The University of Colorado's Department of Neurosurgery has a long history of clinical excellence. CU Neurosurgery's doctors practice at University of Colorado Hospital, The Children's Hospital, Veteran's Administration Medical Center and Denver Health Medical Center. Our neurosurgeons treat the following conditions & diseases:
A brain abscess can be caused by bacteria, fungus and parasites.
Infections of the face, ears, or sinuses may spread to the brain by
direct extension through adjacent tissues. Infections in other body
organs such as pneumonia, dental abscess or endocarditis, may spread
through the blood stream and cause one or more brain abscesses.
Occasionally, brain abscesses develop in patients following
neurosurgical procedures, such as surgery for brain tumor.
Patients who have weakened immune systems (immunocompromised) are at higher risk for brain abscesses. AIDS patients, cancer patients, and others with autoimmune diseases have a high predilection for developing fungal as well as other unusual infections of the brain.
Patients may complain of headaches, low-grade fever, neck stiffness, and nausea or vomiting. Some will present with seizures or mental status changes. Focal neurological problems, such as speech problems, weakness or numbness can be noted if the abscess involves critical areas of the brain. If the brain abscess has arisen from another infectious process, there may be symptoms suggestive of the primary infection, for example pneumonia.
The MRI scan above shows severe contrast enhancing lesions suspicious for brain abscess.
The diagnosis is usually made by a combination of the history, physical exam and brain imaging. MRI with and without contrast is the study of choice. Unlike other brain infections, a brain abscess is usually not diagnosed by CSF studies. A lumbar puncture may actually be contraindicated in these patients secondary to the mass effect the abscess has on the brain. If CSF is removed, the swollen brain can shift into small openings in the dura and skull causing neurological deterioration.
Patients are usually hospitalized and treated with IV fluids. Intubation may be necessary if the patient is significantly lethargic or has difficulty breathing. The treatment of the cerebral abscess depends on the organism identified. If abscesses are small or multiple, stereotactic aspriration may be performed to obtain a sample of tissue. Once the organism is identified, long term intravenous antibiotics are used to treat the infection
CU Neurosurgery takes care of all types of brain tumors. The following is a list of tumors that we typically see. Visit our Brain Tumor page in the Multi-Disciplinary Program section to learn about the entire team and the services that we offer.
Three nerves (median, ulnar and radial) supply sensation and promote movement of the hand. The median nerve, arising from multiple nerves of the spinal cord, travels along the middle arm and forearm through the wrist and into the hand. This nerve passes though the wrist in a tunnel known as the carpal tunnel. Numerous tendons that control finger movement form the base and walls of the carpal tunnel. A broad fibrous band, the transverse carpal ligament, forms the tunnel roof. When there is thickening of this ligament the median nerve can expreience compression in this tunnel causing pain and numbness in the hand.
Risk factors for carpal tunnel syndrome include repetitive movements of the wrist in certain jobs such as assembly line work or typing. . Retained fluid or soft tissue swelling can cause median nerve entrapment in pregnancy, diabetes, rheumatoid arthritis, degenerative arthritis, lupus, and trauma. Endocrinologic causes of carpal tunnel syndrome include acromegaly and hypothyroidism.
Other disorders that may cause similar pain are cervical spine disease, brachial plexus injuries and other peripheral nerve problems.
Patients may complain of tingling or "pins and needles" in their fingers and hand, most significantly in the thumb, index and middle fingers. Sensory loss and a burning sensation are also commonly reported. Pain may radiate up into the arm. Often patients notice difficulty with fine motor movements. Eventually, there is wasting of the muscles in the hands. Many times symptoms are worse at night.
The diagnosis of carpal tunnel syndrome involves and neurological history and physical examination and diagnostic electrical studies. Tapping over the wrist (Tinel's sign) or placing the hand in a flexed position (Phalen's sign) may reproduce the tingling or pain. Wasting of the hand muscles may be seen as a late sign.
Electromyography (EMG) and nerve conduction studies (NCS) are done to confirm the diagnosis.
