Skull Base Surgery

Ramin Rak is a board-certified neurosurgeon with years of experience specializing in complex tumors, spine treatments, awake craniotomies, and skull base surgeries.

Skull base surgery is a specialized type of surgery performed to treat tumors and other diseases occurring in certain areas of the skull such as behind the eyes or in the nasal cavity. The skull is made up of bones and cartilage, forming the face and the cranium. The bones that form the base of the cranium also form the eye socket, some of the sinuses, the roof of the nasal cavity, as well as the bones surrounding the inner ear. The base of the skull is a very complex area where many vital parts of the body pass through including blood vessels, nerves, and the spinal cord.

Ramin Rak | Skull Base Surgery

Ramin Rak uses the latest in minimally invasive techniques to perform skull base surgery.

Skull Base Surgery requires a multidisciplinary approach often involving ear, nose, and throat surgeons, neurosurgeons, plastic surgeons, radiologists, pathologists, oncologists, and other specialists. There are two main ways to perform skull base surgery. It may be done through a minimally invasive endoscopic procedure. This involves making a small incision through the natural openings of the skull, normally the nose or mouth. A small hole may also be made just above the eyebrow. Through this method, a neurosurgeon is able to remove the growth through a thin lighted tube referred to as an endoscope. An MRI picture of the skull base will usually be taken during this process to ensure that the entire growth has been removed successfully. The second way to perform skull base surgery is often referred to as traditional or open skull base surgery. This procedure requires making an opening in the skull. Parts of bone may be removed in order to reach the growth and have it properly removed.

Listed below are some of the common growths and conditions that may be treated with skull base surgery:

  • Growths caused by infections
  • Pituitary tumors
  • Sinus tumors
  • Glomus tumors
  • Cysts developed from birth
  • Cerebrospinal fluid leak
  • Meningiomas
  • Chordomas
  • Trigeminal neuralgia
  • Acoustic neuroma

Meningitis Symptoms

Thank you for visiting my (Dr. Ramin Rak’s) medical blog!

Today we will be going over the life-threatening condition known as meningitis.

Meningitis SymptomsThe swelling many times identified with Meningitis triggers the early symptoms of fever, headache, and sore neck.

In many cases, the reason for meningitis stems from viral infections.

However, sometimes bacterial and fungal infections can cause meningitis. Depending upon the cause of the inflammation and the associated infection, meningitis conditions can be as simple as waiting a few days, or in some severe cases, can require immediate emergency care. People experiencing symptoms of meningitis are encouraged to see a doctor as soon as possible to safeguard against life threatening conditions.

Meningitis is fought off by antibacterial medication.

Early treatment of bacterial meningitis can prevent serious complications. I urge anyone experiencing the following symptoms to seek medical care immediately. Visit http://about.me/DrRaminRak for more info about my medical background.

  • Sudden high fever
  • Severe headache that isn’t easily confused with other types of headache
  • Stiff neck
  • Vomiting or nausea with headache
  • Confusion or difficulty concentrating
  • Seizures
  • Sleepiness or difficulty waking up
  • Sensitivity to light
  • Lack of interest in drinking and eating
  • Skin rash in some cases, such as in meningococcal meningitis

Symptoms in newborn babies are presented differently.

Please be on the lookout for these symptoms of early meningitis. If your newborn baby diagnosed with meningitis, I recommend parents seek professional counseling simultaneously with the newborn’s treatment and recovery period. The inability to comfort the newborn mentally can be burdening to any parent.

Look for these early signs:

  • High fever
  • Constant crying
  • Excessive sleepiness or irritability
  • Inactivity or sluggishness
  • Poor feeding
  • A bulge in the soft spot on top of a baby’s head (fontanel)
  • Stiffness in a baby’s body and neck

Always seek medical care first before self-prescribing medications.

Any of the listed symptoms could be signs of many of other medical conditions.  A misdiagnosis could lead to life-threatening implications. Visit my website or Tumblr for more information.

