expert type icon EXPERT

Prof. Christopher Robert Mascott, M.D.

Neurosurgeon

Chris Mascott. I am a neurosurgeon currently working in Omaha, previously in Denver, Dublin Ireland, Toulouse France, New Orleans Louisiana.
I trained in Motreal at McGill University in the 80s and 90s. In addition, I was at Memorial Sloan Kettering Cancer Center (MSKCC) for a year for brain tumor training (neuro-oncology), 2 additional years in Montreal for epilepsy training, 1 year at the University of Cincinnati for epilepsy/skull base/neurovascualr training, 1 year in Dublin for medical epilepsy work and another year for spine tumor training.

Maximal expertise: Epilepsy and epilepsy surgery, brain function mapping, brain tumors, skull base and pituitary tumors, neurovascualr problems. Radiosurgery
33 years Experience
Prof. Christopher Robert Mascott, M.D.
  • Omaha, NE
  • UniversitÈ de Lausanne FacultÈ de Biologie et de MÈdecine
  • Accepting new patients

Is it possible to lose your ability to talk after neurosurgery?

"Not talking" requires some further explanation. There are speech areas in the brain (usually on the left side in right handed people) which are speech related. Interference with READ MORE
"Not talking" requires some further explanation. There are speech areas in the brain (usually on the left side in right handed people) which are speech related. Interference with these can lead to a variety of temporary or permanent speech problems ranging from problems naming things, to difficulty with fluency to totally garbled speech. There are other areas of the brain that can lead to mutism (no speech at all, notably in an area called the supplementary motor area or in the cerebellum). Fortunately mutism from surgery in these areas is almost always reversible although this may take weeks to months. In primary speech areas we can do awake surgery and stimulate the brain to see where speech is to avoid trouble. This is necessary because no two people are alike with regard to where speech is although usually in the same general area.

How long does it take for one to recover from a brain tumor surgery?

There are lingering effects from long anesthesia for up to a week but with regard to the tumor, it very much depends on location, size and tumor type. A small superficial tumor READ MORE
There are lingering effects from long anesthesia for up to a week but with regard to the tumor, it very much depends on location, size and tumor type. A small superficial tumor will have much faster recovery than larger and deeper ones. It also depends what functional brain areas are nearby. Is it close to movement areas, speech areas, coordination areas etc ? Having nearby functional brain areas will affect function and recovery after surgery.

Can a brain surgery cause speech defects?

There are specific areas in the brain needed for speech (usually on the left side of the brain in right handlers and also on the left in most left handlers but with a higher chance READ MORE
There are specific areas in the brain needed for speech (usually on the left side of the brain in right handlers and also on the left in most left handlers but with a higher chance of some speech on the right). There are classic areas known to be involved in speech but some of these vary from person to person, so if we are concerned about speech function, we can do a wake-up during surgery to test for speech and avoid messing with speech areas. Speech mapping has been done since the 1920s and 1930s but came into more widespread use in the 1990s.
There is no way to replace brain areas of damaged but time and speech therapy usually helps considerably.

Is there a surgery to treat symptoms of seizures?

Epilepsy (recurring seizures) can be treated with surgery in selected cases. This is usually predicated on medications not working and a subsequent detailed investigation with READ MORE
Epilepsy (recurring seizures) can be treated with surgery in selected cases. This is usually predicated on medications not working and a subsequent detailed investigation with regard to whether there is a cause for seizures and where they are coming from. This involves MRI scans (to look for abnormal areas), extended hospital admissions to record video and EEG (brain waves) to see if seizures start in one location, other tests such as MEG (magnetoencephalography), PET (Positron emission tomography.... radioctive tracer to look at brain activity), SPECT (single photon emission tomography) and other tests. All this requires a specialized team for surgical treatment of epilepsy including specially trained neurologists, neurosurgeons, neuropsychologists, nurses, EEG technicians etc. In young children this should be in a specialized children's hospital.
Seizures starting in a localized abnormal area can be helped by removing that area surgically. "Generalized" seizures that start all over cannot be helped by surgical removal of brain areas but there are options for disconnection of stimulation of either brain areas of the vagus nerve in the neck by implanted pacemakers.
In summary, most seizures are not treated by surgery because medications work. When medications are not working optimally, surgery can be a consideration in some if the extensive work-up leads to reasonable surgical options.... so only a minority for surgery overall.

Can a blood clot in the brain be removed with medication alone?

No medication will remove a clot but clots absorb with time. In the head, location is important. If the clot is in the brain but not large enough to require urgent surgery to relieve READ MORE
No medication will remove a clot but clots absorb with time. In the head, location is important. If the clot is in the brain but not large enough to require urgent surgery to relieve symptoms it will resolve. It is also important to know if there is a cause that may bleed again. If the blood is outside the brain (subdural for example) the blood will go from acute to chronic to water. If the clot outside the brain is stretching little veins on the surface of the brain, additional bleeding could increase the clot and eventually require surgery.

How long should a skull fracture take to heal?

