Spinal stenosis is narrowing of the spinal canal or spinal neve root foramen (hole). Spinal stenosis can compress the spinal cord and nerves which can lead to pain, numbness and weakness in your legs or hips (lumbar stenosis) or neck and shoulders (cervical stenosis). Spinal stenosis can affect any part of the spine however most commonly it affects the lower back (lumbar stenosis, lumbar canal stenosis and lumbar foraminal stenosis).

What causes spinal stenosis?

Spinal stenosis usually results from age-related conditions and therefore typically affects people aged 40 or above. Causes include:

• wear and tear in the spine, including overgrown ligament or bone (osteoarthritis or spondylosis);
• disc herniation (also known as disc protrusion or slipped disc);
• spondylolisthesis.

What are the symptoms of lumbar spinal stenosis?

One of the most common symptoms of lumbar canal stenosis is neurogenic claudication: pain, numbness or weakness in one or both buttocks or legs after walking or standing for any length of time. Lumbar spinal stenosis can also cause pain in the lower back, weakness, numbness, and/or pins and needles and/or other sensory disturbance in the legs or feet; numbness or sensory disturbance affecting the groin, perineum and genital region; and/or a change in bladder or bowel function.

What types of non-surgical treatments are available?

Depending on your symptoms and your medical history, conservative non-operative treatment might be recommended initially to try and relieve symptoms of spinal stenosis. If you have severe pain, limb numbness or weakness, or significant neurological deficits such as loss of normal bowel or bladder function, surgery may be the first and safest option.

Conservative treatment options for spinal stenosis include:

• remaining active and undertaking low-impact exercise which including walking, stretching, swimming, yoga and Pilates;
• optimising your posture, weight and diet;
• pain relief tablets: using over the counter painkillers and anti-inflammatory medication such as paracetamol or ibuprofen or specific nerve pain relief such as pregabalin or amitriptyline;
• CT-guided injections (typically with a combination of local anaesthetic and steroid);
• alternative treatments such as topical creams, hot and cold compresses, TENS machines, acupuncture, memory foam pillows and mattresses.

Is spinal stenosis a serious condition?

Spinal stenosis, when it becomes severe, can cause cauda equina syndrome – a rare but serious condition requiring immediate treatment. If the nerves in the lower back are severely compressed by the narrowing of the spinal canal it can cause the following symptoms:

• sciatica on both sides;
• weakness or numbness in both legs that is severe or getting worse
• numbness around or under your buttocks or your groin area
• a change in bladder function (such as loss of bladder control) or
• a change in bowel function (such as being unable to control bowel functions or know when you are experiencing a bowel function)

The longer it is left untreated the greater the chance it can lead to permanent incontinence and/or paralysis and if you have any of these symptoms you should seek immediate medical attention.

Does spinal stenosis require surgery?

Spinal stenosis may be treated conservatively and, therefore, does not always require surgery. However, if a patient has tried non-surgical treatments without success, is in severe pain or has significant neurological deficit, surgery will usually be recommended.

The primary goal of spinal surgery for patients with spinal stenosis is to reduce symptoms and improve the chance of recovery. It is very effective in reducing pain and gives the best chance for weakness and numbness to recover.

The surgical procedure performed aims to decompress the spinal cord/nerves by increasing the availability of space for the patient’s spinal cord and spinal nerves. Decompression is achieved through a laminectomy, foraminotomy or a microdiscectomy depending on the cause and location of the spinal stenosis.

In some cases, spinal stabilisation (fusion) surgery may be recommended in order to optimise decompression and limit symptoms from spinal instability.

Sydney Spine Surgeon

If you are concerned about any symptoms you have, do contact our friendly team today to book an appointment to see Dr James Laban on (02) 8320 0577.

Dr Laban is a fellow of the Royal Australasian College of Surgeons and of the Royal College of Surgeons of England and has trained, worked, published and presented nationally and internationally. Dr Laban is a specialist spinal surgeon with expertise in spinal stenosis. Dr Laban is a Sydney neyrosurgeon and Sydney spine surgeon who works out of his North Shore, Northern Beaches and Central Coast consulting rooms. We are open to talk to you between the hours of 8:00am 5:00pm, Monday to Friday.

