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This on line resource is a collection of our most frequently asked questions from our patients and their families.  The answers contained in this section are continually updated as new questions arise.

Select a topic from the list or scroll down to read all of the questions and answers.

  1. What is a neurosurgeon?
  2. What is a stroke?
  3. What is brain death?
  4. What is a craniotomy?
  5. What is an aneurysm?
  6. What is an arteriovenous malformation?
  7. What is a postconcussive syndrome?
  8. Are all brain tumors fatal?
  9. What is hydrocephalus?
  10. What is a laminectomy or laminotomy?
  11. What is an anterior cervical discectomy?
  12. What is a lumbar fusion?
  13. What is stereotactic radiosurgery?
  14. What is a pinched nerve?
  15. What is a herniated disc?
  16. What is an MRI Scan?
  17. Are lasers used in brain or spine surgery?
  18. Bad backs run in my family, will I develop one?
  19. How can you operate in the brain and not cause any new symptoms?
  20. Whenever I walk or exert myself, my legs become numb, weak and “crampy”…Why?
  21. Do you accept pediatric patients as part of your practice?
  22. Do you perform spine surgery as well as intracranial procedures?
  23. Which Las Vegas hospitals are your physicians on staff?
  24. At which hospitals will your physicians perform surgery?
  25. Are any of the physicians members of the medical staff of hospitals outside of Las Vegas?
  26. Prior to scheduling an appointment, does one of the doctors need to review any records or radiology reports?
  27. Do the patients need to bring their actual films with them to their scheduled appointment?
  28. Do you accept worker’s compensation?
  29. Do you accept attorney liens?

  1. What is a neurosurgeon? A neurosurgeon is a physician specially trained in the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spine, brain, nervous system and peripheral nerves. Neurosurgeons treat both adult and pediatric patients. They evaluate and operate on disorders of the brain and skull, blood vessels within this region, disorders of the pituitary gland, diseases of the spinal cord and vertebral column and disorders of the nerves exiting the brain and spine. Neurosurgeons also perform surgery on the carotid arteries in the neck and treat congenital and birth related problems of both the brain and spine.Neurosurgeons, after four years of medical school, enter a training program consisting of one year of internship usually in general surgery and then a residency program of 5 to 7 years. back to top
  2. What is a stroke? A stroke is the common name for a type of cerebrovascular accident. There are two types of stroke. The first is an actual hemorrhage within the brain (intracranial hemorrhage, either in the brain itself or in the subarachnoid space surrounding the brain). The second results from a region of the brain being deprived of blood flow (bland stroke).Usually, a stroke can be identified beginning with a sudden neurologic deficit or symptom. The symptom can be as subtle as a headache or as severe as the onset of unconsciousness (coma). In some cases, the symptoms may be temporary.Treatments for stroke vary depending upon its cause. These include simple methods such as taking aspirin and can range to more complicated methods including surgery to improve or open clogged arteries to the brain. back to top
  3. What is brain death? Brain death is both a medical and legal condition that represents the irriversible ending or termination of function of both the entire brain and the brainstem. Even though the body may have relatively normal or near normal vital signs, brain death suggests that the individual who is comatose will never awaken. Various neurologic tests and procedures can be done to confirm brain death. If the criteria for brain death are met by the examinations, the patient may be declared legally dead. back to top
  4. What is a craniotomy? A craniotomy is an operation in which a neurosurgeon will be able to operate on the brain tissue, vessels or other structures within the skull. This consists of making an incision in the skin followed by removal of a portion of the skull, exposing the brain and its covering layer, the dura. The dura is then opened, exposing the brain, structures at the base of the skull and the nerves exiting the brain from the brainstem. These nerves go to organs that are involved with special sensations such as vision, smell, hearing, taste, etc.Once the procedure is complete, the dura is closed. The bone removed from the skull is replaced into the area that it was removed from and secured with tiny plates and screws (which go into the skull). The skin is then closed. back to top