 

Treasurer of the Suffolk County Medical Society

Dr. Ramin RakSuffolk County Medical Center Banner, M.D., is a highly qualified neurosurgeon, specializing in brain and spinal surgeries.

He is an expert in intraoperative brain mapping, which he uses to plan and guide his surgeries. This allows him to understand each patient’s brain more thoroughly when performing awake craniotomy operations, which are necessary in order to avoid touching brain areas that control critical functions. His expertise in minimally invasive micro-neurosurgical techniques and awake craniotomies has established him as a highly sought out surgeon throughout Long Island and New York City.  In addition, it enabled him to land a position as treasurer of the Suffolk County Medical Society.

Ramin Rak speaks highly of the organization and is thrilled to have been chosen to serve in the position.

The society is the premier professional medical association for physicians in Suffolk County and works toward upholding the highest standards when it comes to the medical profession. In an article on BusByway.com, he states, “I look forward to working with my colleagues on the Medical Society Board to help uphold the highest standards for the medical profession.”

His newly established position adds to his impressive contributions to the medical community.

Currently, he acts as Director of the Brain Tumor Program at NS-LIJ Huntington Hospital, as well as Co-Surgical Director and Director of the Awake Craniotomy and Brain Mapping Program of the Long Island Brain Tumor Center at Neurological Surgery, P.C. (NSPC). He is also a member of the American Association of Neurological Surgeons, the Congress of Neurological Surgeons, and serves on the Executive Board of the Society for Brain Mapping & Therapeutics. The latter affords him the opportunity to network with more than 200,000 scientists, physicians, engineers, and surgeons worldwide.

His success and dedication to the field makes Ramin Rak a worthy choice for the prestigious and honorable treasurer position. His term will begin July 1, 2014.

Learn more about Ramin Rak by visiting Certified Consumer Reviews, or by visiting his LinkedIn page: https://www.linkedin.com/in/raminrak.

Symptoms of Brain Aneurysms

Brain Aneurysm

Brain Aneurysms are one of many conditions that Dr. Ramin Rak treats.

Ramin Rak is a Board Certified neurosurgeon with Neurological Surgery. P.C.

He is highly skilled at treating a number of conditions involving the brain and spine, including Aneurysms. A brain aneurysm is a weak area in the artery wall, comparable to a thin balloon. Over time, blood flow pounds on these weakened areas and the artery wall becomes thinner and swells outward.

Statistics from the Brain Aneurysm Foundation show that an estimated 6 millions people in the United States have an un-ruptured brain aneurysm, or 1 in 50 people.

Certain factors can increase your risk of developing an aneurysm, including aging, hardening of the arteries, family history, race, gender, high blood pressure, and smoking.

Unfortunately, brain aneurysms that are un-ruptured are typically asymptomatic since they are so small in size.

Larger un-ruptured aneurysms, however, can press on the brain or nerves, causing various neurological symptoms such as:

  • Localized Headache
  • Weakness and numbness
  • Blurred or double vision
  • Pain above and behind eye
  • Difficulty speaking
  • Dilated pupils

When a brain aneurysm ruptures, it causes bleeding into the subarachnoid space, otherwise known as a subarachnoid hemorrhage.

As the blood seeps into the skull, sudden symptoms can occur all at once that require immediate medical attention. These include:

  • Loss of consciousness
  • Vomiting/Nausea
  • Stiff Neck
  • Sensitivity to light
  • Dizziness or sudden trouble walking
  • Sudden numbness and weakness
  • Sudden severe headache
  • Sudden blurred or double vision
  • Drooping eyelid
  • Sudden pain above/behind the eye or difficulty seeing
  • Sudden change in mental status or awareness
  • Seizure

A ruptured brain aneurysm can cause a stroke, brain damage, or even death.

Approximately 15% of patients that suffer from subarachnoid hemorrhage die before reaching the hospital, while four out of seven who recover are faced with disabilities. Though the statistics are grim, Dr. Ramin Rak and the skilled surgeons at Neurological Surgery, P.C. are able to administer advanced surgical treatment to provide patients with the best care possible.