In this article we discuss symptoms of trigeminal neuralgia and available treatments.

Trigeminal neuralgia (also called tic douloureux) is a type of severe facial pain. The pain is like sudden, excruciating, stabbing electric shocks. Typically, it only affects one side of the face. 

There are twelve pairs cranial nerves which originate in the brain, each with a different function for sensation or movement or both. The fifth cranial nerve is called the trigeminal nerve. It is responsible for facial sensation (such as touch, temperature and pain) as well as chewing. 

The trigeminal nerve has three main branches hence its name. Each branch supplies a different area of the face: the ophthalmic branch supplies the upper eyelid and forehead; the maxillary branch supplies the lower eyelid and cheek; the mandibular branch supplies the jaw.

Trigeminal neuralgia is usually caused by a blood vessel (artery or vein) pressing on the trigeminal nerve where it enters the central base of the brain (brainstem). The pressure on the nerve (neurovascular compression) damages the nerve’s insulation (myelin). This causes cross firing of nerves and abnormal electrical activity within the trigeminal nerve so that normal facial sensations such as light touch, wind, brushing teeth or chewing can cause sudden episodes of severe electrical pain.  

Much less commonly, trigeminal neuralgia is caused by multiple sclerosis, a stroke, a tumour, a facial injury or other medical condition.

Trigeminal neuralgia affects women more often than men and is rare in people under the age of 40, although it can occur in younger people. 

If you suffer from trigeminal neuralgia, even mild stimulation of the face can be extremely painful. Trigeminal neuralgia is invariably described by patients to be the worst pain that they have ever experienced. In this article we discuss the symptoms of trigeminal neuralgia to help you identify when to contact a neurosurgeon to discuss treatment options.

Can you have a mild case of trigeminal neuralgia?

Early symptoms of trigeminal neuralgia include mild, short-lived jolts of pain when the face is touched. It often starts near the nose, top lip or corner of the eye. The pain may be bearable at first; however, in most cases the condition will continue to progress and cause increasingly frequent, increasingly severe episodes of extreme pain often also involving the cheek, jaw or sometimes the forehead. Without treatment the condition will likely continue to develop until the pain experienced during attacks becomes unbearable.

What are the symptoms of trigeminal neuralgia?

The symptoms of trigeminal neuralgia can often easily be confused with migraine headaches or dental problems.  As the pain caused by trigeminal neuralgia is often felt in the cheek, jaw, teeth or gums, many people with this condition visit a dentist before going to their GP and some may have teeth extracted to no avail.

Symptoms used to identify the trigeminal neuralgia include:

• sudden, intense, shooting pain that feels like electric shocks on one side of the face or the jaw; or
• a more constant background aching, burning, tingling sensation;
• pain only on one side of the face (not crossing the midline), usually in the cheek or the lower jaw (rarely will it occur on both sides of the face and if it does then not at the same time);
• pain that typically comes and goes, although the condition can be progressive with attacks worsening over time with shorter periods of relief from the pain.
• no changes in the skin or eyes. There are other similar headache conditions that cause symptoms such as numbness of the face, redness of the eyes and tearing. Trigeminal neuralgia does not cause these symptoms.

Everyday activities can trigger the attacks of pain, such as brushing your teeth, shaving, eating, talking, smiling, exposure to cold temperatures such as a light breeze or air conditioning. Attacks can also happen spontaneously with no obvious trigger.

Do I have trigeminal neuralgia?

There is no specific diagnostic test for trigeminal neuralgia. Making the diagnosis often requires an experienced medical specialist.  

As there are other causes of facial pain, it is important to seek medical advice if you experience one or more of the symptoms described above so that other possible causes can be ruled out. Trigeminal neuralgia is mainly diagnosed by precise description of symptoms including details of the pain, where it is felt and how the pain is triggered. 

If you do have trigeminal neuralgia, an MRI (magnetic resonance imaging) brain scan can identify the presence of any vascular compression or can rule out other causes of trigeminal neuralgia such as a tumour or multiple sclerosis. Sometimes the vessels compressing the trigeminal nerve are not reported or the scan is not precise enough to pick up these structures. Therefore, the MRI scan should be reviewed by a specialist prior to ruling out “neurovascular compression” as the cause of trigeminal neuralgia.