Conservative treatment involves a extension wrist splint and the use of non-steroidal anti-inflammatory pain relievers. Many patients will have significant improvement with medical management. Steroid injections may also be helpful.
Patients who fail conservative therapy and those with severe symptoms may be candidates for surgical decompression. This surgery is typically performed under local anesthesia with intravenous sedation. A one inch incision is made in the palm over the carpal ligament. The soft tissue is dissected to the level of the ligament and it is cut to relieve the pressure on the median nerve. This surgery is a short outpatient procedure with a very high success rate.
Chiari malformation describes a group of conditions that are very different but share in common the characteristic that a small portion brain tissue protrudes from the skull into the spinal canal. They were all originally described by an Austrian pathologist, Hans Chiari.
The rates of Chiari Malformation, Type I are not known, as many people may have Chiari Malformation, Type I without any symptoms. In this context, it rarely requires surgical treatment. Symptoms associated with Chiari Malformation, Type I can develop during childhood or adulthood.
Chiari Malformation, Type II is a developmental condition that is always present at birth and is almost exclusively associated with a condition known as myelomeningocele, or spina bifida. Although most children with Chiari Malformation, Type II do not require surgical treatment for the Chiari Malformation, they all require surgical treatment for the myelomeningocele.
Chiari Malformation, Type I The symptoms and signs of a Chiari Malformation, Type I are related to the compression of the cerebellar tonsils, which are the small portion of the brain that protrudes through the base of the skull, or due to compression of the lower portion of the brainstem. Chiari Malformation, Type I may also be associated with the development of a fluid collection within the spinal cord, known as a syrinx, or with scoliosis. These conditions may lead to sensation or strength changes in the arms or legs. The most common symptom is headache, which occurs in the back of the head and the neck, and is increased by coughing or sneezing. In infants and children, headaches may manifest as irritability or crying, and the pain may be associated with arching of the neck in a hyperextended posture.
Less common symptoms may include dizziness, an impaired ability to coordinate movement, double vision, and involuntary, rapid, downward eye movements. Because many symptoms of Chiari malformation can also be associated with other disorders, a thorough medical evaluation is important. Headache, for example, can be caused by migraines, sinus disease or other causes.
Chiari Malformation, Type II The symptoms and signs related to Chiari Malformation, Type II are often complex, as patients with this condition usually have a condition known as hydrocephalus, as well. Typical symptoms include difficulty swallowing and difficulty breathing.
The diagnostic process begins with your primary care doctor or neurologist taking your medical history and giving you a complete physical examination. Your doctor will ask whether you're having symptoms such as head and neck pain, and will ask you to describe them. He or she will also check your fine motor skills and swallowing ability. If you have symptoms such as head pain, and the exact cause isn't apparent to your doctor, he or she may recommend a radiographic study, such as a computed tomogram (CT) or Magnetic Resonance Image (MRI). These studies are the best tools to evaluate for the presence of a Chiari Malformation.
Chiari Malformation, Type I The severity of symptoms related to Chiari Malformation, Type I is highly variable. The majority of patients do not require surgical treatment. Many have relief of headaches with over the counter pain medications. For cases in which a patient has severe symptoms that clearly result from the Chiari Malformation, there is not effective medical treatment at this time.
Chiari Malformation, Type II Although patients with Chiari Malformation, Type II require surgical treatment for the associated spina bifida and often require surgical treatment for hydrocephalus, the majority will not require surgical decompression of their Chiari Malformation. In such cases, the patient will have had multiple interactions with her/his neurosurgeon prior to making a decision to pursue surgical treatment.
Reducing pressure by surgery
The most effective treatment for patients with severe symptoms from Chiari Malformation, Type I, is a surgical procedure known as posterior fossa decompression. In this procedure, a portion of the bone at the bottom of the skull is removed in order to allow more space for the cerebellum. In adults and some children, the protective membrane overlying the brain, or dura mater, is also opened and a patch may be sewn into position, also to create more space for the cerebellum. In some children, it is not necessary to open the dura mater. Surgery usually takes 2-3 hours and the patient leaves the hospital 2-4 days after surgery.
