Brain Surgery Information:

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CHAPTER 9: WHAT A SURGEON MAY BE THINKING ABOUT

As William J. Mayo, one of the founders of the Mayo Clinic stated: “The best interest of the patient is the only interest to be considered.” When it comes to a patient with a brain lesion, the following must be carefully considered:

·  For symptomatic lesions: The lesion may be causing neurological problems or complaints in the patient such as headaches, seizures, cranial nerve palsies or dysfunction, limb weakness, imbalance, impaired or double vision and other sensory disturbances, and hydrocephalus. After a careful history, physical examination and appropriate studies (Chapter 6) are obtained, the physician should be able to determine if the lesion is symptomatic or not. If it is symptomatic, treatment is favored.

·  For asymptomatic lesions: A physician may elect to observe an asymptomatic lesion, and will generally arrange for periodic brain imaging and Office visits to assess if the lesion is becoming symptomatic. However, even if it is not causing any neurological disturbance, treatment of an asymptomatic lesion may still be recommended if the lesion is enlarging or of a worrisome type, size, shape or location.

·  The patient’s history: For example, if the patient has a personal history of rupture from a previous separate brain aneurysm, or a family history of aneurysmal rupture, or an inherited connective tissue disorder that predisposes towards the growth of brain aneurysms, treatment of a newly diagnosed aneurysm in that patient may be favored, even if it is a smaller one (www.brain-aneurysm.com).

·  The treatment option(s): The rationale for which treatment(s) to offer varies according to many factors (Chapters 7 and 8). These factors should be carefully weighed by the treating physician(s), and decisions made on an individualized or “case-by-case” basis. This involves appropriate discussion with the patient, and possibly also with medical colleagues of the treating physician, particularly if the condition is a complex one.