Is trigeminal neuralgia treatable?

Simply put, yes. There are a variety of treatment options available for trigeminal neuralgia. 

The attacks of pain of trigeminal neuralgia can sometimes be brought on or made worse by certain triggers so it may help to avoid these triggers if possible.

Trigeminal neuralgia can often be well controlled with medication: Carbamazepine is the gold standard medication and first line treatment. Oxcarbazepine can be used if carbamazepine side effects are not tolerated. Monitoring with blood tests and for skin rash is required when starting these medications because of potential side effects. Other medications, such as pregabalin, lamotrigine, phenytoin baclofen, can be trialled if required. All these medications also have potential side effects; most commonly, sleepiness, difficulty concentrating, forgetfulness or feeling off balance.

A significant group of patients will find that their medication dose needs to be increased as time progresses.  When the medication becomes ineffective, or the side effects are significant they  may wish to consider other treatments. These include percutaneous (through the skin) ablative procedures which work by deliberately damaging the trigeminal nerve to disrupt the pain signals (glycerol injection, radiofrequency rhizotomy or balloon compression), stereotactic radiosurgery or surgery. Of these, surgery has the best long-term cure rate.

The surgical procedure is known as microvascular decompression. This operation deals with the cause of classical trigeminal neuralgia; the blood vessel or vessels pressing on the trigeminal nerve. The vessel is moved away from the nerve and the nerve is protected from the vessel by tiny pieces of Teflon felt. Unlike the other invasive treatment options, surgery relieves pain without intentionally damaging the trigeminal nerve. For most people, surgery cures their trigeminal neuralgia. For these reasons, after trial of medication, surgery (microvascular decompression) is usually the gold standard treatment.

Contact Dr James Laban

If you are concerned about any symptoms you have, do contact us today to book an appointment to see Dr Laban on (02) 8320 0577 and get the diagnosis and help you need.

Dr Laban is a fellow of the Royal Australasian College of Surgeons and of the Royal College of Surgeons of England and has trained, worked, published and presented nationally and internationally. Dr Laban is a specialist cranial surgeon and trigeminal neuralgia specialist.  Dr Laban works out of his North Shore, Northern Beaches and Central Coast consulting rooms. We are open to talk to you between the hours of 8:00am and 5:00pm Monday to Friday.

Brain tumours are a mass or growth of abnormal cells inside the cranium (the part of the skull that encases the brain). There are two main groups of brains tumour: primary and metastatic. Tumours that originate from the brain’s tissue or its immediate surroundings are called primary brain tumours. Primary brain tumours can be benign or malignant. Metastatic brain tumours are tumours that originated elsewhere in the body and have spread to the brain. Metastatic brain tumours are considered malignant.

Types of Benign Brain Tumours

Benign tumours are not cancerous. They are made up of cells that are similar to normal cells. They do not invade nearby tissue or spread to other parts of the body. Even though they are not cancerous, benign brain tumours can cause a problem if they involve or compress nerves or brain tissue.

There are many types of benign brain tumours including:

• Meningiomas – these are the most common typically benign intracranial tumour which develops within the meninges (the layer of tissue that covers the brain) of the brain.
• Pituitary adenomas – largely benign and slow growing tumour that rarely spread to other parts of the body. Pituitary tumours can be split into two groups depending on whether they make hormones or not: non-secreting / non-functioning tumours vs secreting / functioning pituitary tumours.
• Vestibular schwannoma (formally known as acoustic neuroma) – these benign brain tumours start in the nerve that connects the brain to the ear. They are slow growing tumours and do not spread to other parts of the body.
• Hemangioblastomas – these are rare, slow growing brain tumours which originate in cells that line the blood vessels in the brain, spinal cord and brain stem. Most occur in the cerebellum. Some hemangioblastomas result from a rare inherited syndrome called von Hippel-Lindau syndrome: people with this syndrome have a higher risk of developing certain types of tumours including hemangioblastomas. 
• Pilocytic astrocytomas
• Subependymomas
• Choroid plexus papillomas
• Certain neuronal and mixed neuronal-glial tumours such as gangliocytoma, ganglioglioma and dysembryoplastic neuroepithelial tumours.

