Brain and Nerve Surgery (Neurosurgery) has shown a rapid progress in both our country and in the world. The last decade of the 20th century has been accepted as “the Decade of the Brain” and more resources have been reserved for neurological scientific researches in that period. Genetic engineering studies focus on extension of the human lifespan and tumor biology. Moreover, diagnosis methods have been also improved and technological developments have made great contribution to science. Neurosurgery has reached a good position in terms of both diagnosis methods and surgical instruments and materials.
CT, MRI, PET, Angiography, CT Angiography, EEG, Sleep EEG, EMG, Doppler Ultrasonography facilitate the diagnosis of nerve-occupying, space-occupying, vascular occlusive and bleeding-causing lesions.
The main diseases covered by neurosurgery
- Brain tumors
- Cerebral hemorrhage
- Lumbar and cervical hernias
- Head traumas
- Vertebral colon trauma, spinal cord tumors
- Peripheral nerve disruptions and pressure
- Epilepsies that do not respond to medical treatment.
10% of brain tumors in human body are composed of nerve system tissues. 80-90% of them develop in the cranium. According to the World Health Organization, tumors with nerve system involvement are classified as follows:
Tumors of neuroepithelial tissue:
- Ependymal tumors
- Mixed gliomas
- Choroid plexus tumors
- Embryonal tumors
- Meningeal tumors
- Nerve sheath tumors
- Vascular tumors
- Germ cell tumors
- Malignant lymphomas
- Locally developed tumors
- Metastatic tumors
- Sellar region tumors (Craniopharyngioma and pituitary tumors)
Among them, glioblastoma multiforme, a type of astrocytomas, is the most common and malign tumors. Meningiomas are often bening and have a recurrence rate of 15-20%, which are also called as anaplastic meningiomas. Medulla blustom that is one of the childhood tumors are among malign tumors. 44% of metastatic brain tumors originate from lung, 10% from breast, 7% from kidney and 6% from gastrointestinal system. The most common symptoms of brain tumor include headache, epileptic seizure, reduced leg and arm muscle strength, diplopia, balance disorder, vomiting, menstrual irregularity and nipple discharge. BT and MR examinations are made and its treatment is surgical. It is decided if radiotherapy, chemotherapy and immunotherapy should be added to surgical intervention, depending on the pathological diagnosis.
Subarachnoid hemorrhage (SAH)
- Aneurysm and AVM bleeding 80-85%
- Of unknown origin 15-20%
Intracerebral, intracerebellar hemorrhage caused by hypertension or hemorrhagic disorders
Subarachnoid hemorrhage (SAH)
It’s often accompanied by nausea, vomiting and changes in consciousness. The patient diagnosed with BT is undergone is underwent cerebral angiography and then a treatment plan is made. Surgery is the first treatment option for the patient diagnosed with aneurysm. If there is a circumstance constituting impediment for surgery and the aneurysm cannot be operated because of its location and size, then endovascular intervention is planned. Intervening in the aneurysm as soon as possible is important for recurrence of hemorrhage and occurrence of vasospasm. AVMs are treated by surgery, radiation therapy and endovascular intervention.
Lumbar and Cervical Hernias
They usually occur as a result of herniation of the nucleus pulposus backwards, which is located between vertebrae. The symptoms of cervical hernias include neck, back, arm pain, numbness, and weakness while the symptoms of lumbar hernias include waist pain, leg pain, leg numbness, thinning and weakness. In the acute period, resting, muscle relaxants and pain reliever are recommended. If the complaints do not resolve, then final diagnosis is made by MR scanning and then physical treatment and if necessary surgical intervention are applied.
Neurological situation and BT findings of the patient suffered from head traumas are evaluated and then commotio, contusio, contrcoup, diffuse axonal injury profiles are obtained. Post-traumatic intracranial hematomas include acute subduralhematoma, intracerebral hematoma, epidural hematoma and SAH. Head traumas should be ideally followed in centers with adequate monitorization including respiration support with intubation and tracheostomy.
Since the spinal cord is located in the vertebral column, vertebral fractures and injuries should be handled profoundly. Depending on the findings of the case, stabilization can be achieved conservatively with corset. If necessary, decompression is ensured and stabilization surgery is made. In order to improve neurological findings, rehabilitation treatment should be initiated immediately after the surgical procedure. Interfascicular anastomosis, and if necessary, nerve grafts are used in peripheral nerve incisions.
Drug-resistant epilepsy patients who are suitable for surgery are selected then operated after making preliminary examinations and necessary preparations. Medical treatment failure is often caused by inaccuracies in genetic diagnosis and drug selection and problems related to the patient and his/her environment. Before surgical procedure, collaborative works of well-trained neurology, neurophysiology, psychiatry, radiology, neurosurgery specialists are very important for surgical results. The patients who are deemed suitable by psychiatric method following EEG, long-term EEG monitoring and MR scanning are treated by surgical procedure. However, severe chronic psychoses and mental retardation constitute impediment for surgery.
The most common surgical methods;
- Removal of the cause of epilepsy; lesionectomy
Patients diagnosed with comprehensive neurological examination and the most advanced research methods are operated with micro-surgical and state-of-the-art techniques, and if necessary adequate intensive care support is provided and it is ensured that they return to normal life as soon as possible by planning their discharge.
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