Dr. Jacob Januszewski

Good news is meningiomas are benign, slow growing tumors that generally do not pose any health risks nor require surgical resection. There is a caveat to that of course. If they continue to grow they can get to a size that may compromise important local brain structures, cause swelling in the brain, or seizures. Most of these tumors, however, can grow your entire life and never get to that point. That is why serial screening with an MRI over many years is necessary. Convexity meningiomas, such as yours, are typically away from any important brain structures and are not an issue unless they grow significantly in a short period of time. Yours is extremely small (less than 1 cm) and is unlikely to cause you any harm. You still need to see your neurosurgeon to have screening MRIs performed until the tumor is shown to be stable. Yes, they are curative once completely resected, but most do not need to be.

There is nothing you can do. Only time will tell how he recovers. I am not sure what kind of surgery he had so I cannot tell what the speech loss is from exactly. This can result from what's called a "syndrome of the trephined" which sometimes happens after a decompressive hemicraniectomy, or could be from the head injury itself. Unfortunately you have to give it some time and see how he recovers. His recovery could take up to even 1 year, not just 3 weeks, and he could have gradual and progressive improvement over that course of time.

Vertigo is very hard to treat and may be related to many causes

You should have this evaluated by a neurologist with an MRI

No, paralysis does not happen in the lower back. However, sometimes what’s called a cauda equina syndrome may develop from a herniated disc for example which is a surgical emergency

No some can be benign

There is no need on your part other than preoperstive labs and medical clearance by your primary care or cardiologist. Once you decide to have surgery you should already have all information needed and everything to be done, done.

Surgery for stroke is not always indicated. If it is, it is usually a life saving measure and may not bring any meaningful function back. It is generally reserved for younger patients in a reasonably good neurological condition.

Yes, back injury can certainly cause a neurological deficit. Lower back is more likely to cause leg symptoms (such as leg/foot pain and weakness, foot drop, etc.). Neck is more likely to cause arm symptoms (pain and/or weakness in your arm or hand grip). You should consider getting an MRI and following up with a specialist if it shows anything of concern. However, be mindful that lack of coordination and weakness can also be caused by other problems somewhere else in the body and you should really be fully evaluated by a doctor to pinpoint where the problem may be coming from.

Sometimes it can be dissolved with anticoagulants (medication that makes the blood very thin by preventing it from clotting). However, these medications come with their own risks and cannot be used in all situations or for all blood clots. I do not know what kind of blood clot he has so I cannot tell you specifically. Risks vs. benefit must always be evaluated and this depends on case by case basis.

I would have to evaluate her case and her MRI to know what happened to her vision specifically. However, if there was any injury to the optic nerves, then, generally those do not repair themselves. If her vision loss was due to retinal detachment or problems within the globe then her prognosis might be different. She would also need to be evaluated by a neurologist and a neuroopthalmologist.

I am not aware of it. Headaches can have a plethora of causes. Sometimes neck can cause neck muscle spasm and result in some occipital headaches, but usually not lower back.

Your baby's head should also be getting larger with time as he grows. If the head size is getting too large too fast then this may be a sign of a problem (such as hydrocephalus, or water on the brain). Your pediatrician needs to evaluate your baby's head size and compare it to a head circumference growth chart. If it is consistently above the 95th percentile, he should be evaluated by a pediatric neurosurgeon.

Vein of Galen malformations generally cause problems in infancy. It may cause headaches for you now, however, if they can be controlled with medications then this would be preferable over surgical treatment. You need to have routine annual follow-up, however, to ensure this aneurysm is not growing with time as it may need treatment down the road if it does.

Pituitary adenoma can be either functional (secreting hormones) or non-functional (not secreting hormones). Functional adenomas may need to be treated first as some cause complications with any surgery depending on the hormone it is secreting. Non-Functioning adenoma is most often found incidentally and should not be problematic until it becomes large enough to exert pressure on your optic nerves and effect your vision. You should have your vision evaluated first prior to the back surgery. If the tumor is already effecting it, then it needs to be taken care of first. Otherwise, if small enough, it shouldn't influence your back surgery.

Pain radiating from your lower back or your buttocks down the back of the leg all the way down to your ankle and toes is described as "sciatica." Sciatica is usually from an L5 or S1 nerve root irritation, generally from a disc herniation. There are other types of leg pain symptoms that are not true sciatica but correspond to different nerve roots being pinged at different levels. You should consider an MRI of the lumbar spine to investigate the reason for your symptoms. If you have no leg or foot weakness, starting with at least 3 months of conservative therapy including pain management, injections, and physical therapy is the best first step before considering surgery.

There are many types of spinal fusion surgeries performed for many different reasons. A spinal fusion on the neck can be performed either on the front of the spine, the back of the spine, or both. Fusion means that a degenerated and diseased portion of the patient's disc is removed and replaced with a titanium or plastic cage filled with artificial bone. Sometimes patient's own bone can be used to replace the degenerated disc. This cage is then sometimes backed up with a titanium plate or screws and rods to immobilize the unstable segment and increase the chances that bone fusion will take place.

While it is true that a fusion surgery immobilizes that particular level of the spine, 75% of neck movement comes only from the first two upper levels of the neck vertebra. These levels are very rarely fused in typical degenerative spine conditions. Patients rarely notice any difference in the range of motion of their neck after neck fusion from the front and, in fact, typically experience improved neck movement because the restrictive, painful stimulus has been removed. Complete inability to move your neck only comes with what is called "occipital - cervical" fusions which require fusion of the first upper two vertebra to the base of the skull. These operations are only performed in rare situation from traumatic fractures and/or instability at that level.

Of note, it is critical that your surgeon understands the spinal biomechanics when performing any spinal fusion surgery. The biggest benefit of fusion only comes if the spine is fused in the proper alignment. Correct cage size with proper amount of angulation must be used, sometimes combined with specialized compressive techniques to either maintain the natural alignment of the spine, or to restore this alignment in patients who have degenerative changes that already caused neck deformity.

Very few brain operations are performed with a patient awake. This is done only in situations when a pathology in the brain is located in a dominant brain hemisphere (usually left) and close to eloquent brain areas (such as areas controlling your speech or movement). This is performed only to avoid a deleterious complication that would effect a patient's quality of life after surgery. However, patients are always put to sleep and woken up during surgery only after the area of the brain to be operated on is already exposed.

In cases of high velocity trauma, such as yours, requiring craniotomy for intracranial pressure management or evacuation of a traumatic hematoma, you may have also suffered any form of traumatic brain injury (TBI). There are many levels of TBI, mild to severe, and many symptoms can accompany this. Your problems with concentration may sure be one of those symptoms and may take few weeks to even few months to recover. You may need assistance from a neuropsychiatrist to help you cope with symptoms of traumatic brain injury or post-concussive symptoms.

Surgery is not always necessary for a herniated disk. In most circumstances, when pain or nubmness down your leg is the only symptom, conservative therapy with pain management (such as epidural steroid injections, facet blocks, foraminal injections, non-steroidal anti-inflammatory medications) and physical therapy for at least 3 months should be attempted. If conservative therapy does not improve symptoms only then surgery becomes an option.

There are situations, however, when a herniated disc may become a neurosurgical emergency with urgent surgery as the only option. In a setting of acute leg/foot weakness, bowel or bladder incontinence, or numbness around your groin area or upper inner thighs, MRI should be immediately performed and if a large disc herniation is diagnosed surgery should be performed within 24 to 48 hours. This is called "cauda equina" syndrome and is a neurosurgical emergency. Cauda equina does not occur with every disc herniation but it can occur in any age group and in people of any fitness level.