ONS offers Neurological Treatments for:

• Cerebral aneurysms
• Arterial-venous Malformations (AVMs)-
• Cavernomas (Cavernous Malformations, Cavernous Angioma)
• Carotid Stenosis

Our affiliation with the Department of Neurosurgery at Weill Cornell allows us to use the latest endovascular and open surgical treatments to treat neurovascular disorders.

The ONS philosophy centers on a team approach. Patients are matched to the physician specialist best suited for their condition. Call 203.869.1145 to schedule an appointment with one of our neurosurgeons.

A brain tumor is an abnormal mass of tissue in which cells grow and multiply seemingly unchecked by the mechanisms that control normal cells. The two main brain tumor groups are primary and metastatic.

Primary brain tumors include those which originate from the tissues of the brain, or the brain’s immediate surroundings. Primary tumors are categorized as glial or non-glial, and benign or malignant.

In general, brain tumors are treated with surgery, radiation, and/or chemotherapy – alone or in various combinations. Although radiation and chemotherapy are more often used for malignant, residual or recurrent tumors, treatment decisions are made on a case-by-case basis, depending on a number of factors. There are risks and side effects associated with each type of therapy.

Gliomas account for 78 percent of malignant brain tumors. They arise from the supporting cells of the brain, called the glia. These cells are subdivided into astrocytes, ependymal cells and ologodendroglial cells (or oligos).

Meningiomas are the most common benign brain tumors comprising 10 to 15 percent of all brain neoplasms. These tumors originate from the meninges, the membrane-like structures that surround the brain and spinal cord and are rarely malignant. Meningiomas may also arise in the spine.

The most common brain tumor after gliomas, meningiomas and schwannomas are pituitary adenomas. The large majority of pituitary adenomas are benign and fairly slow growing. Even malignant pituitary tumors rarely spread to other parts of the body. Adenomas are the most common disease affecting the pituitary. They most often occur in people in their 30s or 40s, but may also be diagnosed in children. Most can be treated with successful outcomes.

An acoustic neuroma is a benign primary brain tumor of the myelin-forming cells of the vestibulocochlear nerve. About 25% of all acoustic neuromas are treated with medical management; periodic monitoring of the patient’s neurological status, and serial imaging studies.

Microsurgery for acoustic neuroma is the only technique that actually removes the tumor. Radiation treatment is commonly used to slow or stop the growth of the tumor and is effective approximately 90% of the time. Most tumors will stabilize in size, and then will shrink slowly. Shrinkage occurs in approximately 1/3 of tumors within a year after treatment. After 4 years, 2/3 of tumors are smaller, and within 10 years, more than 90% have diminished in size.

In the rare cases that radiosurgery does not result in control of the tumor, it can generally be repeated, or the patient may undergo surgery at that time.

Schwannomas are common benign brain tumors in adults. They arise along nerves, comprised of cells that normally provide the “electrical insulation” for the nerve cells. Schwannomas often displace the remainder of the normal nerve instead of invading it. Acoustic neuromas are the most common schwannoma, arising from the eighth cranial nerve, or vestibular-cochlear nerve, which travels from the brain to the ear. Although these tumors are benign, they can cause serious complications if they grow and exert pressure on nerves and eventually on the brain. Schwannomas may also be found in the spine.

Metastatic brain tumors are tumors which arise elsewhere in the body (such as the breast or lungs) and migrate to the brain, usually through the bloodstream. Metastatic tumors are considered cancer, and are malignant.

Metastatic tumors to the brain affect nearly one in four patients with cancer, or an estimated 150,000 people a year. In the past, the outcome for patients with these tumors was very poor. Newer sophisticated diagnostic tools and innovative surgical and radiation approaches can now lead to longer survival and a better quality of life, measured in months to years.

Spinal Tumors

Spinal tumors are caused by abnormal cell growth. In primary spinal tumors (tumors that originate in the spine), it is unclear why the cells grow abnormally. Exposure to radiation or cancer-causing chemicals or environmental factors may be a cause. Genetics may also play a role. Secondary spinal tumors, or metastatic tumors, are caused by cancer that has spread from another part of the body.

Peripheral Nerve Tumors

Tumors arising from the peripheral nerves can cause pain, numbness, or even weakness in the area supplied by the nerve in which arise. The most common peripheral nerve tumors are schwannomas and neurofibromas, which may occur sporadically, or in association with a genetic syndrome of predisposition, such as neurofibromatosis.