Types of Malignant Brain Tumours

Malignant tumours are made up of cancerous cells. They will usually grow faster than benign tumours, spread into surrounding tissues and may metastasise (spread to other parts of the body through the bloodstream or lymph system to form secondary tumours).

Metastatic brain tumours which originate from cancer elsewhere in the body and spread to the brain are the most common type of malignant brain tumour. Cancers which are most likely to spread to the brain are melanoma, lung, breast, kidney and bowel.

The most common malignant primary brain tumour is glioblastoma which is a type of glioma (tumour arising from the glia, the supporting cells of the brain).

Gliomas

Gliomas are tumours arising from the glia, the supporting cells of the brain. They are classified according to cell type, molecular genetics, grade and location. The WHO classification is the most recognised and ubiquitously used. 

Classification of glioma by cell type includes:

• Astrocytic tumours – these tumours develop from astrocytes (cells which support neurons in the brain and spinal cord).
• Oliodendroglial tumours – these tumours develop from oligodendroglia (cells which insulate nerve fibres in the brain and spinal cord)
• Ependymal tumours – these are tumours that develop from ependymal cells which line the fluid filled areas of the brain (ventricles) and the spinal cord.

Classification by grade is a means of predicting biological behaviour by cellular pathology. 

• Grade I tumours are biologically benign, slow growing and can potentially be cured by surgical excision.
• Grade II tumours are infiltrative and, despite slow growth, almost always recur. Grade II gliomas (known as low grade gliomas) tend to progress to higher grades of malignancy, e.g. low-grade diffuse astrocytoma that transform to anaplastic astrocytoma and glioblastoma.
• Grade III / IV tumours are malignant and fast growing and have a worse prognosis. Grade III / IV gliomas include anaplastic astrocytoma, anaplastic oligodendroglioma and glioblastoma (collectively known as high grade gliomas).  Glioblastoma is the fastest growing and most aggressive brain tumour.

Symptoms of Brain Tumours

Symptoms will vary depending on there the tumour is in the brain, however there are several symptoms commonly associated with a brain tumour:

• headaches (these may be more severe in the morning or wake you at night);
• seizures or convulsions;
• personality changes;
• difficulty thinking or speaking;
• vision changes;
• hearing changes such as tinnitus;
• loss of balance or dizziness;
• facial numbness or tingling;
• feeling or being sick;
•  difficulty swallowing;
• confusion/disorientation.

Treating Tumours

Treatment of a brain tumour will depend on the type of tumour, where it is in the brain, the grade of the tumour and your general health and level of fitness. 

Initial diagnosis of a brain tumour is usually by CT or MRI scan. These tests can usually help identify the precise location and size of the tumour as well as indicate the most likely type of tumour. Sometimes further imaging or surgery is needed to confirm the type of tumour, e.g. whether it is fast or slow growing, benign or malignant.

Treatment options for brain tumours include surgery, chemotherapy, immunotherapy, radiosurgery and radiotherapy. Steroids are often used to reduce swelling caused by the tumour. Anti-epileptic medication may be used for seizures.

Contact Dr James Laban 

If you are concerned about any symptoms you have, do contact our friendly team today to book an appointment to see Dr James Laban on (02) 8320 0577. 

Dr Laban is a fellow of the Royal Australasian College of Surgeons and of the Royal College of Surgeons of England and has trained, worked, published and presented nationally and internationally. Dr Laban is a specialist cranial and neuro-oncological surgeon with expertise in treatment of benign and malignant brain tumours. Dr Laban works out of his North Shore, Northern Beaches and Central Coast consulting rooms. We are open to talk to you between the hours of 8:00am 5:00pm, Monday to Friday.

Whatever your age, general health or fitness levels, you may suffer from neck or back pain or other symptoms from an underlying spinal condition. Spinal conditions can have a serious impact on mobility and quality of life. In this article we describe three common spinal conditions and their implications. If you are concerned about any symptoms you have, please do contact Dr James Laban’s excellent and personable team to schedule an appointment. You will be able to discuss your problem with Dr Laban and, after appropriate investigation, he will offer tailor-made advice about the diagnosis and treatment options for your spinal conditions.

