Conditions of interest

Gliomas are tumours arising from cells of the nervous system and show varying degrees of aggressiveness. They can present with seizures, language problems, weakness, cognitive changes or headache, making specialist neurosurgical assessment advisable from diagnosis.

Brain metastases are tumours that develop in the brain from a cancer originating in another organ. Their size and location can produce widely differing symptoms, including weakness, language problems, balance difficulties, seizures or headache.

Meningiomas arise from the membranes surrounding the brain, and many behave benignly and grow slowly. Their size and location can lead to seizures, visual disturbances, weakness, headache or other neurological symptoms.

A vestibular schwannoma is a usually benign tumour arising from the vestibular nerve. It can cause progressive hearing loss, tinnitus and balance problems; larger tumours can compress the brainstem and other neurological structures.

These meningiomas are located in deep regions of the skull base, often in contact with cranial nerves and major vascular structures. Symptoms reflect their location and can include visual disturbance, hearing loss, double vision, sensory changes or headache.

Schwannomas of other cranial nerves, chordomas, chondrosarcomas and other lesions can develop in deep skull-base regions. Their manifestations reflect the structures involved and can include visual, auditory, sensory, motor or cranial-nerve dysfunction.

Intraventricular tumours develop inside the brain's ventricles and can interfere with normal cerebrospinal-fluid circulation. They can cause hydrocephalus, headache, nausea, cognitive changes, balance problems or other neurological deficits.

Some tumours and lesions are located in deep brain regions close to essential neurological structures. Symptoms vary with location and can include motor, sensory, cognitive, visual or language problems.

Some brain tumours can recur or continue to grow after surgery or other treatments. A new assessment reviews the course of the disease, imaging and the available alternatives.

A cervical disc herniation occurs when a cervical disc compresses a nerve root or the spinal cord. It can cause neck pain, pain radiating into the arm, tingling, sensory loss or weakness.

Cervical stenosis reduces the space available for the spinal cord and can cause progressive compression. It can present with loss of hand dexterity, balance problems, difficulty walking, weakness or sensory changes.

A lumbar disc herniation can compress a nerve root and produce pain extending from the back into a leg, commonly known as sciatica. It can also cause tingling, sensory loss or muscle weakness.

Lumbar stenosis narrows the spinal canal and compresses the nerves travelling to the legs. It commonly causes pain, heaviness, tingling or weakness while walking, with improvement on sitting or bending forwards.

Spondylolisthesis occurs when one vertebra slips relative to the one below and can be associated with spinal instability. It can cause lower-back pain, sciatica, nerve-root compression or difficulty walking.

Vertebral tumours can originate in the spine or result from cancer in another organ. They can cause progressive pain, spinal instability or compression of the spinal cord and nerve roots, leading to weakness, sensory changes or difficulty walking.

Spinal meningiomas are usually benign tumours that grow inside the spinal canal and can progressively compress the spinal cord. They can cause pain, sensory changes, weakness, balance problems or difficulty walking.

Schwannomas are generally benign tumours arising from nerves and can develop inside the spinal canal. Their location and size can cause pain, tingling, sensory loss, weakness or spinal-cord compression.

Intramedullary tumours develop within the spinal cord itself. They can cause pain, sensory changes, progressive weakness, coordination problems or difficulty walking.

After spinal fusion surgery, the levels above or below can develop degenerative changes over time. This can lead to renewed pain, nerve-root compression, stenosis or instability.

Symptoms can persist after cervical or lumbar surgery, or new problems can arise from renewed compression, scarring, degeneration, instability or spinal instrumentation. A focused assessment identifies the cause of symptoms and reviews the available alternatives.

Trigeminal neuralgia causes sudden, extremely intense episodes of facial pain, often described as electric shocks. Everyday activities such as speaking, chewing, brushing the teeth or touching certain areas of the face can trigger the pain.

Hemifacial spasm causes involuntary, repeated contractions of the muscles on one side of the face. They usually begin around the eye and can progressively spread towards the cheek and mouth. In many patients, it results from contact between a blood vessel and the facial nerve.

Parkinson's disease is a progressive neurological disorder that can cause tremor, rigidity, slowness of movement and gait disturbance. As it progresses, motor fluctuations, involuntary movements and periods of inadequate symptom control with medication can appear.

Essential tremor is one of the most common movement disorders and mainly affects the hands, although it can also affect the head, voice or other parts of the body. Severe tremor can hinder everyday activities such as writing, eating, drinking or performing precise tasks.

Dystonia is a movement disorder characterised by involuntary muscle contractions that cause repetitive movements or abnormal postures. It can affect one part of the body or have a more extensive distribution and significantly interfere with everyday activities.

Neuropathic pain results from injury to or alteration of the nervous system and can present as burning, electric shocks, tingling or pain in response to normally non-painful stimuli. It can significantly affect sleep, mobility and quality of life.

Some patients experience persistent neuropathic pain after one or more spinal operations, even without new compression explaining the symptoms. Pain can remain in the back or radiate into one or both limbs.

Radicular pain arises from involvement of a nerve root and follows the nerve into an arm or leg. Persistent radicular pain can become a chronic problem with a major functional impact.

Some pain syndromes persist despite medication, rehabilitation and other therapeutic measures. Identifying the mechanism responsible for the pain supports an individual review of the available alternatives.