Epilepsy or seizure disorder is a symptom of disturbed electrical activity in the brain. The nervous system is electrical, with impulses constantly shuttling between billions of neurons (nerve cells) and the parts of the body involved in various activities both voluntary (such as walking) and involuntary (such as breathing). Nerve cells may malfunction, causing the normally smooth-running pattern of electrical activity to be disrupted. The damaged cells "overload," becoming over-excited and giving off too much electricity. The result of this temporary overload is a seizure that causes some of the body's activities to go awry: there's a sudden loss or disturbance of consciousness often in association with motor activity; there's no pain associated with the seizure and usually no long-term after effects. Those whose epilepsy is controlled by medical treatment may experience no seizures at all. Approximately 2.5 million people in the U.S. alone suffer from epilepsy. It is really many diseases but they all have in common the repetitive occurrence of epileptic seizures. These seizures can occur in a small region of the brain (partial seizures) or throughout both of the brain’s hemispheres (generalized seizures). Epilepsy can strike at any age, but it is especially common in children and the elderly.
Evaluation for an accurate diagnosis is the first step. Epilepsy can be confused with other conditions such as syncope, stroke and certain psychological disorders. Several tests are used in the evaluation of epilepsy. An EEG records patient’s brain wave activities. For patients being considered for epilepsy surgery, inpatient EEG monitoring, an MRI of the brain or PET scan and neuropsychological testing may also be ordered. Once the appropriate tests have been accomplished, the surgical candidate will be evaluated by a multi-specialty team to determine if they would be an appropriate candidate for surgery.
Accurate diagnosis of the type of epilepsy a person has is crucial for finding an effective treatment. There are many different ways to treat epilepsy. Currently available treatments can control seizures at least some of the time in about 80 percent of people with epilepsy.
Vagal nerve stimulator may be considered for complex partial seizures and the other forms of epilepsy that are resistant to medical therapy. In patients who are not candidates for open, traditional resective surgery, a vagal nerve stimulator may be used. This implanted device, attached to the left vagus nerve, has been shown in multiple studies to reduce the seizure frequency and intensity by 50% or more in 30% of the patients nine months after the onset of stimulation. With additional stimulation (i.e., greater than 18 months), 54% of the patients develop a 50% or better reduction in seizure frequency and intensity. The procedure itself takes approximately one and a half hours, and the patients usually go home the next day. The procedure has very few risks.
Cortical mapping is a technique used to localize both the region of the brain generating seizures as well as areas that are responsible for thought and movement. There are various ways of mapping the brain. Noninvasive systems like fMRI, PET, MEG, SPECT can give a good starting point for localization of seizures and thought processes. However, the detail and resolution needed to plan a surgical resection often requires direct recording from the surface of the brain. To do this, surgeons will place a grid electrode directly on the surface of the brain and then record in the operating room or close up the surgical site and record for some days with the electrodes in place, a so-called phase II recording.
Callosotomy is a surgical procedure in which the some or all of the corpus callosum is divided. The corpus callosum is the major fiber connection between the two halves of the brain. The procedure is primarily used to treat "drop attacks" seizures. Many centers are using a trial of vagal nerve stimulation before performing callosotomies.
Deep brain stimulation for epilepsy is currently under investigation. Although a number of early trials show promise, it has not yet developed to the point where it may be considered a viable alternative to traditional medical management. In some patients, chronic electrical stimulation through electrodes implanted deep in the brain can relieve some of the major symptoms of Epilepsy and Parkinson's disease. Based on results from about 30 patients, the FDA recently approved deep brain stimulation (DBS) within the thalamus for relief of tremor of Parkinson's disease and also for non-Parkinsonian "essential tremor."
Removal of the seizure focus is the most common type of surgery for epilepsy, removing a small area of the brain where seizures originate. This is also referred to as a lobectomy or lesionectomy.