“Slipped Disc”

The spine is made up of a column of bones called vertebrae which are separated from each other by intervertebral discs. This vertebral column has a bony canal through which the spinal cord runs, carrying all the electrical information from the brain to the arms, body and legs. The intervertebral discs which separate the vertebrae act as shock absorbers and are made up of a tough fibrous outer layer (annulus fibrosus) and a gelatinous inner core (nucleus pulposus).

The term “slipped disc” can be a bit misleading as the whole disc does not move. If the outer layer (annulus fibrosus) develops an area of weakness or tear, some of the inner gel-like material (nucleus pulposus) can bulge or leak out; a “slipped disc”.  The term “slipped disc” is used interchangeably with bulging disc, herniated disc, disc protrusion and prolapsed disc. There is not one single correct phrase.

In younger people, most discs are well hydrated and the outer layer securely encases the inner gel. However, as discs get older and degenerate they become less hydrated and flatter and less efficient at shock absorption (disc degeneration). The outer layer of annulus fibrosus becomes more brittle and more likely to tear and can allow some of the inner gel leak out or bulge. If the discs sustain a sudden high-pressure load, for example from heavy lifting, twisting or straining, this can also cause disc protrusion.

The leakage of the nucleus pulposus gel can press on nearby nerves and irritate them causing pain. Whilst this most commonly occurs in the lower back or lumbar region, it also often occurs in the neck or cervical region.

Sciatica

Sciatica refers to a pain which radiates from the lower spine, through the buttocks and down the legs. This pain can range from fairly mild pain to excruciating debilitating pain. Most patients feel pain radiating from the lower back running down the back of the leg (although sometimes pain is felt on the front of the leg as well) and most people find it hard to get comfortable in any one position for more than 10 minutes. You might also experience tingling, pins and needles, or numbness. If you have pain in both legs or weakness in your legs or feet, numbness in your buttocks or perineum, or a change in bladder and bowel function you should seek immediate neurosurgical opinion.

Sciatica is a very common condition: most people have an 80-90% chance of experiencing back pain in their lifetime and 2-3% of these patients will go on to experience sciatica. Sciatica is most commonly due to irritation and/or compression of the lumbar (lower back) nerves by a “slipped disc”. The disc most commonly bulges or herniates to one side pressing on a lumbar nerve root as it begins to exits the spinal canal triggering sciatica down that leg.

Spondylolisthesis

Spondylolisthesis is simply when a bone in the spine (vertebra) slips out of place, usually forwards relative the one below it. Most commonly this is due to arthritis wear-and-tear changes. It is also often seen due to a stress fractures through a vertebra known as pars defects. These are thought to most commonly occur in childhood but usually do not cause significant symptoms until many years later. Some people are born with a defective vertebra and again this may not be identified until much later in life. Spondylolisthesis can cause common symptoms including:

•  lower back pain
• pain and/or weakness in one or both legs or thighs
• a tingling sensation that radiates from lower back down to the legs
• tenderness or stiffness in the back
• tight hamstring and buttock muscles
• difficulty walking or running.

There are many ways to treat spondylolisthesis. Initial treatment regime may be simply avoiding straining including heavy lifting, twisting or jerking movements or sports which exacerbate the symptoms. This can give your back a chance to get back to your normal followed by targeted multimodal non-invasive therapy including physiotherapy with core strengthening. For some patients, injections could be considered, for others, surgery may be the best option.

Diagnosis of Spinal Conditions

Optimal treatment relies on accurate diagnosis to identify the exact underlying cause of spinal symptoms. Diagnostic imaging technology has evolved to the point where we are able to produce high resolution images of the spinal column, intervertebral discs and nerves and pinpoint precisely where an issue has arisen.

MRI (magnetic resonance imaging) is generally recognised as the gold standard investigation for spinal pathology in most circumstances. CT scans and X-Rays can produce excellent images of broken, fractured or misaligned bones. However, CT scans and X-Rays cannot display soft tissues, such as discs or nerves, as clearly as MRI. Specialised X-rays, termed EOS imaging, can be very useful for spinal deformity such as scoliosis. SPECT-CT (single photon emission computed tomography-CT) combines CT imaging with a very low dose of radioactive tracer and can be used to diagnose or localise excess activity as seen in active arthritis or degenerate disc disease.