  5. What is an aneurysm? An aneurysm is a dilation of a blood vessel within the brain. The majority of aneurysms are congenital however others can be due to trauma or various types of infection. In most congenital aneurysms, the wall of the vessel has not formed normally from birth. In doing so, pressure from the blood flow in the intercranial artery causes the wall to weaken leading to a dilation of the vessel wall.If this weakened wall hemorrhages (subarachnoid hemorrhage) it is a medical emergency and the individual should be taken immediately for further evaluation including a CAT scan or arteriogram (a test in which dye is placed in the vessels of the brain and X-rays are taken to study them).It is imperative that the blood flow to an aneurysm be stopped before any further hemorrhaging takes place. This is usually done through a craniotomy during which a metal clip is placed at the base of the aneurysm.In some cases, the anatomy of the aneurysm is such that a clipping cannot take place or the patient is too ill to undergo a craniotomy. In these cases, endovascular treatment can occur through the same mechanism as an arteriogram. A special catheter is passed into the arteries of the brain following which special detachable coils are placed into the opening of the aneurysm. Although less invasive than a craniotomy, there are no long-term results on the effectiveness of endovascular treatment. back to top
  6. What is an arteriovenous malformation? An arteriovenous malformation is a collection of blood vessels within the brain or spinal cord that do not share a capillary system between the arteries and veins. Due to this, blood from the incoming arterial system does not have normal regulation and is shunted through the malformation out into the veins. The inner brain tissue is deprived of oxygen and is usually nonfunctional and scarred. The malformation itself can steal blood from functioning areas of the brain leading to neurologic symptoms and seizures.In its most extreme case, a subarachnoid hemorrhage (bleeding into the fluid space surrounding the brain and spinal cord) or an intraparenchymal or intraventricular hemorrhage (leading into the brain substance or the ventricular fluid system of the brain, respectively) may occur. back to top
  7. What is a postconcussive syndrome? A postconcussive syndrome consists of symptoms of headache, confusion, memory and mentation problems that follow a moderate-degree head trauma. The severity of the postconcussive syndrome is directly related to that amount of time a person is unconscious following the injury (concussion). There also is no anatomic damage to the brain seen on MRI or CT scanning.Symptoms may last up to six months and in the most severe cases even up to a year. There is no surgical or medical treatment for this other than mild analgesics, which are usually non-narcotic, for headaches. back to top
  8. Are all brain tumors fatal? As in all areas of the body, tumors (abnormal growths of tissue) can be either malignant (cancerous) or benign (noncancerous).In both adults and children, the majority of brain tumors are in fact cancerous. There are quite a few, however, that are noncancerous but become symptomatic when they compress or invade areas of the brain next to normal tissue.In either case, a biopsy is necessary to correctly diagnose if a tumor is cancerous or not. There are some cases where masses within the brain or skull can be followed by regular MRI scanning, with surgery reserved only if it shows signs of growth or invasion into other structures.If a brain tumor is cancerous, then attempts should be made to remove it if at all possible, or at a minimum obtain a piece of tissue for a pathologist to identify its origin. This would allow a diagnosis of tumors arising from the tissue within the brain and its surrounding structures, as well as those from other organs (metastases).In any case, malignant tumors will require other treatment such as radiation therapy or chemotherapy. back to top
  9. What is hydrocephalus? Each day the brain produces approximately 20 to 40 cc of cerebrospinal fluid. This is the liquid that supports the structures of the nervous system.Anatomically, hydrocephalus represents a dilation of the fluid system blocked by the brain. The ventricles (spaces where the cerebrospinal fluid is located within the brain) becomes dilated and the pressure of the brain itself (intracranial pressure) increases. This leads to many neurologic symptoms, most commonly headaches.Certain tumors can cause hydrocephalus by producing too much spinal fluid. Other masses within the brain can block the outflow of the spinal fluid leading to obstructive hydrocephalus. Finally, there can be a decrease in the absorption of the cerebrospinal fluid causing communicating hydrocephalus.If a mass is present blocking the outflow of spinal fluid, it should be removed. If this cannot be safely done, a drainage tube (ventriculoperitoneal shunt) should be placed to direct fluid from the ventricles (fluid centers) of the brain into the abdomen. Similarly, a lumboperitoneal shunt directing spinal fluid from the lumbar spine to the abdomen can also be used for certain types of hydrocephalus. back to top
  10. What is a laminectomy or laminotomy? A laminectomy or laminotomy is removal of all or part of the posterior portion of the spine. This operation is done primarily for compression of the spinal cord due to arthritis, tumors or infection. Laminectomy consists of complete removal of the posterior elements (spinous process, lamina and part of the facet joint) of the spine. A laminotomy is only partial removal of the lamina with part of the facet joint. back to top
