A fully equipped center, team approach and multidisciplinary treatment approach are very important for success in brain and nerve diseases that are common in society. With the developments and innovations in technology, Brain, Spinal Cord and Nerve Surgery is advancing day by day, and in parallel, more successful results can be obtained in diagnosis and treatment.
Services Provided in the Department of Brain, Spinal Cord and Nerve Surgery
Cerebrovascular Diseases
There is an endovascular, that is, interventional neuroradiology and surgery (microsurgery) working group for the treatment of cerebrovascular diseases. Treatment methods can be applied separately or together depending on the patient’s condition.
Cerebrovascular Aneurysms: It is a cerebrovascular disease that occurs in the form of bubbles in the brain vessels and can cause sudden deterioration with bleeding and death.
Arterio-Venous Malformation: It is a vascular disease prone to bleeding in which the arteries and veins appear as a ball in the brain.
Carotid Stenosis: It is the narrowing and occlusion of the carotid artery in the neck or brain. Stroke occurs with clot formation and treatment must be done within hours.
Brain Hemorrhages: It is a condition of blood leaking into the brain membranes or brain tissue.
Cerebrovascular Occlusion: (It is a situation in which the blood flow to the brain is suddenly interrupted due to brain chamber obstruction. This situation is known as stroke or paralysis and should be treated quickly. It is possible to open the blocked vessel with endovascular methods or to provide brain blood flow again with microsurgery or to relieve the compressed brain tissue.
Brain and Spinal Cord Tumors
Surgical intervention is performed using microsurgery and endoscopic techniques for brain and nerve tumors in both adults and childhood. Patients are evaluated by a council consisting of a neurosurgeon, radiation oncologist, medical oncologist and neuroradiologist. | For some tumors, long-term chemotherapy (drug therapy) and/or radiotherapy (radiation therapy) is planned. Surgeries for skull base tumors, especially pituitary tumors, are performed with the participation of the ENT specialist who is part of the surgical team.
Spine Diseases
of the spine; Surgical intervention is performed in traumatic diseases such as accidents and injuries, in diseases that occur in the aging process such as narrowing of the spinal canal and slippage in the waist, and in congenital diseases. In addition, diseases such as lumbar and neck hernia are treated by neurosurgeons. In the “Minimally invasive spine center”, where lumbar disc herniation, cervical disc herniation and spinal stabilization (instrumentation) surgeries are performed using microsurgical and endoscopic surgical methods, rehabilitation services are also planned together with the physical therapy department. Minimally invasive pain interventions, that is, non-surgical interventional treatments for pain, are also carried out within this discipline.
Childhood Brain and Nerve Diseases (Pediatric Neurosurgery)
Surgical intervention is performed for congenital and acquired head and spine diseases.
Among these, tumors, vascular diseases, hydrocephalus, which is defined as the accumulation of brain water in the head, and “spinal dysraphism”, which is more common especially in the newborn period, can be counted predominantly.
Traumas (Brain Injury Resulting from Assault or Accident)
Emergency interventions are applied to patients with head trauma without wasting time. Patients are treated together with the intensive care unit. They are also simultaneously directed to physical therapy and rehabilitation programs. The aim is to eliminate life-threatening risks and improve the quality of life. Rapid diagnosis, diagnosis and care of all kinds of trauma (head trauma, spine trauma, etc.) that may develop due to various accidents can be carried out by the brain, spinal cord and neurosurgery department, which works in coordination with the emergency service and intensive care unit for 24 hours.
Treatment of Functional Diseases
In diseases such as Parkinson’s and similar involuntary movement disorders, where the quality of life decreases, surgical interventions, especially known as implanting a pacemaker into the brain, are performed. The treatment of spasticity that occurs later due to congenital reasons or severe head trauma is performed by “selective dorsal rhizotomy” or “baclofen pump placement” surgeries. Epilepsy surgery is planned in cases of epilepsy, that is, epilepsy, where drug treatment cannot be successful. The working group, formed with the participation of neurologists, psychiatrists and physical therapists, makes the necessary evaluations and decides whether surgical treatment is necessary or beneficial for all functional diseases.
Correct Method for Evaluation During Surgery is Applied
In surgeries on sensitive areas of the brain and spinal cord, neuromonitoring is performed in order to preserve functions and avoid harm to the patient. Thanks to neuromonitoring, neurological functions are monitored during surgery. During the surgery, the electrical functions of the brain and its working rhythm are monitored by a neurologist experienced in this field. This method ensures high patient safety. e Imaging methods such as Neuronavigation, Computed tomography, Ulirasonography are used to evaluate and follow the process during the surgery. We work with a Neuroradiologist to evaluate all of these.
