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

Good Bedside Manner

Bedside Manors Ramin Rak is a leading Neurosurgeon with a long history of expert specialties and training in micro-neurosurgical procedures. He has performed countless surgeries, and specialized in highly-complex awake craniotomies, skull-based surgeries, spine treatments and tumors. Ramin Rak attended the Free University of Brussels for his medical degree, and previous to this, for his undergraduate degree with high honors in Medical Basic Sciences. Ramin Rak has, since this time, gained a considerable amount of training, expertise, which has helped him gain effective bedside manner. While the actual procedural and administrative aspects of a successful surgery are vital to a smooth surgery for a patient, knowing what a good bedside manner is and how to employ it, is arguably just as important. Here are some tips for gaining and employing a good bedside manner to quell fears in your patients and make the entire process as comfortable and positive as possible.

  1.       Mind Your Manners: First rule of thumb in presenting the best bedside manner-which should be included in any profession- is using good manners at all times, with the necessary please and thank yous, as well as an overall gesture of respect.
  2.       Professionalism: As a doctor, you should always be well-groomed, confident, assured, and knowledgeable.
  3.       Familiarity: Make sure that you patients feel like you care about them specifically, You may deal with 100 patients a day, but you should address each singularly with names, histories, and the care that each patient deserves. Doing so will bring more comfort to each patient more than you might think.
  4.       Listening: Yes-you are the more knowledgeable about medicine in the room, probably, but listening to what your patients are feeling, their fears, symptoms, and questions is a vital part both to better understanding how to best treat them, but also, how to make them feel like an important part of the process (and they are).

Learn more about Ramin Rak on his About.me page.

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/

Glioblastoma

GBM

Glioblastoma in an x-ray. (Source: Wikipedia.org)

Hello again, this is Ramin Rak, back with another post about a medical procedure I performed at Neurological Surgery, P.C. in Long Island.

I specialize in treating disorders related to the brain and spine, and recently removed a glioblastoma multiforme tumor during a high-profile surgery.

Glioblastomas (GBM) are tumors found in the cerebral hemisphere or spinal cord.

These tumors are highly cancerous due to their ability to reproduce cells quickly. In addition, they are supported by a large network of blood vessels. The cause of these tumors are unknown but due to their rapid growth, symptoms commonly involve pressure on the brain. Headache, vomiting, nausea, and drowsiness are the most common.  Treating GBM is very difficult because these tumors contain many different types of cells. Furthermore, the network of tentacles in the brain make it extremely difficult to remove these tumors without affecting the patient’s language and coordination. For these reasons, your surgeon may decide to combine several approaches to treat your GBM.

Recently, Donald Squire, 52, of East Northport was diagnosed with a GBM that required surgery.

His only symptom was a twitching in one of his eyes. His wife suspected a stroke but brain scans revealed that the twitching was due to a tumor. Fortunately, I was able to use proprietary technology to enter the inner labyrinths of his brain and remove the tumor. To reach the tumor, I used brain-mapping technology and neuronavigation, which made it possible to move eloquently throughout the delicate areas of his brain. The patient was awake during surgery in order for me to monitor his language, vision, and speech. After the surgery, I had concerns that Squire might lose some of his peripheral vision, but he hasn’t noticed any changes. Squire is very fortunate to have had access to this technology, as not too long ago, this area of his brain would have been unreachable using conventional techniques.

You can learn more about Squire’s procedure here: http://grow-your-practice.net/wp-content/uploads/2013/07/Dr-Rak-Newsday-062213.pdf

 

Thanks for reading,

Ramin Rak

You can learn more about me and my specialties in the Commack Patch, or by connecting with me on Doctor’s Hangout: www.doctorshangout.com/profile/DrRaminRakMD

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.

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)

My Second Awake Craniotomy

Good afternoon and welcome back to my blog.

My name is Ramin Rak, I am a neurosurgeon with Neurological Surgery, P.C. in New York and one of my specialties is performing awake craniotomies.