  11. What is an anterior cervical discectomy? An anterior cervical discectomy is the most common approach to treat paretic and disc problems in the cervical spine. It consists of making an incision in the front of the neck, exposing the anterior (front) portion of the spine and then removing the disc itself. If necessary, two or more discs can be removed along with an entire vertebral body (corpectomy).In most cases, the disc itself is fused using bone from the patient or bone from a bone bank. This can also be supplemented with a cervical plate to provide immediate stability and enhance the rate of bone fusion. back to top
  12. What is a lumbar fusion? A lumbar fusion is a procedure in which bone is placed either between the vertebral bodies or between the transverse processes of the spine in an attempt to grow new bone. This new bone will ultimately provide stability for the spine.In most cases today, this bone fusion is supplemented by instrumentation. This includes plates, rods, and screws attached to the pedicle (which connects the front and back parts of the spine) to keep it from moving. Age can also lead to collapse of the space between each vertebral body. In some cases, pieces of bone or metal cages filled with bone can be placed between the vertebral bodies in order to increase the separation between these structures.Lumbar fusion can be performed solely from the front (anterior interbody lumbar fusion), the back (posterior lateral or posterior lumbar interbody fusion) of the spine, or both (global fusion). back to top
  13. What is stereotactic radiosurgery? Stereotactic radiosurgery (Gamma Knife) is the use of focused radiation directed at a lesion within the brain. The accuracy of this treatment is very precise and can work on an area of the brain as small as a few millimeters. This surgery without a scalpel is an alternative treatment for small intercranial arteriovenous malformations and tumors that are located in very sensitive or difficult to reach areas of the brain and skull base. It is also an option for recurrent brain tumors or when more than one metastases (tumors from a separate organ, or organs, outside the nervous system) is present in the brain.More recently, it has been investigated as a possible treatment for pain and movement disorder syndromes. back to top
  14. What is a pinched nerve? A pinched nerve represents essentially radiculopathy. This is a condition in which the nerve root exiting from the spinal cord is compressed either in the spinal canal or as it exits the spine in one of the nerve openings (foramen). Symptoms resulting from this include pain in the cervical region of the spine that radiates into the extremity, numbness in the same pattern as the pain, and weakness of various muscles.Causes of a pinched nerve include a herniated disc (also known as a slipped disc, extruded disc, or severely bulging disc), spondylosis (arthritis, bone spurs, or calcium deposits) of the spine, or can be due to a tumor, infection or hemorrhage. back to top
  15. What is a herniated disc? Spinal discs are located between nearly all spinal vertebrae, the exceptions being at the top of the cervical spine (to allow rotation), in the sacrum and coccyx, and at the bottom of the back. They perform a cushioning function between each vertebral body.The disc is made up of two components: the inner potion, a soft nucleus and a very fibrous annulus surrounding it. Disc herniation occurs when the fibers of the annulus weaken, allowing the nucleus to protrude through. Disc material can then press on the spinal cord or nerve roots resulting in myelopathy or radiculopathy, respectively.There are various grades of disc problems. These include degeneration in which both the nucleus and annulus wear down leading to collapse of the disc without any protrusion of disc material into the spinal canal (degenerative disc disease). The disc can bulge due to weak annular fibers and push out into the spinal canal (disc bulge). A herniated disc can occur when the disc material pierces through the annular fibers and is sits separate from the disc space and annulus within in the spinal canal. back to top
  16. What is an MRI Scan? An MRI Scan is a scan that measures the amount of energy released by hydrogen molecules (the component that makes up 2/3 of water {H20} which comprises 70% of your body) when they rotate back and forth through magnetic fields. The energy is measured by sensors and then sent to a computer to reconstruct images of your body.MRI scanning can look at any part of the nervous system. The area studied can be “sliced” in all directions (coronal, sagittal and axial) to obtain the best information possible.Dye (not the same dye as other radiographic studies, so there is no problem in patients sensitive to iodine) is used to further study any abnormal tissue. It also is used to selectively look at the blood vessels of the brain (MR Angiogram). MR angiography is useful to screen individuals for aneurysms or arteriovenous malformations, especially if a close family member had one of these lesions. back to top
  17. Are lasers used in brain or spine surgery? Up until about ten years ago, lasers had a limited role in both brain and spine surgery. Today however, lasers are used on some endoscopic spine procedures. Even these procedures are not performed routinely throughout the world. Other surgical techniques have been developed that are safer and more accurate than those using the laser.The main problem with lasers is that they are difficult to focus. If the length of the laser beam is not measured correctly, it can shoot through the desired tissue and damage normal brain and spinal structures. back to top
