Neurosurgery
What is Neurosurgery?
Neurosurgery is a medical specialty that treats various diseases and disorders of the brain and spinal cord. The scope of neurosurgery is broad, encompassing a wide range of conditions and illnesses. Surgeries in this field are typically aimed at resolving problems that occur in different parts of the brain and nervous system.
Diseases and Treatments in Neurosurgery
- Brain and Spinal Cord Tumors: Surgical removal of tumors in the brain and spinal cord is necessary. These tumors can affect brain functions and lead to various neurological symptoms.
- Spinal Disc Herniation: Herniated discs in the back and neck caused by the displacement of discs can be surgically treated. These hernias may press on nerve roots, leading to pain and loss of function.
- Cerebral Artery Blockages: In cases where blood vessels in the brain become blocked, surgical intervention may be required to open the vessels or apply alternative treatments.
- Brain Hemorrhages: Brain hemorrhages, caused by trauma or other health issues, often require urgent surgical intervention.
- Aneurysms and Bulging: Aneurysms in the brain’s blood vessels pose a bleeding risk and may require surgical intervention.
Neurosurgery and Nerve Surgery
- Epilepsy: Neurosurgery can be used to control seizures in patients with epilepsy. Surgery targets the source of seizures for treatment.
- Parkinson’s Disease: In advanced stages of Parkinson’s disease, surgery may be applied to alleviate symptoms, including methods like deep brain stimulation.
Neurosurgery Process
Neurosurgery typically requires a detailed evaluation and preparation. Prior to the surgery, the patient’s overall health, surgical risks, and the stage of the disease are considered in the planning process. The recovery process after surgery can vary based on the patient’s condition and the specific intervention.
Conclusion
Neurosurgery is an effective treatment option for a wide range of brain and spinal cord-related diseases. Early diagnosis and appropriate surgical intervention can lead to successful outcomes in many serious health conditions. Surgical practices in this field play a critical role in managing diseases of the brain and nervous system.
Arteriovenous Malformation
Arteriovenous Malformation (AVM)
Arteriovenous malformations (AVMs) are abnormal vascular structures that form a direct connection between the arteries and veins in the brain, bypassing the capillaries. This results in vessels being directly linked together, creating nests or tangles.
Characteristics of Arteriovenous Malformation
- Congenital: AVMs are typically congenital and grow over time.
- Risk of Bleeding: Enlarging vessels may rupture and break, leading to bleeding at a young age. Bleeding typically occurs around the age of 20.
- Affected Population: AVMs are estimated to affect 1% of the population, regardless of gender or race.
Symptoms of Arteriovenous Malformations
- Bleeding: Symptoms generally appear after bleeding. Bleeding may cause headaches, changes in consciousness, and other neurological signs.
- Epilepsy: Seizures may occur in about 40% of cases.
- Neurological Deficits: Reduced blood flow can lead to decreased healthy brain tissue and neurological changes in surrounding neurons.
Treatment of Arteriovenous Malformations
The goal of treating AVMs is to remove the malformation from circulation and eliminate it safely. Treatment options should be determined by a multidisciplinary team consisting of neurosurgeons and interventional specialists.
- Microsurgery: Surgical resection immediately eliminates the bleeding risk of the AVM and is generally the preferred treatment method. However, this method may be invasive and carry some risks.
- Stereotactic Radiosurgery: AVMs can be targeted using high-precision radiation therapy. This method can reduce surgical risks in some cases.
- Endovascular Techniques: Treatment can be applied through the blood vessels. These techniques are often used before or after surgery.
Each treatment option is determined based on the patient's condition and the characteristics of the AVM. Evaluations made by an expert team during the treatment process help in creating the most suitable treatment plan.
Brain Tumor Surgery
Brain Tumor Surgery
Brain tumor surgery is a procedure aimed at treating tumors caused by abnormal cells in the brain. Tumors are masses formed when abnormal cells accumulate during the regeneration of brain cells.
Treatment of Brain Tumors
Brain tumors can cause pressure inside or around the brain, which may affect brain functions. If left untreated, this pressure can impair brain functions and lead to serious health problems. Brain tumors can occur at any age, and the treatment process varies depending on the patient's age and the type of tumor.