Hydrocephalus results from the excessive accumulation of fluid in the cavities of the brain. The word hydrocephalus derives from the Greek words "hydro" meaning water and "cephalus" meaning head. Although the condition is known as "water on the brain," the fluid is actually cerebrospinal fluid (CSF). In the normal person approximately 10-20 cc of fluid is produced every hour. This fluid provides a cushioning barrier in which the brain floats and is also used to carry nutrients to the brain and carry away waste products. The fluid is mainly found in the cavities of the brain known as the ventricles. Two lateral ventricles drain into the third ventricle, which drains into the fourth ventricle and out of the brain to be reabsorbed by the blood stream.
When an injury or illness alters the circulation of the CSF, one or more of the ventricles becomes enlarged as the CSF accumulates. The skull is rigid and does not allow for this excess fluid to be reabsorbed. In such a case, the pressure in the brain may increase profoundly.
In adults this can occur for many reasons, but most often it is due to hemorrhage, infections, brain damage, stroke, or tumors. In some cases no cause can be identified.
Symptoms of Hydrocephalus
Headaches and nausea are common symptoms of hydrocephalus. Other signs of the condition are difficulty focusing the eyes, unsteady walking, weakness of the legs, sudden falls, and a distinctive inability to walk forward, as if the feet are stuck to the floor. As the condition progresses, those with hydrocephalus show decreased mental activity, reflected in withdrawn behavior, lethargy, apathy, impaired memory, and speech problems. Urinary and bowel incontinence can also occur. Dementia, involving loss of movement, sensory functions, and cognitive abilities, are signs as well.
Your physician has a wide variety of diagnostic tools to evaluate hydrocephalus:
Computed Tomography (CT) scan of the head uses an x-ray beam, which passes through the head allowing a computer to make a picture of the brain in slices. It is reliable, safe, painless, and quick (about 15 minutes). A CT will show if the ventricles are enlarged or if there is an obvious blockage.
Magnetic Resonance Imaging (MRI) uses radio signals and a very powerful magnet to create a picture of the brain that can reveal if the ventricles are enlarged and evaluate CSF flow.
Isotopic cisternography involves injecting a radioactive isotope into the lower back through a spinal tap. This allows the absorption of CSF to be monitored over a period of time (up to 4 days). Isotopic cisternography is considerably more involved than a CT or MRI but can aid the diagnosis of Normal Pressure Hydrocephalus (NPH).
Lumbar puncture (spinal tap) can be used to measure CSF pressure and analyze the fluid. Sometimes the procedure helps indicate whether a shunt, the common treatment for hydrocephalus, would work. If lumbar puncture improves symptoms even temporarily, then the shunt is more likely to be successful.
Intracranial pressure monitoring may be able to detect an abnormal pressure or pattern of pressure waves. Monitoring requires insertion of a catheter or small fiber optic cable through the skull into the fluid around the brain or possibly into the ventricle within the brain. Both insertion techniques are safe and require admission to the hospital for 24 hours.
The most common treatment of hydrocephalus involves diverting the buildup of CSF to somewhere else in the body through the use of a device called a shunt. A shunt is a small tube inserted into the ventricles to drain the fluid away from the brain. Usually, the tube is routed beneath the skin to the peritoneal cavity (the area surrounding the abdominal organs). The CSF is eventually absorbed into the bloodstream. A valve is attached to the shunt to ensure that the CSF flows in a single direction and to regulate the pressure. The valve opens automatically when the CSF pressure in the brain exceeds a certain limit and closes when the pressure returns to an acceptable level.
Shunt operations are relatively common. An average of 75,000 shunt operations are performed annually in the United States, the majority in children. This surgical procedure controls hydrocephalus but does not cure it. Hydrocephalus can be a lifelong condition in which complications from the shunting can arise. The shunt surgery is not particularly painful, and the hospital stay is typically short. After surgery, the shunt system is completely inside the body and often cannot be easily felt.
Over time, the shunt controls hydrocephalus by diverting the fluid before pressure can build up. Often the cause for the condition can be treated directly. For example, a surgeon can remove a brain tumor that is causing obstruction of the ventricles or the connecting passages between the ventricles.