In July of 2010, I received media attention after completing the first awake craniotomy that had ever been performed at the North Shore-LIJ Huntington Hospital.

The procedure was notable for me because it was only my second awake craniotomy.

The need for the procedure was uncovered after 23-year-old Boris Arrazia experienced a seizure while driving his car. Arrazia’s passenger was able to navigate the car to the side of the road and put it in park, and a passerby performed CPR and then called for help.

Arrazia was brought to Huntington Hospital where doctors uncovered the cause of the stroke: a tumor located in the temporal lobe of his brain.

Due to the tumor’s unusual location, the tumor did not show up when using advanced imaging techniques. Because the tumor was right on his speech area, there was no way to map and understand how we are going to control the reception of the brain without the patient being awake. By performing an awake craniotomy, my team was able to make sure we did not damage areas of the brain dealing with speech during surgery by asking Arrazia to repeat phrases or describe pictures. Arrazia recounts:

“I was nervous when Ramin Rak first told me the diagnosis, but happy to hear that the tumor was operable,” Arriaza said. “Ramin Rak told me that I would be conscious for the surgery, and that it might be uncomfortable and possibly a little painful. During the surgery, they showed me pictures and asked me to name the objects [like] a horse [or] a table.”

Though there are a lot of risks associated with awake craniotomies, including serious bleeding, there were no complications seen while removing Arrazia’s tumor. Four days later, he walked out of the hospital and reunited with his family.

Learn more about this particular awake craniotomy by taking a look at the media coverage this procedure received:

http://www.northshorelij.com/NSLIJ/Islip+Man+Undergoes+Brain+Surgery+While+Awake  

http://huntington.patch.com/articles/huntington-hospital-doc-performs-awake-craniotomy

 

If you are interested in learning more about how I perform awake craniotomies, visit my Quora profile.

Thank you for reading,

Ramin Rak

Ramin Rak awake craniotomy

Boris Arrazia thanks Ramin Rak following completion of the awake craniotomy.

Leslie Munzer Neurological Institute

Hi all, Dr. Ramin Rak here with another blog post about neurosurgery.

Some of my past blog posts have focused on complex neurosurgical techniques that I use, but I do not spend all of my time in the operating room. Part of my success can be attributed to the education along the way, from my eight years of undergraduate and medical schooling at the Free University of Brussels to the countless residencies I completed in hospitals throughout the United States. For this reason, I make it a priority to give back to the medical community by educating them on the techniques that I use. One way that I do so is by keeping up this blog, but I also present lectures at medical seminars across the country.

Back in 2009 I was asked by the Leslie Munzer Neurological Institute (LMNI) to speak at a comprehensive educational seminar on Brain Tumor and Stroke Awareness.

This two hour seminar took place at the Jefferson’s Ferry Lifetime Retirement Community’s Community Center in New York, and lecture topics included, “Stroke- Treatment, Recovery, and Prevention,” “Current Treatments of Brain Tumors,” “A Stroke Overview,” and “New Chemotherapy Options for the Treatment of Brain Tumors.” My lecture was titled “Advancements in Brain Tumor Surgeries” and I discussed advanced microneurosurgical techniques like awake craniotomies, the Gamma Knife procedure, and the CyberKnife system.

The Leslie Munzer Neurological Institute was formed in 2006 by Neurological Surgery, P.C. and at the time was called The Long Island Neurological Institute, Inc.

This organization coordinated funds for research related to the brain and spinal cord while supplying information to patients and the medical community about neurological ailments.

The organization changed its name in 2008 in memory of Leslie Munzer, who passed away in 2004 from a ruptured arteriovenous malformation (AVM).

Shortly after her passing, the Munzer family had formed a charity in her name to raise funds for AVM research and awareness, and in 2008 donated the collected funds to The Long Island Neurological Institute, Inc.

