higher chance of some speech on the right). There are classic areas known to be involved in speech but some of these vary from person to person, so if we are concerned about speech function, we can do a wake-up during surgery to test for speech and avoid messing with speech areas. Speech mapping has been done since the 1920s and 1930s but came into more widespread use in the 1990s.
There is no way to replace brain areas of damaged but time and speech therapy usually helps considerably.

Epilepsy (recurring seizures) can be treated with surgery in selected cases. This is usually predicated on medications not working and a subsequent detailed investigation with regard to whether there is a cause for seizures and where they are coming from. This involves MRI scans (to look for abnormal areas), extended hospital admissions to record video and EEG (brain waves) to see if seizures start in one location, other tests such as MEG (magnetoencephalography), PET (Positron emission tomography.... radioctive tracer to look at brain activity), SPECT (single photon emission tomography) and other tests. All this requires a specialized team for surgical treatment of epilepsy including specially trained neurologists, neurosurgeons, neuropsychologists, nurses, EEG technicians etc. In young children this should be in a specialized children's hospital.
Seizures starting in a localized abnormal area can be helped by removing that area surgically. "Generalized" seizures that start all over cannot be helped by surgical removal of brain areas but there are options for disconnection of stimulation of either brain areas of the vagus nerve in the neck by implanted pacemakers.
In summary, most seizures are not treated by surgery because medications work. When medications are not working optimally, surgery can be a consideration in some if the extensive work-up leads to reasonable surgical options.... so only a minority for surgery overall.

No medication will remove a clot but clots absorb with time. In the head, location is important. If the clot is in the brain but not large enough to require urgent surgery to relieve symptoms it will resolve. It is also important to know if there is a cause that may bleed again. If the blood is outside the brain (subdural for example) the blood will go from acute to chronic to water. If the clot outside the brain is stretching little veins on the surface of the brain, additional bleeding could increase the clot and eventually require surgery.

Skull fractures usually only need surgery if they are depressed. Linear (straight line) fractures are non surgical.
Most surgeons use little titanium plates and screws for skull repair which confers some immediate stability. The bone usually grows together over 6 months or so with some variability.

85% of meningiomas are benign. Others referred to as "atypical" or grade 2 have a higher chance of coming back. Malignant meningiomas are quite rare. A vertex meningioma has a higher chance of cure with surgery although the limiting factor may be how close to the midline it is since there is a large vein structure called the sagittal sinus along the midline. If the meningioma is up against this, it may not be possible to remove all the attachments since the sagittal sinus is important and must be preserved. Even when attachemnts cannot be completely removed, cauterizing attachements at surgery is a "second best" option.
Is your meningioma really 5x5x3mm not cm?
I don't think anyone in their right mind would suggest treating that if it is mm.
Overall options include observation with serial MRIs (always a choice but really the only reasonable one if that is in mm), surgery or radiosurgery. Radiosurgery is computer-guided radiation, usually in one session (sometimes 3-5) which is proven to work usually more by stopping growth with slight shrinkage, not disappearance. All these options should ber discussed in anyone with a meningioma. If it is tiny as described, observation is the only reasonable option. I usually use 3D MRI sequences for observation so that small changes in volume can be seen by computer matching way before radiologists see a change.... this with a view to discussing treatment as opposed to further observation. Again if tiny, even a small change should not prompt intervention.
Meningiomas cause symptoms isf they get large and affect adjacent brain or sometimes if irritation of adjacent brain lowers the threshhold for seizures. Otherwise no particular health risks.

Pituitary tumors are mostly benign (with very few exceptions) and hardly ever life threatening. Small tumors are found either because they produce excess hormones or can be found by accident on a scan. For tumors producing hormones, the first line of treatment is medical if it is the kind of hormone that can be suppressed. Lager tumors can present with visual loss from pushing on the nerves for vision. If those tumors produce hormones, medical treatment can come first but many larger tumors do not produce hormones and treatment is surgical through the nose to preserve vision. I am not sure how any of this would impact your back surgery, on the other hand I am not a big believer in back surgery and think most is not indicated and eventually makes people worse.

Chris

Since you have time to type this question, this is not an emergency or they would have already removed the blood clot surgically. Blood clots in the brain absorb by themselves. If it is not an emergency, the clot is not getting bigger or there are no incapacitating symptoms, the blood clot will absorb by itself usually over weeks. There is no medication to make this go faster. Also, it depends exactly where the clot is... inside the brain? Outside and pushing on brain etc. more importantly what caused the clot... trauma or did it happen by itself. In a 13 year old, there must be an underlying cause such as a vascular malformation which requires further investigation.

It's not the surgery, it's the head injury! Even without surgery significant head head trauma can have long lasting effects. A significant concussion with a normal scan and no surgery can often result in "post concussion syndromes" consisting of poor concentration, memory problems, headaches, nausea, dizziness etc. everyone is different but these symptoms can last for months in some people. Concussions have gotten a lot of press recently in sports. Prolonged rest is advised and there are some specialists in concussion that can advise.

Awake brain surgery goes back to the early 1900s (Fedor Krause) and the 1920s and 30's (Wilder Penfield). Initially awake surgery was for treating epilepsy to map out brain function and see where seizures might be coming from. In the 1990s surgeons started doing this more frequently for brain tumors in areas close to speech and movement in order to electrically stimulate these brain areas to identify function and avoid damaging function when removing tumor and this has remained a gold standard today. Modern anesthesia makes it easier to wake up a patient just during testing as opposed to being awake for the whole procedure. Implanting electrodes for brain pacemakers for Parkinson's disease treatment is often done awake in order to test function, stimulate and record electrical activity. Local anesthetic is always used and the brain has no pain sensation. Patients do get tired doing tasks during testing though.