Dr. Schwartz focuses his Neurosurgical Expertise in two key areas:

• SPINAL DISORDERS, including the surgical and non-surgical treatment of neck & back pain, cervical, thoracic, and lumbar disc problems, along with stenosis issues.


• BRAIN TUMORS, particularly gliomas, meningiomas, and acoustic neuromas.

Herniated Disc
Lumbar Spinal Stenosis
Cervical Spine
Low Back Pain
Neck Pain
Spinal Tumors
Brain Tumors
Astrocytoma Tumors
Glioblastoma Tumors
Meningiomas
Brain Metastasis
Steotactic Radiosurgery
Adult Onset Hydrocephalus
Chiari Malformation
Trigeminal Neuralgia
Anatomy of Spine & Peripheral Nerves
Glossary of Spine & Related Terms
Anatomy of the Brain
Neurological Diagnostic

Brain Tumors can be either benign (non-cancerous) or malignant (cancerous). Depending on their location, brain tumors can be treated with open neurosurgical procedures, radio surgery, or minimally invasive approaches. Cancerous brain tumors are usually treated with surgery, chemotherapy, radiotherapy or a combination of these treatments.

Pituitary & Cranial Tumors

The pituitary gland sits in a bony structure at the base of the skull, and is sometimes the site of the benign (non-cancerous) growths. It is especially suited to minimally invasive procedures due both to its location, and to the thin, and therefore easily penetrated, bone layer surrounding it. Both benign and malignant tumors can cause many symptoms, from abnormal thickening of bone to secretion of milk from the breasts in both males and females.

Other tumors in the base of the cranium can be addressed through traditional, open procedures or through a minimally invasive technique that is used to treat anatomical features close to the base of the skull. This approach uses instruments called endoscopes to visualize and reach the surgical target. These targets can be reached through the openings around the eyes and ears, and within the nasal sinuses. Typical targets include the pituitary gland, as well as, the complex system of blood vessels that supply the brain. This minimally invasive approach generally results in less blood loss, reduced risk of infection and faster recovery times when compared to open surgeries. Skull-base surgery can be used to treat many types of neurological problems, from the removal of pituitary tumors to the treatment of facial pain resulting from cranial nerve compression.

Radiosurgery uses ionizing radiation (most commonly x-rays) to treat benign (non-cancerous) or malignant (cancerous) tumors in the brain. Modern radiosurgery is referred to as stereotactic radiosurgery (SRS), because a stereotactic device is used to hold the head in a carefully planned position for each treatment. This technology allows high doses of radiation to be delivered to the tumor with minimal exposure to surrounding healthy tissue.

Treatments

Minimally-invasive Spine

"In selected patients, the minimally invasive approach can be used in spinal surgeries. MIS procedures can be used to treat certain types of spinal conditions, including degenerative or herniated disc disorders, lumbar (lower back) spinal stenosis, curvature of the spine such as kyphosis or scoliosis, spinal infections, instability of the spine, and compression fractures of the spine, such as those caused by osteoporosis (thinning of the bones). The minimally invasive approach typically used one or two small incisions and an endoscope to visualize the structures of the spine. MIS reduces patient down time and the risk of infection with typically excellent results.

MIS - Spinal fusion techniques

Minimally Invasive Lateral Interbody Fusion (XLIF and DLIF)

This newly developed fusion procedure is meant for patients who have degenerative disc disorders, or abnormalities in the vertebral structure that limit movement or cause pain. It can also be used to treat conditions where one vertebra slips over another, or when disc degeneration pinches the nerves that exit the spinal cord. XLIF (eXtreme Lateral Interbody Fusion) and DLIF (Direct Lateral Interbody Fusion) both use small incisions on the side (lateral) of the body to access the spine, and thus can only be used for vertebra that can be reached from the side. These are generally 60 to 90 minute procedures. Most patients are able to get up and walk about within a few hours of the surgery, and some patients report returning to work within a few weeks.

Minimally Invasive Posterior Lumbar Interbody Fusion (PLIF)

The PLIF procedure is used to access the lumbar spine, the second lowest region of the spine, just above the sacrum, to relieve pain and discomfort from degenerative or herniated disc disorders. PLIF is also used to reposition vertebra that have slipped out of normal alignment. PLIF uses two small incisions on either side of the lower back to access the spine, and generally takes 3 to 3.5 hours to complete. Patients who have undergone PLIF benefit from quicker recovery and bone fusion times, with less blood loss during surgery and a reduced need for narcotic pain medication after surgery.

Minimally Invasive Transforaminal Lumbar Interbody Fusion (TLIF)

Minimally invasive transforaminal lumbar interbody fusion is a technique used in the lower (lumbar) spine to treat herniated discs, degenerative disc disease, or vertebra that have slipped over one another. It is used in patients who continue to have problems after disc procedures called laminectomies, which involves trimming a bony section of the vertebra called the lamina. TLIF can also be used to treat spinal injuries and a condition called pseudoarthrosis. The name refers to a “false joint” that results from either an inborn error, or from an unsuccessful fusion procedure. “Transforaminal” refers to the foramen, which is the opening in the vertebra through which the spinal nerve passes as it exits the spinal cord. TLIF uses one incision to gain access to the spine, just a few inches away from the middle of the back. Compared with open surgeries, TLIF causes less blood loss during surgery, and results in a shorter hospital stay as well as a reduced need for narcotic pain medication after surgery. TLIF generally takes 2½ hours to perform.