 

Related Article: http://raminrak.com/aneurysm-coiling/

Traumatic Brain Injury

Hello again, Ramin Rak here, welcoming you back to my blog.

As a spine and brain specialist, I deal with an increasingly large number of patients who suffer from traumatic brain injury, or TBI.

Ramin Rak's symptoms of TBI

Ramin Rak recommends seeking medical help if you experience any of these symptoms taking a blow to the head.

According to the CDC, TBI contributes to a substantial number of deaths or permanent disability annually.

A TBI occurs when an individual experiences trauma to the head that disrupts the brain’s normal function. The severity of a TBI can vary from mild to severe, but experts like myself encourage patients to treat all forms of TBI very seriously.

Perhaps the most common type of TBI is a concussion. While they are not typically life threatening, their effects can be serious. The CDC recommends contacting a health care professional if you begin to experience any of the following after a blow to the head:

  • Headache that won’t go away
  • Decreased coordination
  • Vomiting
  • Slurred speech
  • Drowsiness
  • Lose consciousness
  • Unusual behavior

With proper treatment, it is unlikely a concussion will have a lasting effect. Contrary, there are two types of TBI that have the potential to cause long terms effects and even death. Closed head injuries, often due to falls or vehicle crashes, occur when the brain moves within the skill.  Penetrating injuries occur when an object enters the skull, such as firearm injuries. Statistics show that after a severe TBI, 43% of patients hospitalized suffer from short or long term issues a year later. These can include:

  • Loss of cognitive function, such as memory and attention.
  • Loss of motor function, including weakness and poor coordination.
  • Sensation; for example impaired perception, hearing, or vision.
  • Emotional changes, including depression, aggression, and lack of impulse control.

The consequences of a severe TBI can affect an individual’s life, but there are steps that can be taken to limit the injuries impact. The CDC recommends primary intervention, early management, and treatment of severe TBI for best results.

Learn more about me, Ramin Rak, and my unique skill sets here: http://www.linkedin.com/in/raminrak, and here http://raminrak.com/ramin-rak-traumatic-brain-injury-treatments/.

 

Aneurysm Coiling

Hi all, Ramin Rak here with another blog post about a complicated neurosurgical procedure I perform at Neurological Surgery, P.C.: aneurysm coiling.

I primarily treat conditions in the brain and spine so I only perform aneurysm coiling to address brain aneurysms. Endovascular aneurysm coiling is one of two techniques (along with open surgical clipping) that can be used to treat brain aneurysms, but sometimes a physician will choose to closely observe an aneurysm instead of recommending one of these two treatments.

Aneurysm coiling is a minimally invasive endovascular procedure performed to treat an aneurysm, which is a balloon-like bulge of an artery wall (learn more).

As an aneurysm grows, it will thin and weaken until it becomes so thin that it leaks or ruptures. A ruptured aneurysm will release blood into the space around the brain, called a subarachnoid hemorrhage, and is life threatening. Treatment involves stopping blood from flowing into the aneurysm but still allowing blood to flow freely through the normal arteries. While open surgical clipping accomplishes this from the outside, aneurysm coiling does so from the inside.

Ramin Rak Aneurysm Coiling

This diagram depicts the insertion of small platinum coils into the aneurysm using a catheter

I begin the procedure by giving the patient anesthesia while they are on the x-ray table.

Next, I locate the femoral artery and use a needle to insert a long plastic tube (the catheter) into the bloodstream. Dye is then injected through the catheter to make blood vessels visible on my x-ray monitor, allowing me to guide the catheter to one of four arteries in the neck that lead to the brain. After the catheter is placed, I take x-ray photos and use them to take measurements of the aneurysm.

A second smaller catheter travels through the first catheter and makes its way to the aneurysm itself.

Small platinum coils are then passed through the catheter until they emerge in the aneurysm, and this process continues until the aneurysm is completely packed with coils. I then inject contrast agent so that I can confirm that blood is no longer flowing into the aneurysm and finally close the puncture site in the artery.

Endovascular aneurysm coiling has a long-term success rate between 80 and 85%.

