Brain tumours may be primary (they arise in the brain or nearby tissue) or metastatic (they have originated in another part of the body and travelled to the brain). Primary tumours may either be benign (they do not spread to other tissues) or malignant (they spread). Surgery may be the only treatment approach for a brain tumour, or it may be used in combination with radiation therapy and/or chemotherapy. Typically, the skull is opened up (craniotomy) giving the surgeon access to the tumour and allowing removal of as much of the tumour as possible without damaging brain tissue. A stereotactic biopsy is another surgical procedure often performed to aid in tumour diagnosis. A small hole is drilled into the skull and a sample of tissue removed for examination under the microscope. Radiation therapy uses high energy x-rays to kill abnormal cells, while chemotherapy uses chemicals (medicines) to destroy cancer cells.

A subdural haematoma is a collection of blood that forms beneath the outer protective covering of the brain, the dura mater. It is usually caused by tiny blood vessels becoming torn as the result of serious head trauma such as a fall, blow to the head or car accident. Symptoms include: · Headache · Speech problems · Vision problems · Seizures · Confusion · Weakness · Nausea and vomiting With an acute haematoma, symptoms appear within 24 hours of the trauma while in the case of subacute or chronic haematomas symptoms take longer to appear. If a haematoma is left to grow, it puts pressure on the brain which may lead to brain damage and possibly death. Surgical treatment involves drilling a small hole in the skull, allowing the haematoma to drain and thus relieving the pressure on the brain. In the case of a larger haematoma, a hole may be cut in the skull (craniotomy) allowing the surgeon access to the brain to repair damaged vessels and remove the blood clot.

Tumours may be found within the spinal cord itself, between the spinal cord and its tough outer covering, the dura, or outside the dura. They may be primary (they arise in the spine or nearby tissue) or metastatic (they have originated in another part of the body and travelled to the spine, usually via the bloodstream). Spinal tumours may be treated by any combination of surgery, radiotherapy and chemotherapy. Surgery may be performed to take a small sample of tissue to examine under the microscope (biopsy) or to remove the tumour. Typically, the patient will be lying face downwards and a procedure known as a laminectomy is performed (the bone overlying the spinal cord is removed). This gives the surgeon access to the spinal cord and allows removal of the tumour.

Between the vertebrae in your spine are flat, round discs that act as shock absorbers for the spinal bones. Sometimes some of the gel-like substance in the center of the disc (nucleus) bulges out through the tough outer ring (annulus) and into the spinal canal. This is known as a herniated or ruptured disc and the pressure it puts on the spinal nerves often causes symptoms such as pain, numbness and tingling. Initial treatment for a herniated disc may involve low level activity, nonsteroidal anti-inflammatory medication and physiotherapy. If these approaches fail to reduce or remove the pain, surgical treatment may be considered. Discectomy This surgery is performed to remove part or all of a herniated intervertebral disc. Open discectomy – involves making an incision (cut) over the vertebra and stripping back the muscles to expose the herniated disc. The entire disc, or parts of it are removed, thus relieving pressure on the spinal nerves. Microdiscectomy – this is a ‘minimally invasive’ surgical technique, meaning it requires smaller incisions and no muscle stripping is required. Tiny, specialised instruments are used to remove the disc or disc fragments. Laminectomy or Laminotomy These procedures involve making an incision down the centre of the back and removing some or all of the bony arch (lamina) of a vertebra. In a laminectomy, all or most of the lamina is surgically removed while a laminotomy involves partial removal of the lamina. By making more room in the spinal canal, these procedures reduce pressure on the spinal nerves. They also give the surgeon better access to the disc and other parts of the spine if further procedures e.g. discectomy, spinal fusion, are required. Spinal Fusion In this procedure, individual vertebrae are fused together so that no movement can occur between the vertebrae and hence pain is reduced. Spinal fusion may be required for disc herniation in the cervical region of the spine as well as for some cases of vertebral fracture and to prevent pain-inducing movements.

Hydrocephalus is the condition where there is an imbalance between the production and absorption of cerebrospinal fluid (CSF). Depending on the cause of the hydrocephalus, the condition can present anywhere from birth through to old age. Dr Heppner has extensive experience in performing shunt procedures as these are a key component of his paediatric work at Starship Children’s Hospital. He also has extensive experience in Neuro-Endoscopy during which a telescope is placed into the ventricles (CSF chambers within the brain) and new pathways opened up to allow for CSF circulation. Dr Heppner also manages the related condition of idiopathic intracranial hypertension (benign intracranial hypertension; or pseudo tumour cerebrae) and normal pressure hydrocephalus.

Chiari malformation is a condition here the lowest part of the cerebellum herniates out of the skull and into the upper spinal canal. This can present with a range of symptoms from headache through to neurological impairment of the arms and legs due to the formation of a syrinx (cavity within the spinal cord). Most symptomatic malformations are treated with a foramen magnum decompression (posterior fossa decompression) and this is highly successful in the majority of cases. Occasionally, in more “complex” cases there may be evidence of instability necessitating fusion of the skull to the upper cervical spine (occipitocervical fusion). Assessment of a patient with Chiari Malformation involves a detailed history and examination followed by review of the MRI scan (+/- CT Scan). After this, an appropriate treatment plan can be made.

For certain patients with medically intractable epilepsy ( epilepsy that is not controlled by medication), surgery can be highly effective in abolishing or at least ameliorating seizures. Dr Heppner is involved with the epilepsy surgery programme at Auckland City and Starship Hospitals. Typically patients are worked up and investigated by a neurologist with an interest in epilepsy. If a lesion or area of the brain is identified from which the seizures are emanating, and if the area is amenable to resection at an acceptable risk, these patients are often cured of their epilepsy by surgical resection. Dr Heppner routinely performs operations such as temporal lobectomy and lesionectomy (resection of cavernomas, cortical dysplasia, tumors, etc) for epilepsy control.

A wide range of neurosurgical conditions can occur in children. These include congenital anomalies, hydrocephalus, craniofacial conditions (in particular premature fusion of the skull growth plates), tumours and epilepsy. Dr Heppner has extensive experience in managing these conditions and is involved in the multidisciplinary paediatric oncology, craniofacial and epilepsy programmes at Starship Hospital.

Trigeminal neuralgia is a condition characterised by severe, shock like facial pain. It is often triggered by touch, chewing or talking. The severity of pain often waxes and wanes and it is typically well controlled (at least initially) by medication such as carbamazepine (Tegretol). Trigeminal neuralgia is usually caused by an artery compressing the origin of the 5th (Trigeminal) cranial nerve as it exits the brain. If the pain is not controlled by medication, there are a number of surgical options which can be very effective. They range from simple balloon compression of the nerve through to micro surgically moving the offending artery. The most appropriate operation depends on a number of factors including age and other past medical history.