You have been told to see a neurosurgeon. Here is what is worth knowing first.
Twelve topics that account for most of what walks into a neurosurgical clinic. They are written for the moment you leave an office holding a scan and a word you do not understand, and written by the same rule as the rest of this publication: the figures are the ones that exist, including the ones that are not reassuring.
Most people reading these pages will not need an operation. That is stated on every one of them, with the numbers next to it.
Lumbar herniated disc and sciatica
Between 85 and 90 per cent of lumbar herniated discs stop hurting within six to twelve weeks without anyone operating on them, and two out of three resorb on their own. Fewer than one in ten end up in an operating theatre. This page is about how to work out which group you are in.
Read →Lumbar spinal stenosis
It is the reason many people over sixty stop walking any distance. Almost half the people of that age have a narrowed canal on imaging and most of them have no symptoms at all, so the MRI on its own is never enough to decide anything.
Read →Cervical disc herniation and numbness in the hands
In the reference population study, which followed 561 people for almost five years, 74 per cent never needed surgery and 90 per cent ended up with no symptoms or only mild discomfort. Only 15 per cent could recall a strain or an injury before it began.
Read →Brain tumour and meningioma
The words "brain tumour" and "cancer" are not synonyms, and the difference is not a matter of wording: 74 per cent of primary brain tumours are not malignant, and their five-year relative survival is 92 per cent. This page is for the stage where you still do not know which of the two you are dealing with.
Read →Unruptured brain aneurysm
In the largest international study, aneurysms of less than seven millimetres in the anterior circulation, in people who had never had a haemorrhage, carried a five-year rupture risk of zero per cent. Having an aneurysm is not the same as needing an operation.
Read →Hydrocephalus
The same word names two very different situations: parents who are told their baby has large ventricles, and a family watching an older relative walk worse and worse and forget things. This page is written for both.
Read →Trigeminal neuralgia
It is probably the most intense pain medicine describes, and it is also the one that most often ends in an unnecessary tooth extraction. Of every ten patients who reach surgery, eight saw a dentist first, and more than half of them had something done in the mouth that was not needed.
Read →My hand shakes
Almost everyone who arrives here is after the same thing: why their hand shakes when they hold a glass, when they sign their name, when they lift a spoon to their mouth. The likeliest answer is not Parkinson's, and the difference between the two starts to show at the kitchen table.
Read →Epilepsy that medication does not control
Around 63 per cent of people with epilepsy become free of seizures on medication. For the rest, carrying on trying drugs has a measured yield: if the first one failed for lack of effect, only eleven per cent are controlled afterwards. That is the figure that ought to open the conversation about surgery, and it almost never does.
Read →My hands go numb
It is the commonest reason for an appointment on this whole site, and also one of the worst diagnosed. Fourteen in every hundred people have tingling in the hand; only four really have carpal tunnel syndrome. The question that pays off most is not what is wrong with you: it is which fingers go numb.
Read →A blow to the head
If you are reading this at three in the morning with a child in your arms, start with the red box. The rest can wait until tomorrow. And no, you do not have to keep them awake: that is a myth, and what you should be doing is something else.
Read →Your baby's misshapen head
Nearly half of healthy babies have some degree of flattening of the head between seven and twelve weeks, and in four out of five it is mild. Almost all of them settle on their own. The point is to recognise the one that does not, because that one does need surgery.
Read →