Brain Tumor Surgery
Brain tumor surgery is a procedure aimed at repairing abnormal structures within the brain. During the surgery, the brain tumor or other abnormalities are removed. The type of surgery depends on the tumor's location and the affected part of the brain.
- Craniotomy: A cut is made in the skull to access the brain.
- Minimally Invasive Procedures: These carry less risk compared to open surgery and allow for quicker recovery. In some cases, access to the brain may be made through the nose or mouth.
Surgical Process
- Removal of the Tumor: The neurosurgeon aims to remove as much of the tumor as possible without affecting brain functions. In some cases, removing the tumor or controlling it may be sufficient for improvement.
- Additional Treatments: Post-surgery, additional treatments like radiation or chemotherapy are commonly applied. These therapies help shrink the tumor and support the recovery process.
- Symptom Relief: Surgery can alleviate symptoms caused by pressure on the skull, such as headaches, nausea, vomiting, and blurred vision. It may also help control seizures.
Procedure Duration
The duration of brain tumor surgery varies depending on the type of tumor and the area to be treated. Generally, the surgery lasts 6-7 hours, but in some cases, it can exceed 12 hours.
Brain tumor surgery is a critical step in preserving brain health and enhancing the patient's quality of life. Your surgical team will create the most appropriate treatment plan based on the location and type of your tumor.
Radiation Therapy for Brain Tumors
Radiation Therapy for Brain Tumors
A brain tumor is a mass formed by the growth of abnormal cells in or around the brain. Tumors can directly destroy healthy brain cells and cause pressure on other areas of the brain, leading to brain swelling and edema.
Brain Tumors: Benign and Malignant
Brain tumors are generally divided into two categories:
- Malignant Tumors (Brain Cancer): They grow rapidly and may invade healthy brain tissue.
- Benign Tumors: They do not contain cancer cells and usually grow at a slower rate.
Types of Radiation Therapy
Intensity-Modulated Radiation Therapy (IMRT)
- Description: A high-precision radiation therapy using computer-controlled X-rays. Radiation doses are applied according to the tumor’s three-dimensional shape.
- Advantages: Allows for high-dose radiation to the tumor while minimizing damage to healthy cells.
Stereotactic Radiosurgery (SRS)
- Description: Narrow radiation beams are directed from different angles to target the tumor. A rigid head frame may be placed for precision.
- Advantages: Provides highly precise treatment. The tumor's location is identified using computed tomography (CT) or magnetic resonance imaging (MRI). Typically performed in a single session.
Three-Dimensional Conformal Radiotherapy (3D-CRT)
- Description: X-rays are adjusted to match the shape of the tumor. This method delivers the maximum dose of radiation to the tumor while protecting normal tissues.
- Advantages: Customized according to the tumor's location and anatomy. Planning is done using CT and/or MRI scans.
Combination Therapies
Radiation therapy can be combined with oral or intravenous (IV) chemotherapy. Concurrent treatment may be a standard approach for malignant brain tumors. Chemotherapy can slow down or destroy dividing cancer cells. Additionally, radiosensitizers may be used. These drugs can enhance the effectiveness of radiation therapy.
Radiation therapy is a crucial method in treating brain tumors, and your doctor will tailor your treatment plan according to your personal needs.
Deep Brain Stimulation (DBS)
Deep Brain Stimulation (DBS)
What is Deep Brain Stimulation?
Deep Brain Stimulation (DBS) is a treatment method that involves placing electrodes in specific areas of the brain to help individuals with neurological disorders. This procedure is used for patients with movement disorders and other symptoms that cannot be controlled by medication. DBS can be used to treat the following neurological conditions:
- Tremors
- Parkinson's Disease
- Dystonia
- Epilepsy
- Tourette Syndrome
- Chronic Pain
- Obsessive-Compulsive Disorder (OCD)
Deep Brain Stimulation Implant Procedure
DBS typically involves two separate surgeries:
First Surgery:
- Preparation: Before the surgery, an MRI is done, and a stereotactic frame is placed to identify the appropriate area of the brain.
