Clinical Taxonomy & Scope of Practice
Dr. Vitowanu’s surgical and diagnostic focus is built on tertiary clinical practice, rigorous fellowship training, and evidence-informed surgical indications.
Cranial Neurosurgery
Microsurgical assessment and operative treatment for lesions and pathologies affecting the cerebral cortex, ventricles, meninges, and bony cranial vault.
Conditions Treated
- Brain tumors (meningiomas, gliomas, acoustic neuromas)
- Skull lesions and cranial bone tumors (e.g. pediatric giant cell tumors)
- Intracranial cysts and arachnoid cysts
- Elevated intracranial pressure and cerebral edema
Surgical Interventions
- •Image-guided craniotomy with neuro-navigation
- •Microsurgical tumor debulking and total excision
- •Cranioplasty for traumatic or post-craniectomy defects
Unexplained morning headaches with vomiting, unprovoked seizures, progressive one-sided limb weakness, or vision changes.
Spine & Spinal Cord Surgery
Surgical and conservative management of conditions compromising the spinal cord, cauda equina, or vertebral biomechanical alignment.
Conditions Treated
- Severe pyogenic spinal infections (spondylodiscitis, epidural abscess)
- Spinal cord compression and cervical myelopathy
- Lumbar and cervical disc herniations causing radiculopathy
- Spinal trauma, fractures, and spinal instability
Surgical Interventions
- •Spinal decompression (laminectomy, discectomy)
- •Infection debridement and anterior/posterior spinal stabilization
- •Spinal instrumentation and fusion where indicated
Severe unremitting spinal pain with fever, progressive numbness or weakness in the legs, or loss of bladder/bowel control (urgent).
Neurotrauma & Emergency Assessment
Expert evaluation, intracranial pressure management, and acute surgical intervention for traumatic cranial and spinal injuries.
Conditions Treated
- Acute and chronic subdural hematomas (CSDH)
- Epidural hematomas and traumatic subarachnoid hemorrhage
- Depressed and compound skull fractures
- Post-concussive syndrome and secondary hydrocephalus
Surgical Interventions
- •Burr-hole evacuation and closed subdural drainage
- •Emergency craniotomy and decompressive craniectomy
- •Elevation and reconstruction of skull fractures
Any traumatic head blow followed by loss of consciousness, persistent vomiting, worsening drowsiness, or delayed neurological deficits.
Cerebrovascular Neurosurgery
Assessment of complex vascular lesions that place patients at risk of hemorrhage or focal seizures.
Conditions Treated
- Craniospinal arteriovenous malformations (AVMs)
- Cerebral cavernous malformations (cavernomas)
- Unruptured and ruptured intracranial aneurysms
- Dural arteriovenous fistulas (dAVF)
Surgical Interventions
- •Microsurgical clipping and resection of vascular malformations
- •Multimodal coordination with stereotactic radiosurgery and embolization
Sudden thunderclap headache, localized seizures, or after an incidental vascular finding on an MRI/CT scan.
CSF Dynamics & Hydrocephalus
Diagnosis and tailored surgical diversion for disorders of cerebrospinal fluid production, flow, and absorption.
Conditions Treated
- Normal Pressure Hydrocephalus (NPH) in adults
- Congenital and post-infectious hydrocephalus in pediatrics and adults
- Syringomyelia and Chiari malformation fluid blockages
- Shunt malfunction and infection
Surgical Interventions
- •Ventriculoperitoneal (VP) shunt placement with programmable valves
- •Endoscopic Third Ventriculostomy (ETV)
- •Shunt revision and valve pressure adjustments
Gait unsteadiness with frequent falls, memory loss, and urinary urgency (triad of NPH), or rapid head growth in infants.
Acute focal paralysis, sudden coma, uncal pupil dilation, and status epilepticus require immediate emergency hospital care.