Thanks for reading,

Ramin Rak

Learn more about my specialized neurosurgical procedures on Brand Yourself: http://raminrak.brandyourself.com/ or visit my WordPress blog.

Stereotactic Radiosurgery

Hi all, Ramin Rak back again with another blog post about my work as a neurosurgeon with Neurological Surgery, P.C. I specialize in treating disorders related to the brain and spine, and frequently treat benign and malignant brain tumors with the NSPC Brain Tumor Center.

One way that I treat these tumors is by performing stereotactic radiosurgery.

Stereotactic radiosurgery is a form of radiation therapy where high-powered x-rays are focused on a small area of the body where a tumor is located.

This procedure not only does a better job of targeting the specific area where the tumor is located but also is safer because it is less likely to affect surrounding tissue.  Certain types of stereotactic radiosurgery, such as the Cyberknife and Gamma Knife procedures, require the use of a fitted face mask or frame that goes over the scalp.

Despite its name, stereotactic radiosurgery is not a surgical procedure.

This treatment is intended to shrink tumors solely by using targeted radiation. I recommend this option for individuals with small, deep tumors that would be hard to remove during surgery as well as individuals who are unable to have surgery, such as the sick or elderly.

During this procedure, the patient will lie down on a treatment table, which then slides into the treatment machine.

Radiation is applied in sessions that last between 30 minutes and one hour. Usually no more than five treatment sessions are necessary, but the exact number of needed sessions will be determined based on the type and size of the tumor.

While it is most common for stereotactic radiosurgery to be used for non-surgically addressing tumors, it can also be used following surgery to remove abnormal tissue left behind following surgery.

If you have any questions about stereotactic radiosurgery or other complex brain and spine procedures, check to see if I have addressed them on my Quora.

Thank you for reading,

Ramin Rak

 

PS You can learn more about stereotactic radiosurgery by clicking here: http://en.wikipedia.org/wiki/Stereotactic_surgery#Stereotactic_radiosurgery_.28SRS.29_in_Cancer_treatment

Microdiscectomy

Hi all, Ramin Rak here with another blog post about the complex neurosurgical procedures I complete at Neurological Surgery, P.C.

I specialize in the completion of surgeries meant to treat ailments affecting the brain and spine. In previous blog posts I have discussed my work with the NSPC Brain Tumor Center and spinal procedures such as Spinal Fusion and the X-Stop Procedure. One spinal procedure that I have not written about is a microdiscectomy.

When a patient complains of leg pain I can use magnetic resource imaging (MRI) or a computer tomography (CT) scan to determine if the patient has a herniated disc.

Using these results, I then decide whether or not a microdiscectomy will relieve the patient’s symptoms.

This spinal procedure is primarily used to treat leg pain, specifically leg pain arising from a herniated lumbar disc. Compression or impingement on the nerve root, defined as bone colliding with or striking the nerve root, will cause considerable leg pain. A microdiscectomy is used to relieve leg pain, and in many cases the patient will feel relief immediately after completion of surgery.

When completing a microdiscectomy, I examine the disc and nerves under a high powered microscope so that I only need to make a small incision.

By using this microneurosurgical technique instead of performing a discectomy, patients experience a much smaller recovery time because there is less tissue damage.

After the incision is made, I move the back muscles off of the bony arch (lamina) of the spine. I am then able to enter the spine by removing a membrane over the nerve roots and visualize the nerve using operating glasses. Once herniated disc material is removed, the procedure is complete.

For more information about the types of spinal procedures I have completed, take a look at my other blog posts or view some of the surgical videos I have uploaded to Vimeo by clicking here.

Thanks for reading,

Ramin Rak

 

PS For more information on the completion of a microdiscectomy, visit this link.

Kyphoplasty Surgery

Hello again, my name is Ramin Rak and I am writing this post to share information about another complex spinal procedure that I perform at Neurological Surgery, P.C.: Kyphoplasty Surgery.