Advanced Technology Used Increases Patient Comfort
Neuronavigation: Advanced Magnetic Resonance MRI or (Computed Tomography (CT) images) are taken before the surgery. The 3D images obtained are superimposed and uploaded to the “Neuronavigation” device used in the surgery.
In this way, the shortest and safest route map is created for the surgical team to reach the area where the surgery will be performed.
The neuronavigation device, which identifies 3-dimensional radiological examinations of the patient, shows various risk areas in the brain or spinal cord, allowing the surgeon to work while staying away from risky areas.
Neuromonitoring: After the patient is brought to the operating room and put to sleep, electrodes are placed on his face, arms and legs before starting the surgery. During the surgery, the signals received from these electrodes are monitored by the neurophysiologist and surgeon. When there is a decrease in the signal received from the muscles, the neuromonitoring device warns that the patient is in a sensitive area and informs the surgeon. In surgeries where neuromonitoring is used, the system must be compatible with anesthesia.
Intraoperative CT/ O-Arm: Although the location where screws should be placed in the spine varies depending on the anatomical region, it should be determined with 1-2 mm precision. Until recently, spinal screwing surgeries were performed with a C-arm x-ray device called “scopy” that could provide a 2-dimensional view. In these surgeries, there was a risk of a new surgery because the screw had the possibility of going to an undesirable area.
However, today, it is seen that there is no room for error in screwing surgeries performed with O-Arm technology, which can take 3D tomography images and be used during surgery. When working synchronously with neuronavigation and neuromonitoring technology, Oo screws requiring 1-2 mm precision can be placed safely. In addition, it is possible to take tomography under sterile conditions during surgery with the O-Arm device.
Surgery o Microscope: The microscope used in brain, nerve and spinal cord surgeries is produced with the latest technology and offers many conveniences during surgery.
- While operating with both hands, it allows focusing and forward-backward movements with the mouth control, without touching with the hands.
- When performing surgery on vascular pathologies, we can only show the vessels in the image with the angiography image, and thus, there is often no need to perform angiography on the patient after the surgery.
- In cases where tumor tissue can be difficult to distinguish from normal brain tissue, the medicine given to the patient before surgery makes the surgery easier by showing the tumor tissue stained by the microscope with a special fluorescent light.
- By adapting to the navigation system used in lesions located in sensitive areas, it can show the direct route on the microscope screen to move the microscope away from the field.
Biplane Angiography: The angiography device, which is frequently used in the diagnosis and treatment of vascular diseases, has a biplane feature. Thanks to its biplane nature, it can take images from two angles at once, thus shortening the time by almost half and, more importantly, reducing the amount of contrast material taken. The device also takes a rotational view and clearly shows the three-dimensional (3D) structure of the vascular structures.
Intraoperative Ultrasonography: During the surgery, a brain ultrasound is performed by the radiologist to calculate how much of the tumor has been removed. It reduces the risk of remaining a tumor area, especially in tumors that are difficult to distinguish from brain tissue.
Endoscopy: It provides a wide angle of view from a small area, especially in areas where narrow corridors are used surgically, such as pituitary tumors or intraventricular tumors.
Craniotomy: In the surgery of the sensitive areas responsible for arm and leg movements, called the speech center and “motor area”, the patient is kept awake. In this way, the success of the surgery is increased by controlling the person’s speech and cockroach movements instantly.
Gliolan Dyeing Technique: The patient is given a liquid to drink before the surgery. During surgery, normal brain tissue and tumor tissue are seen in different colors with the special filter of the surgical microscope. With this method, while normal brain tissue damage is minimized, tumor removal is maximized and the risk of the patient suffering neurological loss is reduced.
Advanced Radiological Imaging Methods: Performing a biopsy using known methods to obtain information about lesions in the brain can be difficult, risky and time-consuming. With advanced MRI imaging methods, it can be determined whether the suspected lesion in the brain is a tumor or not. With advanced MR imaging methods such as diffusion MR, DTI MR, Functional MR, Perfusion MR and MR spectroscopy, the extent of the tumor, its type, metabolic biochemical structure, and its relationship with the areas and pathways that enable speech, vision and movement can be evaluated. Data obtained with advanced MR imaging methods help determine treatment approaches.
Spinal Table: In the operating room planned for spine surgery, a suitable patient bed, that is, an operating table, is used. These special tables, called spinal tables, are specially designed to leave the abdominal area free and prevent patients from experiencing heart, circulation or similar problems during surgery. The spinal table, which can be flexible to adapt to different body sizes, can move in different axes and adapt to the patient’s position.