Sometimes electrical tests such as nerve conduction studies and electromyography can be useful to determine the source of symptoms particularly if they are caused by a peripheral nerve problem such as generalised neuropathy from diabetes or compression as seen in carpal tunnel syndrome or ulnar nerve entrapment at the elbow. These often produce symptoms also seen in spinal conditions and may co-exist with spinal pathology.

Combining these and other diagnostic tests can aid accurate diagnosis to optimise treatment and improve outcomes.

Contact Dr Laban

If you are concerned about any symptoms you have involving back or neck pain, do contact our friendly team to book an appointment with Dr James Laban. Dr Laban sees patients with all types of back pain related problems and conditions. Even though back pain is common, there can be underlying issues that you may not be aware of. If your back pain and related symptoms are getting in the way of life and not resolving then it is important to get an expert opinion.

Dr Laban is a fellow of the Royal Australasian College of Surgeons and of Royal College of Surgeons of England and has trained, worked, published and presented nationally and internationally. Dr Laban works out of his North Shore, Northern Beaches and Central Coast consulting rooms. We are open to talk to you between the hours of 8:00am 5:00pm, Monday to Friday. Call us on 02 8320 0577 today.

 

Seeking a second opinion, particularly where surgery is indicated, is becoming increasingly common. A second opinion is most useful if the diagnosis is uncertain or multiple treatments are available.  For spinal problems such as disc protrusions, spinal stenosis or degenerative disc disease there are a variety of non-surgical and surgical options for the same condition. Your specialist should have expertise and knowledge of all these available options. Before proceeding with any operation, a patient should feel comfortable with the diagnosis and proposed treatment plan. A second opinion can often put a patient’s mind at ease.

Patients may seek a second opinion from a specialist with more expertise in their particular condition or because they are looking for a better patient-doctor relationship. Some studies have shown that seeking a second opinion may even reduce the rate of surgical intervention. A second opinion can ensure patients have fully investigated their options, have an accurate diagnosis and feel informed as to their choices.

The best spinal surgeons and best neurosurgeons will welcome patients getting a second opinion. Patients wanting a second opinion should explain to their specialist that they would like further advice on the treatment options and ask for a referral to another specialist. Patients often ask to see Dr Laban for a second opinion given his extensive experience, knowledge and surgical expertise. 

Dr Laban is a dual-certified, experienced and internationally-respected spine surgeon and neurosurgeon who sees patients with all types of spinal conditions and neurosurgical conditions including: 

• back pain and neck pain;
• disc protrusions / disc prolapses / bulging discs;
• degenerative disc disease;
• other degenerative spine conditions including spinal stenosis, canal stenosis, lateral recess stenosis and spondylolisthesis;
• spine tumours;
• spinal trauma including vertebral fractures;
• brain tumours;
• peripheral nerve tumours;
• neurovascular compression syndromes such as trigeminal neuralgia and hemifacial spasm;
• infections of the brain or spine;
• brain and peripheral nerve injuries;
• hydrocephalus.

Dr Laban believes deeply in listening to patient’s concerns and prides himself on providing patients with sufficient time and opportunity to discuss a diagnosis. Dr Laban is happy to provide a second opinion for patients considering treatment for a spine, brain or peripheral nerve condition. 

Dr Laban is interested in spinal, brain and peripheral nerve pathophysiology, preventative medicine, non-invasive therapies and minimally invasive techniques. Dr Laban combines his expert knowledge of these non-surgical and surgical therapies to provide tailor-made individualised treatment. Surgery is not always the right or only option and at your consultation Dr Laban will discuss and explain the appropriate alternatives.

If you are concerned about any symptoms you have, or if you want to get a second opinion, do contact our friendly team to book an appointment. You will be able to discuss your problem with Dr Laban and, after appropriate investigation, he will offer tailor-made advice about the diagnosis and treatment options.

Dr Laban is a fellow of the Royal Australasian College of Surgeons and of Royal College of Surgeons of England and has trained, worked, published and presented nationally and internationally. Dr Laban works out of his Double Bay, North Shore and Central Coast consulting rooms.We are open to talk to you between the hours of 8:00am 5:00pm, Monday to Friday. Call us on 02 8320 0577 or email info@drjameslaban.com.au.