- Procedure: The scalp is anesthetized, and electrodes are placed into the brain. The patient is kept awake to ensure the brain area is correctly stimulated.
Second Surgery:
- Procedure: One day later, the neurosurgeon performs a procedure to place a pulse generator in the chest wall. A small incision is made behind the ear, and an extension wire is passed under the skin to connect to the neurostimulator. The device is programmed to send electrical pulses to the brain.
How the ECP System Works
The Electrical Controlled Pulsator (ECP) system uses an implanted pulse generator, an electrode, and an extension wire. The system works as follows:
- The electrode is placed in the targeted area of the brain.
- The extension wire passes under the skin and connects the electrode to the pulse generator, sending electrical signals.
- DBS alters brain activity and is associated with an increased release of ATP (adenosine triphosphate), which triggers a process that reduces tremors and mitigates negative effects of DBS.
Risks Associated with Deep Brain Stimulation
Deep Brain Stimulation can lead to various risks and side effects, including:
- Brain hemorrhage
- Stroke
- Breathing problems
- Heart issues
- Seizures
The procedure involves making small holes in the skull and placing a device in the chest area. It is essential for patients to carefully evaluate the potential risks and benefits before undergoing this type of treatment.
Discectomy
Discectomy
What is Discectomy?
Discectomy refers to the surgical removal of all or part of the discs between the vertebrae. This procedure is typically performed under spinal or general anesthesia and is considered part of brain and nerve surgery. Discectomy is commonly done due to a herniation of the intervertebral disc, and therefore requires an experienced surgeon.
Why is Discectomy Performed?
Discectomy is performed to treat severe back pain and muscle weakness in the legs resulting from herniation of the intervertebral discs. A disc herniation occurs when a disc between the vertebrae partially or completely slips out of place, causing pressure on the nerves, leading to pain and other symptoms.
What Does Discectomy Involve?
The discectomy procedure involves removing part or all of the herniated disc to alleviate pain. The procedure usually takes about two hours, and the patient is admitted to the hospital. Some preparatory steps and post-operative care are necessary:
Preparation:
- It’s important to inform the doctor about any medications you are taking, including over-the-counter herbal supplements.
- It is advisable to make home arrangements for post-hospital care.
- You may need to quit smoking and stop medications that affect blood clotting.
- On the day of the surgery, follow the doctor’s instructions regarding food and drink.
- Take prescribed medications on time.
- Prepare any necessary equipment, such as crutches, walkers, or wheelchairs, and ensure your shoes have non-slip soles.
Surgical Process:
- The surgeon makes an incision and locates the damaged discs using a microscope. The discs are then removed, and the incision is closed with sutures or staples.
Post-Operative Recovery and Care
The recovery process after discectomy is typically quick. Once the anesthesia wears off, the patient is expected to begin walking, and often, they can be discharged on the same day. In the first few weeks, pain, weakness, or numbness may be experienced.
Recovery and Rehabilitation:
- Frequent walking is recommended for optimal recovery, and a rehabilitation program involving physical therapy and home exercises may be implemented.
- Office workers can typically return to work within two to four weeks, while jobs requiring more physical labor may require four to eight weeks.
Discectomy is an effective method for treating spinal herniations, but the recovery process and proper care are essential.
Spinal Tumors
What Are Spinal Tumors?
Spinal tumors are masses that form in the spinal region due to the uncontrolled growth of cells. While cancerous tumors originating in the spine are rare, the spine can be a common site for the spread of cancer from other organs. One in four cancer patients may develop a tumor that can metastasize to the spine, causing pain and damage. However, not all spinal tumors are cancerous, and spinal tumors are classified into three main types:
- Intramedullary Tumors: These develop within the spinal cord cells.
- Extramedullary Tumors: These develop in the cell network surrounding the spinal cord.
- Metastatic Tumors: These consist of cancer cells that spread from other organs to the spine.
Spinal tumors can compress both the spinal cord and nerves, leading to movement and sensory loss in the extremities. Depending on their location, some tumors may be fatal, so early diagnosis is critical.