The most common peripheral nerve tumors are schwannomas and neurofibromas, which may occur sporadically, or in association with a genetic syndrome of predisposition, such as neurofibromatosis.

Neurosurgeon Scott Simon, MD of the Tully Health Center and Orthopaedic and Neurosurgery Specialists PC was called to the emergency room, and it was quickly determined that the impact from the accident caused an acute subdural hematoma and malignant brain swelling, leading to a herniation syndrome, where the brain is pushed into the brain stem and down through the skull. J.L. underwent an emergency hemicraniectomy, where Dr. Simon removed half of her skull as well as the hematoma. (She had the same brain surgery as Bob Woodruff.) Once her swelling subsided, the removed portion of her skull was reattached.

Back home in Virginia, J.L. is now in 11th grade. She loves to sing, draw and go shopping with friends. Thanks to the excellent care she has received at Stamford Hospital and the skills of Dr. Simon, J.L.’s life has returned to normal.

It took years of tests and visits to dentists and other specialists until she was diagnosed with trigeminal neuralgia, a disorder of the nerve which carries sensation from the face to the brain. Effective treatment for her condition however, was even more elusive. I.M.’s condition worsened and she was forced to quit her job. Her life was turned upside down.

Then Dr. Rod Acosta, her primary care physician in Stamford, told her about neurosurgeon Dr. Scott Simon who uses the Cyberknife at Stamford Hospital to treat trigeminal neuralgia. The Cyberknife technology is specifically designed for the delivery of stereotactic radiosurgery and operates through collaborative efforts of the neurosurgeon, radiation oncologist, and radiation physicist. Treatment consists of aiming precisely focused beams of radiation on the trigeminal nerve. The hour-long procedure is non-invasive, painless, requires no incision, and patients go home the same day. Desperate and hopeful for relief, I.M. scheduled treatment.

In a preliminary appointment, a mask of her head was created that would be used to calibrate and guide the beams of radiation. Two weeks later she returned for the actual treatment, which lasted about an hour. That night she had another attack, but over the next few weeks the frequency and severity of the episodes gradually diminished and in four weeks, they had vanished completely. After seven years of agonizing pain, I.M. has made a full recovery and is now living life pain free.

Both M.S. and her primary care physician initially thought her symptoms could have been related to allergies but when they persisted, her doctor advised her to see a neurosurgeon. Dr. Scott Simon, whose office is at ONS at Tully Health Center, performed a thorough neuro-cognitive evaluation and ordered CT scans and MRIs which revealed that she had Chiari malformation.

Chiari malformation is a condition that occurs when the cerebellum is pushed down through the opening in the bottom of the skull, compressing the brain stem, diminishing the flow of spinal fluid in the skull. Chiari malformation occurs in one of 2,000 people; mostly women. For many, the condition may not be detected until after age 30. Characteristic symptoms are severe headaches that are often made worse by neck extension, neck pain, numbness and tingling in the hands and feet, a sense of pressure in the head and trouble with balance.
Dr. Simon recommended that M.S. undergo Chiari surgery in order to enlarge the opening at the back of the skull to decompress the brain. M.S. underwent surgery at Stamford Hospital on November 30, 2009. She stayed in the hospital for three days. It took two weeks until she was again steady on her feet, and during her recovery she was very sensitive to the touch on her head. She took it easy for the following month before returning to work but her headaches were gone. Now she has resumed her regular workout routine which includes jogging, fitness classes and weight training, and no longer worries about having a sudden attack.

Concussion may cause physical, cognitive, emotional, and/or behavioral deficits although it is not usually life-threatening. All concussions however, should be taken seriously.

Each year in the U.S., falls account for the greatest incidence of traumatic brain injury or concussions, followed by motor vehicle accidents. Construction accidents and sports injuries are also major contributors.Bicycle and motor bike accidents also cause a significant number of traumatic brain injuries. According to the Centers for Disease Control and Prevention (CDC), an estimated 1.6 to 3.8 million sports and recreation related concussions occur in the U.S. each year.

Symptoms of concussion may be mild to severe and should be suspected in the presence of any one or more of the following symptoms or abnormal behavior.