I am one of six Neurological Surgery, P.C. neurosurgeons who performs kyphoplasty surgery. The others are:

  • Dr. Stephen D. Burstein
  • Dr. William J. Sonstein
  • Dr. Benjamin R. Cohen
  • Dr. Artem Y. Vaynman
  • Donald S. Krieff, D.O., F.A.C.O.S.

I perform kyphoplasty surgery in order to reverse spinal compression caused by a spinal bone fracture.

Individuals who experience compression lose vertebral body height and experience intractable pain. Fortunately kyphoplasty surgery removes pain relief roughly 48 hours after completion of the procedure, and patients can leave the hospital on the same day the procedure is completed.

Once the patient has been sedated, I make a small incision in the patient’s back so that I can insert a narrow tube-like needle into the fractured vertebral body.

I then use an imaging technique called fluoroscopy, which uses x-rays to provide a real-time moving image of the patient’s spinal structure, to guide the needle into the fractured area. Once a path has been made to the spot of the fracture, I insert a balloon into the tube, guide it to the vertebrae, and then slowly inflate it. The inflated balloon elevates the spinal structure, which restores vertebral body height. Next I remove the balloon and fill the cavity created by the balloon with a cement-like material that hardens quickly and stabilizes the spinal structure.

The entire procedure takes roughly one hour per affected vertebra and following conclusion of the procedure, the patient is observed in the recovery room until my doctors determine that he or she can leave.

This is how I complete kyphoplasty surgery at Neurological Surgery, P.C.

Learn more about how I complete this procedure by reaching out to me on Doctor’s Hangout.

Thanks for reading,

Ramin Rak

 

Ramin-Rak-Kyphoplasty

During kyphoplasty surgery, a balloon is inserted into the spine and inflated via a small tube.

Schwannoma

Thank you for visiting my blog. My name is Dr. Ramin Rak and I am a surgeon with Neurological Surgery, P.C.

I specialize in treating complex spinal and brain complications at the eleven different medical facilities affiliated with Neurological Surgery, P.C. and I am a member of the organization’s Neurosurgeon Brain Tumor Team.

The Brain Tumor team includes an Endovascular Neuroradiologist, two Neuro-oncologists, a Neuropsychologist, myself, and seven other neurosurgeons:

  • Dr. Michael H. Brisman, M.D., F.A.C.S.
  • Dr. Jeffrey A. Brown, M.D., F.A.C.S.
  • Dr. Lee Eric Tessler, M.D., F.A.A.N.S.
  • Dr. Alan Mechanic, M.D., F.A.C.S.
  • Dr. Robert N. Holtzman, M.D.
  • Dr. Vladimir Dadashev, M.D.
  • Dr. Gerald M. Zupruk, M.D., F.A.A.N.S.

The rest of the Brain Tumor Team and I work to treat brain tumors and complications caused by tumors, including gioblastoma, medulloblastoma, acoustic neuroma, and schwannoma.

Schwannoma is a homogenous tumor that is made up entirely of Schwann cells, which conduct nervous impulses along axons, provide trophic support for neurons, and support nerve development and regeneration.

The tumor cells are always on the exterior of the nerve though the tumor itself can cause nerve damage by pushing the nerve aside or into bone. Schwannomas become malignant in less than 1% of cases and are slow growing, but should still be treated if weakness numbness, pain or other symptoms are seen.

The Brain Tumor Team at NSPC uses surgery or stereotactic radiosurgery to treat schwannomas with radiosurgery being an option when the tumor is located in the head or spine.

The most common treatment is stereotactic radiosurgery, or the use of a machine called the Gamma Knife to focus high-powered x-rays at the spot of the tumor. Between 80 and 90% of the patients who opt instead to have surgery report that pain, weakness, and numbness disappears following the procedure.

Learn more about how the Brain Tumor Team treats schwannomas here.

Thank you for reading,

Dr. Ramin Rak

 

Ramin Rak Schwannoma

This is an example of a schwannoma. It typically has dense areas called Antoni A (black arrow) and looser areas called Antoni B (blue arrows). The cells are elongated (spindle shaped) and the nuclei have a tendency to line up as you see here in the Antoni A area. (via ucsf.edu)