Neurosurgery: Nervous System Surgery
Neurosurgery, or Brain, Nerve, and Spine Surgery, is the department that diagnoses and treats the nervous system, starting from the brain to the spinal cord.
3 primary poles of the nervous system: brain, spinal cord, and nerves
To roughly describe the nervous system, we can divide it into three parts: the brain, spinal cord, and nerves. The spinal cord begins as an immediate continuation of the brain and continues to the back-waist compound. Like our arms and legs, all the nerves to our limbs come from our spinal cord. The bone structure that starts just below our skull and extends to our coccyx is called the spine, and it surrounds the spinal cord in the spinal canal that runs in the middle. The nerves come out of the spinal cord after they are separated from the spinal cord inside the spinal canal and leave the spine through holes on both sides of the spine; this is called the foramen. Therefore, the spine is the most basic subject of neurosurgery, and at least 70 percent of the patients admitted to any neurosurgery clinic have spinal-related disorders.
A Continuously Developing Science
Brain, spinal cord, and neurosurgery, which covers the diagnosis and treatment of nervous system diseases seen in both adult and paediatric patients, is increasingly moving forward with advances in technology, innovations, and increased knowledge in the field of medicine. The proliferation of fully equipped centres and multidisciplinary treatment approaches is also increasing the success of diagnostic and treatment outcomes.
Nervous system surgery has developed rapidly, especially since the 2000s.
With the increase of anatomical knowledge, the development of experience in microsurgery, and the contribution of head base openings, areas that were no longer accessible can be reached. Also, tumors can be reached without damaging the intact tissues, and it is possible to remove the tumors without harming the patient.
What treatments are applied in neurosurgery department?
The departments of brain and neurosurgery deal with diseases affecting the nervous system, including the brain. Both paediatric and adult patients are treated in this department. diagnosis, treatment, and follow-up of many diseases, such as vascular obstructions, injuries, hernias of the waist and neck, and tumors and traumas in the brain and spinal cord region, are all included in neurosurgery department. In cooperation with other medical units, the departments of brain and neurosurgery carry out a multidisciplinary study, especially with departments such as neurology, physical therapy, and rehabilitation.
Academic Hospital's neurosurgery department provides all services for the diagnosis and treatment of all diseases entering this field, with full-time expert staff on surgical treatment of central and peripheral nervous system diseases.
Diagnosis and Treatment with Expert Staff
Spine Surgery:
- Lower-back and neck hernia
- Canal stenosis
- Spinal Shift
- Spinal fracture
Paediatric Neurosurgery:
- SpinaBifida
- Hydrocephalus
- Head Malformations
- Cerebellum Sagging
Brain and Spinal Tumors
Peripheral Nerve Surgery
Lower Back Hernia
Our spine consists of 33 bones, from our neck to our coccyx, which we call the vertebrae. There are a total of five vertebrae in our lumbar region. There is a large hole that forms the spinal canal, and when the vertebrae are stacked on top of each other, "foramen" called small holes, appear on both sides, and they allow the nerves to pass towards the limbs. There are cushion-like materials between the vertebrae; they are called "discs." They consist of a hard sheath on the outside and a soft substance on the inside.
What we call a hernia is when the hard sheath around the disc ruptures and the soft substance inside spills out. If this herniation is toward the spinal canal, it presses the nerves leading to the spinal cord, and if it is toward the foramens, it presses the nerves that go down to the legs. The patients usually get back and leg pain in such cases. Examinations and MRI are used to make a diagnosis.
Hernia is a common condition, and only a small part of it requires surgery. The first approach is medication and rest. If it does not improve, physical therapy is recommended. Some patients may benefit from local injections in the area of the hernia.
However, if the patient is unable to recover from his pain despite using all of these methods or if the patient has developed a loss of strength, a condition known as "half paralysis," surgery is recommended. If the patient doesn't have other diseases, the standard surgical procedure for hernias is "microsurgery." In this surgical procedure, a small area is opened in the relevant vertebral bone, and the herniated disc is cleaned under a microscope without damaging the surrounding nerves. Microsurgery patients get up and walk around a few hours after the procedure and are discharged the next day. Most patients fear paralysis due to surgery, but the rate is below 1% with microsurgery, and the recurrence rate of the hernia is less than 3% with microsurgery.