Skull fractures usually only need surgery if they are depressed. Linear (straight line) fractures are non surgical. Most surgeons use little titanium plates and screws for skull READ MORE
Skull fractures usually only need surgery if they are depressed. Linear (straight line) fractures are non surgical.
Most surgeons use little titanium plates and screws for skull repair which confers some immediate stability. The bone usually grows together over 6 months or so with some variability.

Is there a cure for meningioma?

85% of meningiomas are benign. Others referred to as "atypical" or grade 2 have a higher chance of coming back. Malignant meningiomas are quite rare. A vertex meningioma has a READ MORE
85% of meningiomas are benign. Others referred to as "atypical" or grade 2 have a higher chance of coming back. Malignant meningiomas are quite rare. A vertex meningioma has a higher chance of cure with surgery although the limiting factor may be how close to the midline it is since there is a large vein structure called the sagittal sinus along the midline. If the meningioma is up against this, it may not be possible to remove all the attachments since the sagittal sinus is important and must be preserved. Even when attachemnts cannot be completely removed, cauterizing attachements at surgery is a "second best" option.
Is your meningioma really 5x5x3mm not cm?
I don't think anyone in their right mind would suggest treating that if it is mm.
Overall options include observation with serial MRIs (always a choice but really the only reasonable one if that is in mm), surgery or radiosurgery. Radiosurgery is computer-guided radiation, usually in one session (sometimes 3-5) which is proven to work usually more by stopping growth with slight shrinkage, not disappearance. All these options should ber discussed in anyone with a meningioma. If it is tiny as described, observation is the only reasonable option. I usually use 3D MRI sequences for observation so that small changes in volume can be seen by computer matching way before radiologists see a change.... this with a view to discussing treatment as opposed to further observation. Again if tiny, even a small change should not prompt intervention.
Meningiomas cause symptoms isf they get large and affect adjacent brain or sometimes if irritation of adjacent brain lowers the threshhold for seizures. Otherwise no particular health risks.

Is pituitary adenoma life-threatening?

Pituitary tumors are mostly benign (with very few exceptions) and hardly ever life threatening. Small tumors are found either because they produce excess hormones or can be found READ MORE
Pituitary tumors are mostly benign (with very few exceptions) and hardly ever life threatening. Small tumors are found either because they produce excess hormones or can be found by accident on a scan. For tumors producing hormones, the first line of treatment is medical if it is the kind of hormone that can be suppressed. Lager tumors can present with visual loss from pushing on the nerves for vision. If those tumors produce hormones, medical treatment can come first but many larger tumors do not produce hormones and treatment is surgical through the nose to preserve vision. I am not sure how any of this would impact your back surgery, on the other hand I am not a big believer in back surgery and think most is not indicated and eventually makes people worse.

Chris

Can a blood clot in the brain be removed by medicines alone?

Since you have time to type this question, this is not an emergency or they would have already removed the blood clot surgically. Blood clots in the brain absorb by themselves. READ MORE
Since you have time to type this question, this is not an emergency or they would have already removed the blood clot surgically. Blood clots in the brain absorb by themselves. If it is not an emergency, the clot is not getting bigger or there are no incapacitating symptoms, the blood clot will absorb by itself usually over weeks. There is no medication to make this go faster. Also, it depends exactly where the clot is... inside the brain? Outside and pushing on brain etc. more importantly what caused the clot... trauma or did it happen by itself. In a 13 year old, there must be an underlying cause such as a vascular malformation which requires further investigation.

Recovery from craniotomy?

It's not the surgery, it's the head injury! Even without surgery significant head head trauma can have long lasting effects. A significant concussion with a normal scan and no READ MORE
It's not the surgery, it's the head injury! Even without surgery significant head head trauma can have long lasting effects. A significant concussion with a normal scan and no surgery can often result in "post concussion syndromes" consisting of poor concentration, memory problems, headaches, nausea, dizziness etc. everyone is different but these symptoms can last for months in some people. Concussions have gotten a lot of press recently in sports. Prolonged rest is advised and there are some specialists in concussion that can advise.

Awake during brain surgery?

Awake brain surgery goes back to the early 1900s (Fedor Krause) and the 1920s and 30's (Wilder Penfield). Initially awake surgery was for treating epilepsy to map out brain function READ MORE
Awake brain surgery goes back to the early 1900s (Fedor Krause) and the 1920s and 30's (Wilder Penfield). Initially awake surgery was for treating epilepsy to map out brain function and see where seizures might be coming from. In the 1990s surgeons started doing this more frequently for brain tumors in areas close to speech and movement in order to electrically stimulate these brain areas to identify function and avoid damaging function when removing tumor and this has remained a gold standard today. Modern anesthesia makes it easier to wake up a patient just during testing as opposed to being awake for the whole procedure. Implanting electrodes for brain pacemakers for Parkinson's disease treatment is often done awake in order to test function, stimulate and record electrical activity. Local anesthetic is always used and the brain has no pain sensation. Patients do get tired doing tasks during testing though.