• Loss of consciousness
• Seizure or convulsions
• Amnesia/ Memory loss
• Headache
• “Pressure in the head”
• Neck pain
• Nausea/vomiting
• Dizziness
• Blurred vision
• Balance problems
• Ringing in ears
• Light sensitivity
• Noise sensitivity
• Changes in taste and smell
• Feeling slowed down
• Feeling like “in a fog”
• “Don’t feel right”
• Difficulty concentrating
• Difficulty remembering
• Fatigue or low energy
• Confusion
• Drowsiness
• More emotional
• Irritability
• Sadness
• Nervous or anxious

Seek medical attention is any of the following occur: 

• Altered level or loss of consciousness
• Convulsions
• Muscle weakness on one or both sides
• Persistent confusion
• Persistent vomiting
• Unusual eye movements
• Walking difficulty

An initial baseline neurological evaluation should be done by a physician. Normally, treatment involves monitoring the patient by a physician over a period of time and rest from physical activity. Special care should be taken to avoid addition injury during this time. Repeat head injuries or cumulative concussions can have long-term implications. Recovery, which may be prolonged, is usually complete.

Brain Injury Prevention

• Always wear a seatbelt when riding or driving a car.
• Never drive under the influence of drugs or alcohol.
• Remove falling and tripping hazards in the home like curled rugs, loose electrical cords and misplaced toys.
• Install grab bars and handrails if you are elderly or have a physical limitation.
• Use helmets or protective head gear approved by the ASTM for specific sports.
• Always supervise younger children, and do not let them use sporting equipment or play sports that are not age appropriate.
• Do not permit children to play on playgrounds with hard surfaces.
• Do not dive into water less than 9 feet deep.
• Do not participate in sports when you are tired or not well.
• Cyclists and in-line skaters should obey all traffic signals and traffic laws.
• Replace sporting equipment or protective gear that is damaged.

The Cyberknife System

Adjuvant therapies such as chemotherapy, radiosurgery and whole brain radiation may also be indicated. A team of top medical specialists meets regularly to develop an individual treatment plan for each patient. This team of experts is composed of neurosurgeons, neurologists, neuro-oncologists, radiation oncologists, pathologists, medical oncologists and neuroradiologists.

Radiosurgery is delivered through the Cyberknife System, one of the most advanced radiosurgical systems available. The CyberKnife system, manufactured by Accuray Incorporated, is a noninvasive image-guided robotic surgery system designed to continuously track and detect tumor location and correct for tumor and patient movement during treatment. Radiation beams are directed into tumors from virtually unlimited directions with extreme accuracy, with minimal damage to surrounding healthy tissue and vital organs.

The technology has already been used to treat more than 40,000 patients by over 100 institutions around the world, including many of the world’s most prestigious cancer centers.

Dr. Scott Simon and Cyberknife

Dr. Scott Simon is Neurosurgical Director of Cyberknife Radiosurgery for the Stamford Hospital CyberKnife team, which includes radiation oncologists, surgeons, medical physicists, radiation therapists, a nurse and a medical dosimetrist. Patients also have the support of a dedicated CyberKnife nurse coordinator, who communicates with both the patient and physicians.

Tumors arising from the peripheral nerves can cause pain, numbness, or even weakness in the area supplied by the nerve in which arise. The most common peripheral nerve tumors are schwannomas and neurofibromas, which may occur sporadically, or in association with a genetic syndrome of predisposition, such as neurofibromatosis.

The most common peripheral nerve tumors are schwannomas and neurofibromas, which may occur sporadically, or in association with a genetic syndrome of predisposition, such as neurofibromatosis.

Trigeminal Neuralgia, also called tic douloureux, is a disorder of the trigeminal nerves that carry sensation to the face. Patients afflicted with this disorder experience debilitating pain on one side of the face. This pain is often described as sudden, stabbing, electric shock-like pain in the forehead, nose, lips, and/or jaw. Because the second and third divisions of the trigeminal nerve are most commonly affected, the pain is usually felt in the lower half of the face, causing some people to first seek treatment from their dentist.

A less common form of the disorder called “Atypical Trigeminal Neuralgia” may cause less intense, constant, dull burning or aching pain, sometimes with occasional stabbing jolts. Both forms of the disorder usually affect one side of the face, but sometimes patients experience pain on both sides.

The onset of symptoms of Trigeminal Neuralgia usually occurs in mid to late life, but cases in children and even infants have been documented. Attacks of pain may be triggered by something as simple and routine as brushing the teeth, putting on makeup or even a slight breeze. The most subtle touch may trigger an agonizing attack for the individual.

Trigeminal neuralgia can often be managed well with a variety of anti-seizure medications that help “stabilize” the nerve by reducing the irritation to the nerve that stimulates pain.