Neck Hernia
Our spine consists of 33 bones, from our neck to our coccyx, which we call the vertebrae. There are a total of five vertebrae in our lumbar region. There is a large hole that forms the spinal canal, and when the vertebrae are stacked on top of each other, "foramen" called small holes, appear on both sides, and they allow the nerves to pass towards the limbs. There are cushion-like materials between the vertebrae; they are called "discs." They consist of a hard sheath on the outside and a soft substance on the inside.
What we call a hernia is when the hard sheath around the disc ruptures and the soft substance inside spills out. If this herniation is toward the spinal canal, it presses the nerves leading to the spinal cord, and if it is toward the foramens, it presses the nerves that go down to the legs. The patients usually get back and leg pain in such cases. Examinations and MRI are used to make a diagnosis.
A neck hernia is a common condition, and only a small part of it requires surgery. The first approach is medication and rest. If it does not improve, physical therapy is recommended. Some patients may benefit from local injections in the area of the hernia.
However, if the patient is unable to recover from his pain despite using all of these methods or if the patient has developed a loss of strength, a condition known as "half paralysis," surgery is recommended. If the patient doesn't have other diseases, the standard surgical procedure for hernias is "microsurgery." In this surgical procedure, a small area is opened in and through the natural folding line of the neck, protecting the distance between the carotid artery and airway. Without damaging the surrounding nerves, the herniated disc is cleaned under a microscope. At the distance emptied, either a fixed cage or a moving prosthesis is placed, considering the age of the patient and the general condition of the spine.
Microsurgery patients get up and walk around a few hours after the procedure and are discharged the next day. Most patients fear paralysis due to surgery, but the rate is below 1% with microsurgery, and recurrence is not considered a possibility with microsurgery.
Canal Stenosis
Our spine consists of 33 bones, from our neck to our coccyx, which we call the vertebrae. In the middle of these bones there is a large hole, which forms the "spinal canal," which the spinal cord passes through. Due to the degeneration of the spinal bones, which is commonly referred to as calcification, they can deteriorate the shape of the spinal bones and expand to narrow the spinal canal. This is called the narrowing of the spinal canal due to the degeneration of the spinal bones and the compression of the spinal cord in the canal.
Canal stenosis can occur in any area of the spine. If it is in the lower back, the patient will complain of back and leg pain, weakness, burning, and stinging in the legs, reduced walking distance, and walking with rests only. If it is in the neck, the patient may experience pain in the neck and arms, burning and stinging in the arms, etc., and some complaints like not being able to hold things or dropping things from the hand, and also stiffness in the legs and difficulty taking a step. Examinations and MRI are used to make a diagnosis.
Canal stenosis is not a self-healing disorder. Therefore, surgery is recommended as soon as these complaints start to negatively affect the patient's life. In surgery, the trapped spinal cord is relieved by cleaning the degenerate bone structures that compress it. If compression is limited to a very small area, no additional intervention is needed. But in case of two or more distances, after this relief, it is necessary to screw the bones in order to prevent the spine from slipping. Screwing can be done with fixed systems and dynamic systems, considering the patient's lifestyle.
Spinal Shift
The medical name for this disorder is "spondylolisthesis." Our spine consists of 33 bones, from our neck to our coccyx, which we call the vertebrae. If any two of these 33 bones slide back and forth on top of each other, it causes this disorder. The treatment of this disease is surgery, since the slipping of the spine also crushes the spinal cord passing through the middle.
In surgery, the trapped spinal cord is relieved first, and then the sliding bones are screwed together.
Spinal Fracture
Spinal fractures can be divided into three categories. The first type is fractures due to trauma, i.e., traffic accidents, falls from heights, etc. In these cases, if the stability of the spine is impaired, the patient should be operated on immediately. If there are any broken bone fragments that pose a threat to the spinal cord, they are cleaned first, and then the broken vertebrae are screwed into the intact vertebrae, allowing bone fusion.