You can learn more about my efforts to educate the neurosurgical community with The Leslie Munzer Neurological Institute and with other organizations by viewing my other blog posts.

Thank you for reading,

Dr. Ramin Rak

Ramin Rak at May 2009 Seminar

Dr. Ramin Rak (second from the right) and the other speakers asked to present a lecture for the May 2009 Leslie Munzer Neurological Institute (LMNI) seminar.

Gamma Knife Procedure

Hello readers, Ramin Rak here with yet another blog post about a complex neurosurgical method that I have used to treat patients.

Gamma Knife is a procedure, like the CyberKnife System, that allows doctors like me to treat tumors and ailments without having to resort to surgery. Gamma Knife surgery was approved for use by the US Food and Drug Administration (FDA) thirty years ago and I am one of the few New York area neurosurgeons certified in this technique.

When I use Gamma Knife procedures for a patient, I can deliver over 200 beams of radiation right to the tumors and lesions.

Unlike with traditional radiation, patients do not experience the regular side effects because such low doses of radiation are injected. Patients can be given several shots of radiation during one session, and sessions can be repeated until the tumor has stopped growing.Gamma knife procedures can be used to treat:

  • Benign tumors, such as meningiomas, schwannomas, craniopharyngiomas, pineal tumors, acoustic neuromas, and pituitary adenomas.
  • Malignant tumors, such as metastatic tumors, chordomas, ependymomas, medulloblastomas, astrocytomas, and anaplastic astrocytomas.
  • Arteriovenous malformations (ATV)
  • Trigeminal neuralgia
  • Parkinson’s Disease

Generally Gamma Knife use is restricted to those tumors that are less than 4 centimeters in size.

This procedure has a success rate between 90 and 95 percent, as that is how often the procedure stops tumor growth. The majority of the time it also causes tumors to shrink, taking anywhere from one week to a year to stop growth.

When a patient undergoes Gamma Knife treatment, he or she will be fitted with a clear, plastic frame.  My team uses 3D computer imaging to determine where radiation must be aimed to successfully reach the tumor. Patients are then fitted with the Gamma Knife apparatus, which is a metal helmet that emits radiation beams. The apparatus then directs radiation beams to the tumor.

This is how I complete Gamma Knife treatments. If you have any questions, check to see if I have answered them on Quora, or reach out to me directly.

Thanks for reading,

Ramin Rak

 

CyberKnife System

Hi all, Dr. Ramin Rak here with another blog post about an advanced method that I use to complete neurosurgery.

I am one of a select few neurosurgeons who have been certified in the use of the CyberKnife System.

The CyberKnife Robotic Radiosurgery System is a treatment for cancerous and non-cancerous tumors located anywhere in the body.

This treatment shoots rays of radiation at the tumor to offer an alternative to invasive surgery. This procedure is the first and only robotic radiosurgery system that is designed to treat tumors without any cutting. It is also preferred by patients because the treatment offers a pain-free, surgery-free method of addressing inoperable or surgically complex tumors.

CyberKnife SystemI complete the CyberKnife procedure by first imaging the patient’s brain and surrounding area using a high-resolution CT scan.

This map of the patient’s head allows me to determine the size, shape, and location of the tumor. This image is then brought into the CyberKnife workstation so that I can begin to plan the treatment. In formulating a plan, I will determine the desired radiation level for the location of the tumor while ensuring that no radiation reaches the surrounding area. Once the treatment plan has been formulated, it is time to prep the patient for surgery.

Once the patient arrives to my facility, he or she will be placed onto the treatment table so that the CyberKnife can be positioned.

The CyberKnife is computer controlled, so the robot will move around the patient’s head to each of the locations where it will deliver radiation. The robot’s image guidance system allows the machine to track and continually adjust treatment while enabling the patient to breathe normally. The length of the session, as well as the number of required sessions, will differ on a case-by-case basis.

Thanks for reading, and let me know if you have any questions about the CyberKnife system.

Dr. Ramin Rak