  18. Bad backs run in my family, will I develop one? The most common cause of spine problems is injury to the spine, being overweight, and overuse at work or with recreation. Certain spine diseases do have some genetic relationship, but these are rare. Other more common conditions that can run “loosely” in families include congenital lumbar stenosis, congenital cervical stenosis, and spondylolisthesis due to a congenital pars defect. back to top
  19. How can you operate in the brain and not cause any new symptoms? The goal of neurosurgery is to perform this type of surgery without any new deficits at all. Some operations actually do not enter the brain tissue. The brain is lifted or retracted and the operation proceeds outside of it. If the brain tissue has to be entered, we do know the general areas of motor and sensation, speech, vision and the function of the nerves (cranial nerves) leaving the bottom of the brain at the brainstem. Neurosurgeons also know where blood vessels going in and out of the brain travel. These areas are avoided if possible, and operations in the brain are done in “silent areas”, of which we know have little or no obvious function. back to top
  20. Whenever I walk or exert myself, my legs become numb, weak and “crampy”…Why? The symptoms described above are suggestive of claudication. Claudication is caused by a lack of blood supply to the legs (Vascular Claudication) as well as to the nerves going to the legs (Neurogenic Claudication). Vascular claudication is treated by identifying where the blocked vessels are, and re-opening them with surgery or angioplasty (placing a balloon in the vessel and dilating it).Neurogenic claudication is caused by the lack of blood flow to the nerves going to the legs, while they are still within the spinal canal (cauda equina). The poor blood supply is due to physical compression of the nerves and the blood vessels running with them. In the elderly, this is due to overgrowth of arthritic bone (Lumbar Stenosis and Spondylosis). In younger patients, neurogenic claudication can be due to congenital narrowing of the spinal canal (Congenital Lumbar Stenosis) or a slippage of vertebrae themselves (Lumbar Spondylolithesis). This condition can occur suddenly due to a herniated lumbar disc or fracture (Cauda Equina Syndrome). back to top
  21. Do you accept pediatric patients as part of your practice? Yes! In fact, our practice performs the majority of pediatric neurosurgery in Southern Nevada and surrounding communities.  Dr. Stuart Kaplan is also the only ABNS board-certified pediatric neurosurgeon in Nevada.  back to top
  22. Do you perform spine surgery as well as intracranial procedures? Yes! We have one of the busiest and diverse spine practices in Southern Nevada. Our physicians not only evaluate acute and degenerative spine conditions, but also perform complex spinal reconstructive procedures in both adults and pediatric patients. Our practice directs the neuro/spine injury program at the Level 1 Trauma Center in Southern Nevada. We also routinely treat tumor and vascular disease within the spinal cord itself. back to top
  23. Which Las Vegas hospitals are your physicians on staff? All of our physicians have privileges at Sunrise Hospital & Medical Center, University Medical Center, Desert Springs Hospital, Valley Hospital, MountainView Hospital, Summerlin Hospital and St. Rose deLima and Siena Hospitals. back to top
  24. At which hospitals will your physicians perform surgery? Our physicians perform surgery at Sunrise, UMC, desert Springs, Valley, Mountain View, and St. Rose Hospitals. back to top
  25. Are any of the physicians members of the medical staff of hospitals outside of Las Vegas? Yes! We are also part of the medical staff of Western Arizona Regional Medical Center (Bullhead City, AZ), Kingman Regional Medical Center (Kingman, AZ), Havasu Regional Medical Center (Lake Havasu, AZ), Dixie Regional Medical Center (St. George, UT), and Colorado River Medical Center (Needles, CA). Dr. Venger has privileges at Western Arizona Regional Medical Center, Kingman Regional Medical Center, Havasu Regional Medical Center, and Dixie Regional Medical Center. Dr. Anson has privileges at Havasu Regional Medical Center in Lake Havasu City, AZ. back to top
  26. Prior to scheduling an appointment, does one of the doctors need to review any records or radiology reports? In general, the more information our physician has to review prior to evaluating a patient, the more efficiently he can determine what is necessary to arrive at a correct diagnosis. Generally, we ask that records be sent, if possible, to help facilitate this. back to top
  27. Do the patients need to bring their actual films with them to their scheduled appointment? Yes! Before reaching a decision to recommend surgery, we need to personally review all pertinent radiology studies. For this reason, if patients arrive without their actual films, they may need to be rescheduled. back to top
  28. Do you accept worker’s compensation? Yes! We accept many out of state plans, including those in Arizona, Utah, and California where we have satellite offices. back to top
  29. Do you accept attorney liens? Usually not, unless by prior arrangement with your attorney. back to top