There are many medical conditions that require brainstem surgery. Due to its location, surgery on the brainstem is one of the most difficult for surgeons. Aneurysms and hemorrhages, both bleeding events, require immediate surgery to save a patient's life. For the different forms of cancer that cause tumors to develop on the brainstem, surgeons have more time to plan the surgery and avoid negative side effects for the patient.
The brainstem physically connects the brain to the spinal cord. Contained within it are three distinct parts known as the medulla, pons and midbrain. Besides acting as a gateway between the brain and spinal cord, these three areas are responsible for the body's unconscious life functions such as breathing, arousal, blood pressure and digestion of food. The importance of the brainstem makes any medical condition affecting it potentially life-threatening. Brainstem surgery, too, is very risky, as any mistakes by a surgeon could result in the patient's death.
No matter what brainstem affliction a patient presents with, the most important piece of information is the affliction's location on the brainstem. The brainstem is in a very difficult to reach position for surgeons; bones, arteries and veins all block access. Thus, nearly a dozen surgical techniques are available to surgeons. For example, a surgeon may need to make an incision near the ear to reach the brainstem. Though hearing loss may result, many surgeons trade that for saving the patient's life.
Bleeding events such as aneurysm and internal hemorrhage require immediate brainstem surgery if a patient is to survive. Both of these events deprive the brain of blood, causing death within minutes if not treated. Due to the time factor, many patients do not survive unless they are already in a hospital setting.
Many cancers also require brainstem surgery. Though tumors that develop on the brainstem can quickly become fatal if not treated, surgeons generally have more time to plan a surgery than when a patient experiences an internal hemorrhage. One such cancer is pilocytic astrocytoma, a condition that generally affects children and adolescents. In most cases, surgeons can remove the entire tumor. The five-year survival rate after surgery is 90%.
Other afflictions outside of bleeding and cancer require brainstem surgery. Cavernous hemangiomas, for example, present with one or more extremely dilated blood vessels that contain stagnant blood. Though they can appear anywhere in the body, most develop in blood vessels in the brain or near the brainstem. As when removing tumors, physicians in developed countries have access to 3-D images of the hemangioma. Once the vessel is removed, it will not reappear in the patient.