Minimally Invasive Posterior Thoracic Fusion

Minimally invasive posterior thoracic fusion is performed in both the lumbar (lower back) and in the region of the spine located just above the lumbar, called the thoracic spine. The procedure is used to treat spinal injuries or deformities, spinal tumors, and infection. Open surgeries in the thoracic spine are difficult and can cause surgery-related complications, thus minimally invasive approaches are preferred when it is possible to use them. The posterior thoracic approach uses an incision in the middle of the back, and requires x-ray imaging and monitoring to help place instruments in their proper positions. The muscles in this area of the back are also bulkier than in the lower spine and must be held aside with retractors. This procedure can take 3 hours or longer to perform, depending on the complexity of the spinal disorder.

Other MIS Spinal Procedures

Microdiscectomy

Microdiscectomy is used to treat pain and discomfort from herniated discs in the lumbar (lower back) region of the spine, and thus is also referred to as microlumbar discectomy (MLD). Microdiscectomy relieves the pressure on the portion of the spinal nerve that is being affected by the bulging disc. Compared to other minimally invasive spinal surgeries, this is a relatively simple procedure that uses one small incision located right over the affected disc, and requires little or no disruption of the tissue surrounding the spine. The surgeon removes a portion of the disc and a small amount of bone from the vertebra to create room for the spinal nerve, helping to relieve symptoms. Microdiscectomy takes about an hour to perform, and more than 90 percent of patients have a good to excellent outcome, quickly returning to their daily routine.

Microendoscopic Laminectomy

Microendoscopic laminectomy, or microlaminectomy, is used to treat patients with lumbar stenosis, a condition of the lower back in which the spinal nerves are pinched or compressed by an overgrowth of bone, causing pain and limiting movement. In this procedure, bone is removed from the part of the vertebra called the lamina, and occasionally from the foramen, which is the main opening through which the spinal nerve exits from the spinal cord. Microendoscopic laminectomy uses one small incision located over the affected vertebra, and like microdiscectomy, requires little cutting of muscle or soft tissue. The procedure usually takes about 60 to 90 minutes, and most patients report good to excellent results in the form of quickly reduced pain and a fast recovery.

Minimally Invasive Cervical Foraminotomy

Minimally invasive cervical foraminotomy is used to treat vertebra in the neck, a region called the cervical spine. In this surgery, bone is removed from the foramen, the main opening through which the spinal nerve passes on its way out of the spinal cord. This opening can be obstructed by a herniated disc, an excess growth of bone (bone spurs) on the vertebra, or swollen ligaments or joints. This procedure uses a single incision on the affected side of the neck, through which the surgeon removes enlarged tissue, bone or portions of the herniated disc. It takes about two hours to complete.

Vertebroplasty

Vertebroplasty is used to treat compression fractures of the vertebra, which are commonly caused by osteoporosis, but can also result from other disease processes or certain drug regimens. The procedure can be done under local anesthetic as an outpatient or under general anesthesia as an inpatient. Vertebroplasty uses a small incision, through which bone cement is injected into the affected portion of the vertebra. The cement hardens in minutes and stabilizes the weakened bone structure, relieving pain caused by the fracture. The procedure generally takes one to two hours, and can be used to treat multiple vertebrae at one time.

Kyphoplasty

Kyphoplasty is a more complex procedure than vertebroplasty, using two incisions and tools called bone tamps. The bone tamps are balloons that help to create a larger space on each side of the vertebra into which the bone cement is injected. Kyphoplasty can actually add height to the spine, and has a very low complication rate (less than 2 percent)."

Complex Spine procedures, such as fusion of the vertabrae to stabilize the spine, often require open surgeries to allow access to sensitive areas such as the cervical spine (neck). However, when the vertabrae are easily asscessible, as in the lumbar spine (low back), minimally invasive procedures are increasingly used to treat more complicated disorders. Other complex spine procedures include general open surgeries to treat spinal injuries or to remove spinal tumors. "Spinal tumors may be cancerous or non-cancerous. The treatment of benign tumors depends on patient symptoms such as pain or lack of mobility, and may be treated with a watch-and-wait approach, various medications, radiation, or surgery. Cancerous tumors can be treated with radiation or chemotherapy, but if these fail, surgery can often be used to relieve pain, stabilize the spine, and to improve quality of life.

Spinal tumors that arise from the spine itself are divided into three categories, depending on where they originate in the spinal cord. Many spinal tumors are benign and cause problems largely because they interfere with nerve conduction or with the structure of the spine:

* Intradural-extramedullary: menigioma, schwannoma, neurofibroma, nerve root tumors
* Intramedullary: astrocytoma, ependymoma, lipoma
* Extradural: schwannoma, metastatic cancer


Metastatic Spinal Tumor

The skeletal spine is often a site for metastasis (spread) from cancers that originate elsewhere in the body. The vertebrae are commonly affected by metastasized lung, breast, and prostate cancers. Metastatic cancers of the bony portion of the spine can often be successfully managed with radiation therapy, especially for pain relief. Bone-building drugs, such as agents used to treat osteoporosis, along with continued chemotherapy, can also help to slow or stop the progress of bone metastases for a significant period."