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Epilepsy / Seizures

Epilepsy is the second most common brain disorder followed by stroke. Epileptic seizures are recurrent seizures without a reversible metabolic source that are caused by abnormal electrical activity in the brain. Seizures clinically can present as convulsive (unusual body movements) or nonconvulsive seizures. Both types usually involve a change in the level or loss of consciousness. Causes of this hyperexitability could be genetic, congenital, tumor, traumatic or ischemic injury. Therefore, it is important to correctly diagnose and treat the underlying cause. Neurosurgeons at Boulder Neurosurgical & Spine Associates (BNA) can treat epileptic conditions through a variety of means including medications, Vagal Nerve Stimulation (VGN) or surgical resection of the lesion, including temporal lobectomy.

Microvascular Nerve Compression Syndromes

Microvascular nerve compression syndromes are often caused by compression of the cranial nerves at the root entry zone of the brain stem by blood vessels. Trigeminal Neuralgia, Glossopharyngeal Neuralgia, and Hemifacial Spasm are the most often encountered syndromes.

Trigeminal Neuralgia

Boulder Neurosurgical & Spine Associates (BNA) is the only center in the region that uses the most advanced technologies and multidisciplinary approaches to treat these syndromes. BNA’s Trigeminal Neuralgia (TN) program is devoted entirely to the treatment of such pain that occurs in the trigeminal nerve innervation zones. In most cases, this is caused by chronic vascular compression, which results in demyelination and subsequent pathological changes. If conservative treatment does not relieve the symptoms, or patients cannot tolerate medications, a surgical procedure can be performed called Microvascular Decompression (MVD). Up to 80% of patients are pain free at 5 years. Therefore, MVD is considered the most effective treatment method for TN caused by vascular compression. A posterior fossa craniectomy is performed, vascular elements that compress the nerve are dissected and vessels are mobilized using implants.

Sometimes trigeminal pain can be caused by a lesion (e.g. tumor), or trauma. Therefore, it is important to establish the underlying cause of pain and eliminate, if possible.

BNA surgeons offer alternative treatment options to patients that are not ideal candidates for a microvascular decompression due to significant comorbidities or other issues that increase surgery risk . These patients now have an alternative treatment option, which does not even require an incision and is virtually pain-free. BNA surgeons published a landmark paper on CyberKnife Radiosurgery for Trigeminal Neuralgia. Click this link to read more about CyberKnife or about research (PDF) performed by BNA physicians that has literally changed the standard of care.


Figures: CyberKnife Radiosurgery treatment plan shows the distribution of radiation doses (A) and MRI scan after the treatment demonstrate the anterior portion of the trigeminal nerve affected by a highly focused radiation.

Peripheral Nerve Compression Syndromes

Ligament scarring from trauma, bony enlargement due to arthritis, or excessive repetitive movement can all cause peripheral nerve compression syndromes.

The most often encountered syndromes are: carpal tunnel syndrome (median nerve compression), ulnar neuropathy (ulnar nerve compression), and peroneal neuropathy (the peroneal nerve is compressed near the fibular head). All patients should try conservative treatment first, which includes anti-inflammatory medications, physical therapy and/or bracing. If this fails, surgery may be potentially beneficial to release the structures that are compressing the nerves.