Symptoms of Spinal Tumors
As spinal tumors grow, they can cause a variety of symptoms. These symptoms may affect the spinal cord, nerve roots, blood vessels, or bones surrounding the spine. Symptoms may include:
- Pain near the tumor
- Back pain that worsens at night
- Muscle weakness, especially in the joints
- Difficulty walking
- Loss of sensitivity
- Paralysis in various parts of the body
Medical Tests for Spinal Tumors
Several tests may be conducted to diagnose spinal tumors:
- Magnetic Resonance Imaging (MRI): One of the best tests for detecting spinal tumors. It increases the chances of early diagnosis and helps preserve spinal function.
- X-rays: Often used to rule out fractures caused by other degenerative pathologies or tumor invasion, but it does not play a primary role in tumor diagnosis.
- Computed Tomography (CT): Can help identify possible spinal tumors.
- Biopsy: Performed to confirm the presence and type of the tumor.
Causes of Spinal Tumors
The exact causes of spinal tumors are unknown. However, some experts believe genetic factors may play a role in the development of these tumors. It is unclear whether genetic defects are hereditary or develop over time. Spinal tumors require urgent treatment to avoid damaging the central nervous system, and early diagnosis is the best prevention method.
Treatment Methods for Spinal Tumors
Treatment usually aims to eliminate the tumor and may include:
- Surgical Intervention: Surgical removal of the tumor is typically the primary treatment method. If the tumor cannot be completely removed, additional treatments may be necessary.
- Radiotherapy and/or Chemotherapy: If surgical treatment is insufficient or the tumor cannot be entirely eliminated, radiation therapy and/or chemotherapy may be used as additional treatment options.
Treating spinal tumors requires a personalized approach based on the patient's health status and the tumor's characteristics.
Scoliosis Surgery
What is Scoliosis?
Scoliosis is a condition characterized by the sideways curvature of the spine. This curvature leads to misalignment and deformation of the spine. Scoliosis typically develops during childhood and, if left untreated, can lead to structural changes in the spine that affect growth and development.
Scoliosis Surgery and Treatment Methods
Conservative Treatment
The treatment process for scoliosis is determined based on the severity of the deformity (Cobb angle), the location of the curvature, the patient's age, symptoms, and the progression of scoliosis.
- Bracing Treatment: This is usually recommended for children under 10 years old and patients between 10-14 years old with a curvature ranging from 20º to 40º. Braces are used to prevent further worsening of the spinal curvature. The brace is custom-designed by an orthopedic specialist to fit the patient’s body. If bracing is insufficient or scoliosis continues to progress, surgical intervention may be necessary.
Spinal Fusion
Spinal fusion is a surgical method used to treat scoliosis. The procedure aims to correct the curvature by fusing specific parts of the spine.
- Fusion Procedure: The fusion process makes the spine stiff and is irreversible. After surgery, the spine remains rigid, cannot bend, and growth is limited. Once the fusion is complete, the result is permanent.
- Pre-Surgical Preparation: Before surgery, a thorough physical examination is performed, and assessments such as blood tests and electrocardiograms are conducted. If the patient smokes, they should refrain from smoking for at least 2 weeks before the surgery.
- Surgical Process: The surgery is usually performed with an incision approximately 5-6 cm long. Since the spine’s muscles must be separated, the patient typically loses some blood during the procedure. After surgery, the patient may need to stay in the Intensive Care Unit for a few days.
Recovery Process
The recovery process after scoliosis surgery can take time, and results may not be immediately visible.
- Recovery Process: Rest and pain management are essential in the first 24 hours. Incisions typically heal within 1-2 weeks, and the spinal fusion can take 6-9 months. During the recovery period, regular follow-up appointments are essential, and appropriate treatment continues. Signs of recovery are usually observed within about 6 months.
Conclusion
Scoliosis surgery is a crucial procedure aimed at correcting spinal deformities and promoting healthy posture. Early diagnosis and appropriate surgical intervention can lead to successful outcomes. However, the recovery process post-surgery requires attention and patience.
