Clinical Services

Dr. Dlouhy

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Chiari and Craniovertebral

Clinical Services

Spasticity

Dr. Dlouhy treats spasticity using a procedure known as a selective dorsal rhizotomy (SDR) as well as by intrathecal bacoflen infusion by implantation of a baclofen pump. Dr. Dlouhy was a fellow in pediatric neurosurgery at Washington University and St. Louis Children's Hospital where he learned the technique for SDR from Dr. Tae Sung Park, international neurosurgeon and leader in performing SDRs.

Hydrocephalus - Endoscopic Treatment

Dr. Dlouhy treats all types of hydrocepahlus, communicating and noncommunicating, of all etiologies. He specializes in using endoscopic treatments for hydrocephalus. This includes endoscopic third ventriculostomy as well as endoscopic third ventriculostomy and bilateral choroid plexus coagulation.

Pediatric brain and spinal cord tumors

Many brain tumor operations that previously required a large scalp incision and large bony opening (craniotomy) can be performed using minimally invasive surgery - using smaller incisions and craniotomy openings.

Small Key Hole Craniotomies for Brain Tumor Resections

For certain brain tumors deep under the surface of the brain, a very small and narrow opening can be used to reach the tumor. The narrow, minimally invasive surgical opening minimizes damage to normal brain tissue overlying the tumor. Use of intraoperative stereotactic neuronavigation helps determine the trajectory to the tumor. Only a small skin incision is required, resulting in decreased surgical times, less postoperative pain, faster recovery times, minimal to no hair shaving, and small cosmetically pleasing incisions. Incisions are linear (not curved) and therefore only 1-2 inches in length.

Eyebrow Incision for Brain Tumor Resections

For certain tumors in both children and adults, access to the brain and removal of the tumor can be accomplished with a small incision in the eyebrow. The small incision is hidden in the eyebrow and heals quickly without a visible scar. Dr. Dlouhy has published on the largest series of patients in children using this approach. Click here for the abstract.

Neuroendoscopy

This minimally invasive surgical technique uses specialized endoscopes with high resolution video cameras to perform surgery of the brain. Smaller incisions and bony openings often result in less pain and shorter hospital stays. Neuroendoscopy can be used to treat a variety of conditions in both children and adults. The endoscope can be used to assist the keyhole craniotomy surgeries (above) or be used by itself to treat colloid cysts and other tumors or masses in the ventricles (fluid filled spaces) of the brain. The endoscope can also be used through the nose to treat pituitary tumors, craniopharyngiomas, rathke cleft cysts or other tumors at the base of the brain. Additionally the endoscope is used to treat hydrocephalus by performing cyst fenestrations and endoscopic third ventriculostomies (ETVs). The endoscope is also now being used to treat complex Chiari malformations that present with basilar invagination by allowing decompression of the top of the spine.

Endoscopic Craniosynostosis

Dr. Dlouhy uses an endoscopic and minimally invasive approach for the treatment of craniosynostosis. One or two small incisions approximately 2 cm in length are used to remove segments of bone and release the premature fusion of the bone plates at the suture. No plating or reshaping are performed. Prior to surgery, a custom-molding helmet is made, which the infant wears after surgery for up to one year of age. The incisions are practically unnoticeable within weeks of the surgery. Minimal to no hair loss is expected.

Pediatric Epilepsy

Dr. Dlouhy treats all types of surgical epilepsy using the most up to date surgical treatments. This includes temporal lobe resections, extra-temporal lobe resections, selective mesial temporal lobe resection (amygdalohippocampectomy), lesional resections, tumor resections, hemispherotomy, corpus callosotomy – complete and partial, vagus nerve stimulation, and invasive subdural grid and strip and depth electrode placement for seizure localization. Please see the link "Pediatric Epilepsy Program" for more information about the entire program.

Craniovertebral Junction Disorders

See the link "Chiari and Craniovertebral Junction Program"

Chiari Malformation - all types

See the link "Chiari and Craniovertebral Junction Program"

Clinical Expertise and Focus

Brian J. Dlouhy, MD treats all types of pediatric and adult neurosurgical disorders. Dr. Dlouhy specializes and focuses on treating children and adults with Chiari and disorders of the craniovertebral junction (CVJ) as well as treating children with epilepsy and complex brain tumors. He is fellowship trained in both pediatric neurosurgery and minimally invasive neurosurgery, making him one of the few neurosurgeons in the nation to have fellowship training in both. He uses minimally invasive techniques in all of his surgeries. This includes using advanced imaging, specialized instruments, endoscopes, and relying on the keyhole craniotomy principle to make smaller incisions – this results in decreased surgical times, less postoperative pain, faster recovery times, minimal to no hair shaving, and small cosmetically pleasing incisions.