In certain cases of hydrocephalus, a neurosurgeon may recommend a surgical alternative to shunting. The procedure is called an endoscopic third ventriculostomy (ETV). The surgeon uses a special endoscope (small tube with a camera on the end) to create a small hole in the floor of a ventricle. This hole provides an alternative CSF passageway that by passes an obstruction of the normal CSF flow through the ventricles.
The prognosis for hydrocephalus depends on the cause, the extent of symptoms and the timeliness of diagnosis and treatment. Some patients show a dramatic improvement with treatment while others do not. In some instances of normal pressure hydrocephalus, dementia can be reversed by shunt placement. Other symptoms such as headaches can disappear almost immediately if the symptoms are related to elevated pressure.
In general, the earlier hydrocephalus is diagnosed, the better the chance for successful treatment. The longer the symptoms have been present, the less likely it is that treatment will be successful. Unfortunately, there is no way to accurately predict in an individual case how successful surgery will be. Some patients will improve dramatically while others will reach a plateau or decline after a few months.
Shunt malfunction or failure can occur. The valve can become clogged or the pressure in the shunt may not match the needs of the patient, requiring additional surgery. In the event of an infection, removal of the shunt and antibiotic therapy is needed as well. A shunt malfunction may be indicated by headaches, vision problems, irritability, fatigue, personality change, loss of coordination, difficulty in waking up or staying awake, a return of walking problems, mild dementia and incontinence. Fortunately, most complications can be dealt with successfully.
University of Colorado Neurosurgery is one of just a handful of centers in the U.S. to offer Deep Brain Stimulation (DBS) procedures as a treatment for movement disorders such as Parkinson’s disease, essential tremors and dystonia. Its unique team approach makes the Deep Brain Stimulation program at CU Neurosurgery one of the most effective and experienced in the country.
Why Choose University of Colorado Neurosurgery?
The success of the DBS procedure is highly dependent on the ability of the surgical team to effectively place and program the electrode stimulators. This is why experience and collaboration is crucial.
Superior Expertise and Experience
Patient outcomes make the DBS program at University of Colorado Hospital one of the busiest in the country. Dr. Ojemann, neurosurgeon on the DBS team, has performed more than 200 DBS implants.
The University of Colorado program distinguishes itself by providing comprehensive multidisciplinary care that considers every aspect of the disorder and how they impact the individual patient’s life.
See our Deep Brain Stimulation Page for more information.
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For more information, visit our Pediatric Neurosurgery page.
Pituitary tumors are abnormal growths that develop in your pituitary gland. Some pituitary tumors cause excessive production of hormones that regulate important functions of your body. Other pituitary tumors can restrict normal functions of your pituitary gland, causing it to produce lower levels of hormones.
For more information on pituitary tumors, visit our Pituitary page under the Adult Brain Tumor Program.
Strokes occur when blood vessels to the brain are blocked (ischemic stroke) or burst (hemorrhagic stroke). This prevents oxygen from reaching the brain and damage can begin within minutes. the parts of the body controlled by that part of the brain will not work properly.
That is why it is important to know the signs of stroke and act FAST. Minutes matter when the very first stroke symptoms appear. Call 911 immediately!
Stroke Warning Signs
For more information, visit our Stroke page.
The peripheral nerves are a complicated, extensive network of nerves that are the tool for the brain and spinal cord to communicate with the rest of the body. They are fragile and can be damaged easily. When one of these nerves suffers injury or trauma, surgical treatment is sometimes the only remedy. Our highly specialized experience and surgical expertise, coupled with our multi-disciplinary practice, makes University of Colorado the obvious choice for treatment of these injuries.
Causes of Nerve Injuries
Injury to the peripheral nerves can occur through a variety of trauma. Common causes of nerve injuries include:
Nerve Injuries we Treat:
Sunderland Classification System
Your doctor will need to determine the exact location and severity of the nerve injury. A classification system called the Sunderland Classification system divides nerve injuries into five parts. These include:
First-degree injury: A reversible local conduction block at the site of the injury. This injury does not require surgical intervention and usually will recover within a matter hours to a few weeks.
