Treatments and Services
Dartmouth-Hitchcock Medical Center's neurosurgery department offers a wide range of services and treatments.
The goal of epilepsy surgery is to not only reduce the incidence of seizures, but also to cure them in many patients. Some of the surgical options include:
- Lobectomy: If seizures cannot be controlled in other ways, the part of the brain where the seizures begin is removed. The most common form of epilepsy surgery is known as a temporal lobectomy. Almost 70% of partial seizures in adults begin in the temporal lobes.
- Resective: During resective surgery, the lesion as well as the tissue around it is removed if monitoring has shown that seizures begin in that area. Risks are similar to the lobectomy procedure.
- Corpus callostomy: This procedure stops the spread of seizures from one side of the brain to the other and is only done when the origin of a seizure cannot be found. During the operation, the nerve fibers that connect one side of the brain to the other, called the corpus callosum, are cut. No tissue is removed. This procedure is most helpful for generalized tonic clonic or grand mal seizures and drop attacks.
- Hemispherectomy: In some cases, a patient may have congenital brain damage on only one side of the brain that, in turn, causes seizures and paralysis on the other side of the body. If so, a procedure known as a hemispherectomy can be carried out. This entails removing all or almost all of the damaged side of the brain. After this surgery, the function of the rest of the brain may improve and take over some of the functions of the part that was removed. However, any weakness on the side opposite the surgery remains.
- Vagus nerve stimulation (VNS): VNS has become an effective treatment in reducing the frequency of seizures in candidate patients over the age of twelve with partial onset seizures. It is an implantable medical device that consists of a battery powered pacemaker-like generator and nerve stimulation lead. The VNS generator and lead are implanted in the chest and neck in an relatively simple operative procedure.
- Monitoring surgery: These procedures involve placing electrodes on the brain to monitor seizure activity.
The neurosurgical oncology division is staffed by a multi-disciplinary team which includes neurosurgeons, neuro-oncologists, neurologists and radiation oncologists.
A weekly tumor board conference is held to discuss management and treatment protocols on a patient by patient basis at the Norris Cotton Cancer Center (NCCC). The NCCC is one of 40 comprehensive cancer centers designated by the National Cancer Institute. There are over 200 research projects and protocols in progress.
The field of neurovascular therapeutics encompasses surgical and catheter-based approaches to blood vessel diseases of the brain and spine in adults and children. With the J.B. Marshall Laboratory for Neurovascular Therapeutics, we are dedicated to clinical investigations and translational research as a means for education and technical advancement in the treatment of these disorders.
Conditions we treat include:
- Arteriovenous fistulas
- Arteriovenous malformations (AVM)
- Carotid stenosis
- Cerebral cavernous malformations (CCM)
- Developmental venous anomalies (DVA)
- Vein of Galen malformations
Our team includes pediatric neurosurgeons who care for infants, children and adolescents. We also offer help for expecting parents whose unborn child may have been diagnosed with a neurosurgical problem. Learn more about our team at CHaD.
Spine and pain management
Our specialists provide treatment for chiari malformations and chronic cervical and lumbar pain. We work closely with the Center for Pain and Spine in the management and treatment of chronic back pain and other complex pain syndromes.