A neurosurgeon is a doctor who specialises in the diagnosis and surgical treatment of conditions that affect the central nervous system (the brain and spine) and the peripheral nervous system. Examples of the types of conditions that neurosurgeons treat include:

• back and neck pain;
• intervertebral disc disease including disc prolapses / bulging discs;
• degenerative spine conditions;
• brain, skull base, spine and peripheral nerve tumours;
• neurovascular compression syndromes such as trigeminal neuralgia;
• brain and spinal vascular anomalies aneurysms;
• infections of the brain or spine;
• head, neck, spinal and peripheral nerve injuries;
• hydrocephalus;
• epilepsy and movement disorders.

 

Neurosurgeons undergo extensive training before being admitted as a fellow of the Royal Australasian College of Surgeons and permitted to practice as an independent specialist neurosurgeon in Australia.

Medicine is a graduate entry course which means you must complete a bachelor’s degree before commencing your post-graduate medical studies. The majority of students undertake a 3 year undergraduate degree first and then apply for a 4 year post-graduate medical school degree (e.g. MD, MBBS, BMBS, MBBCH).

After successful completion of medical school, a one-year internship is followed by residency and registrar training. Neurosurgical specialty training is extremely competitive. It usually takes several years as a resident and registrar before being selected to the training programme. It then requires a further 5 to 9 years to complete this higher specialist neurosurgical training.

This is usually complemented by one or more fellowships, undertaken after the completion of training, where neurosurgeons gain further skill in one or more neurosurgical sub-specialties. Neurosurgeons, as with other specialities, are also required to continue to undertake professional development each year throughout their career.

There are various sub-specialities within neurosurgery which include:

• spinal surgery: the surgical management of degenerative conditions, prolapsed discs, trauma;
• neuro-oncology: the surgical management of brain and spinal tumours;
• neurovascular surgery: complex aneurysms and abnormal or narrowed blood vessels;
• skull base surgery: skull base tumours and disorders of the skull base;
• peripheral nerve surgery: surgical management of peripheral nerve disorders;
• functional neurosurgery: this involves the surgical management of a range of conditions such as epilepsy and movement disorders.

 

What is the Nervous System?

The nervous system is comprised of the central nervous system and the peripheral nervous system.  The central nervous system is made up of the brain and the spinal cord. The peripheral nervous system is made up of nerves that connect your brain and spinal cord to the rest of your body. Neurons, which are cells within the nervous system, receive sensory input and relay information to other cells and muscles. The nervous system controls your basic bodily functions such as breathing and sweating. It is responsible for movement, learning and memory and it controls your senses.

What is a Neurologist?

A neurologist is a doctor who treats disorders affecting the brain, spine and peripheral nervous system which do not require surgical intervention. In contrast, neurosurgeons look after patients with conditions affecting the brain, spine and peripheral nervous system which may require surgery as part of their treatment.

What does a Neurosurgeon do?

A neurosurgeon diagnoses conditions affecting the brain, spine and peripheral nervous system and provides surgical treatment options. The following are examples of operations undertaken by neurosurgeons and which Dr James Laban performs:

• minimally invasive spine surgery;
• degenerative spine and disc protrusion surgery (including laminectomy and microdiscectomy);
• spinal fusion surgery;
• cervical spine surgery, thoracic spine surgery and lumbar spine surgery;
• brain tumour surgery;
• spine tumour surgery;
• microvascular decompression;
• peripheral nerve surgery;
• skull base surgery;
• pituitary surgery;
• shunt surgery.

Best Neurosurgeon Sydney

Future articles will discuss the above procedures in more detail. If you are concerned about any symptoms you have, do contact us to book an appointment. You will be able to discuss your problem with Dr Laban and, after appropriate investigation, he will offer tailor-made advice about the diagnosis and treatment options.

Dr Laban is a dual-certified, experienced and internationally-respected neurosurgeon. He is a fellow of the Royal Australasian College of Surgeons and of Royal College of Surgeons of England and has trained, worked, published and presented nationally and internationally. Dr Laban works out of his Double Bay and North Shore Private Hospital consulting rooms.