Second-degree injury: There is a loss of continuity of the axons or electrical wires within the nerve. If this kind of injury can be confirmed through pre-operative nerve testing, surgical intervention is usually not required.
Third-degree injury: There is damage to the axons and their supporting structures within the nerve. In this case, recovery is variable. Intra-operative nerve conduction studies are often able to help predict outcome and need for simple cleaning of the nerve (neurolysis) or a more extensive repair with grafting.
Fourth-degree injury: In this case, there is damage to the axons and the surrounding tissues sufficient to create scarring that prevents nerve regeneration. Intra-operative electrical testing confirms that no electrical energy can be passed along the neural pathways in this injured nerve. Surgical intervention with nerve grafting is necessary to repair the damage.
Fifth-degree injury: These injuries are usually found in laceration or severe stretch injuries. The nerve is divided into two. The only way to repair a fifth-degree injury is through surgery.
In order to fully determine the extent of the damage to the nerve, your doctor may order an EMG / NCV, an electrical conduction test to determine the passage of electrical currents through the nerves. These tests are sometimes done during actual surgery while the patient is sedated.
Your doctor may also order any of the following imaging techniques:
Nonsurgical treatment for nerve injuries may include:
Surgery for nerve injuries
The goal of surgical repair is to repair the nerves so that function is restored to the area. Depending on the type and severity of the injury, your doctor will discuss different methods of nerve repair and create a treatment plan that is appropriate for you.
Dr. Kevin Lillehei specializes in the treatment of peripheral nerve injuries. He, along with Dr. Neil Pitzer of the Physical Medicine and Rehabilitation Service have run the Peripheral Nerve Injury Clinic for more than two decades. This muljti-disciplinary approach has proven to provide the optimal care for nerve-injured patients.
Trigeminal neuralgia (TN) is a chronic pain condition that causes extreme, sporadic, sudden burning or shock-like face pain. The pain seldom lasts more than a few seconds or a minute or two per episode. The intensity of pain can be physically and mentally incapacitating. TN pain is typically felt on one side of the jaw or cheek. Episodes can last for days, weeks, or months at a time and then disappear for months or years. In the days before an episode begins, some patients may experience a tingling or numbing sensation or a somewhat constant and aching pain. The attacks often worsen over time, with fewer and shorter pain-free periods before they recur. The intense flashes of pain can be triggered by vibration or contact with the cheek (such as when shaving, washing the face, or applying makeup), brushing teeth, eating, drinking, talking, or being exposed to the wind. TN occurs most often in people over age 50, but it can occur at any age, and is more common in women than in men. There is some evidence that the disorder runs in families, perhaps because of an inherited pattern of blood vessel formation. Although sometimes debilitating, the disorder is not life-threatening.
The presumed cause of TN is a blood vessel pressing on the trigeminal nerve in the head as it exits the brainstem. This contact puts pressure on the nerve and causes it to malfunction. TN may be part of the normal aging process but in some cases it is the associated with another disorder, such as multiple sclerosis or other disorders characterized by damage to the myelin sheath that covers certain nerves.
Is there any treatment?
Because there are a large number of conditions that can cause facial pain, TN can be difficult to diagnose. But finding the cause of the pain is important as the treatments for different types of pain may differ. Treatment options include medicines such as anticonvulsants and tricyclic antidepressants, surgery, or radiosurgery. Typical analgesics and opioids are not usually helpful in treating the sharp, recurring pain caused by TN. If medication fails to relieve pain or produces intolerable side effects such as excess fatigue, surgical treatment may be recommended. Several neurosurgical procedures are available. Some are done on an outpatient basis, while others are more complex and require hospitalization. Some patients choose to manage TN using complementary techniques, usually in combination with drug treatment. These techniques include acupuncture, biofeedback, vitamin therapy, nutritional therapy, and electrical stimulation of the nerves.