The second type of fractures seen in the elderly are those caused by bone loss. These usually do not require surgery. They can be treated with corsets and rest. But sometimes the patient can have very severe pain. In these cases, "methyl methrilade", method which is popularly known as cement, can be injected into the broken bone with a small surgical intervention. Depending on how it is used, this method is known as kyphoplasty or vertebroplasty.
Tumor-related fractures are the third type. The spine, unfortunately, is a frequent metastasis area for tumors in other parts of the body. This condition can sometimes occur even without knowing the presence of the actual tumor. In such cases, it may be necessary to take a biopsy of the bone and perform surgical intervention if the integrity of the spine is threatened. But the treatment of these metastases is usually done by radiotherapy.
Paediatric Brain Surgery
Spina Bifida
Spinabifida is the collective name of a very large group of diseases. To summarize briefly, these diseases are congenital spinal cord diseases that we see as a result of incomplete development in the womb. The case where the baby is born with the spinal cord outside falls into this group; also, the case of a tiny hole between the buttocks falls into this group.
Roughly dividing it in two, medically known "myeloschisis" or "myelomeningocele" cases fall under "open" or "exposed spinal cord" category.
"Tethered Cord," "Dermal Sinus Thracti," "Diastematomyelia," and "Diplomyelia" cases fall under "closed" or "not exposed spinal cord" category.
Cases of open spinabifida should be operated on immediately. In fact, if the diagnosis is made while the baby is still in the womb using ultrasonography, the baby can be taken to surgery as soon as possible after birth. Typically, these babies are born with severe weakness from the back down. The most effective way to preserve what little strength they have is to operate within the first 24 hours. Aside from the loss of strength, the longer the surgery is postponed, the greater the risk of meningitis is, due to the spinal cord being exposed.
Cases of closed spinabifida are usually diagnosed with a skin sign. Either a hole inside the buttocks or just above it, excessive hair occurs on the back, or various skin lesions appear. Examinations and MRI are used to make a diagnosis. Surgery is essential, but it's not urgent. In these patients, this usually leads to the spinal cord being stuck in a specific area. As the baby grows, the spinal cord begins to stretch. If the spinal cord is not liberalized by surgical intervention, conditions such as loss of strength, incontinence, etc. may occur.
Hydrocephalus
Both inside and around our brain and spinal cord, there is a fluid we call cerebral spinal fluid that constantly moves. In some cases, either the circulation of this liquid is blocked, its absorption is blocked, or its formation increases. In this case, the water-filled cavities in the brain, which we call the "ventricle," expand, and this is called "hydrocephalus."
Treatment of hydrocephalus is surgical. The most commonly used method is a closed system silicone tube application, which has one end in the water-filled cavity in the brain and the other end in our abdominal cavity, which we call a "shunt." Excess water in the brain is excreted into the abdominal cavity with the help of the tube, and from there, out of the body through urine.
If the cause is a permanent blockage of the cycle, endoscopic or microsurgical methods can also be tried to open the blockage in specific cases.
Head Deformities
When we're all born, we're born with gaps between the bones in our skull, and it's called a "suture." Our skull's development occurs perpendicular to these sutures. If one of these sutures closes prematurely, the development of that line stops and the development of other lines increases, which leads to disfigurement of the head. It's medically called craniosynostosis.
This is only a cosmetic problem. If all sutures do not close at the same time and the skull is not small, it has no negative effect on brain development. However, studies have shown that children with impaired heads are affected by their psychology, and their intelligence development is damaged by the cynical attitude of their friends when they reach school age.
Therefore, if the family or paediatrician has the slightest doubt, it is imperative to see a neurosurgeon. A diagnosis is made by examination and 3D tomography. The treatment is surgery. During the operation, the closed suture is opened, and the disfigured skull is reshaped. The younger the child has surgery, the easier the surgery will be, and the results will be much better cosmetically.
Cerebellum Sagging
The medical name of this disease is "cerebellum sagging." It is commonly known as "chiari" syndrome. Type 2 occurs in infants usually with other congenital disorders. As for type 1, it usually manifests itself in the 30s.
Anatomically, part of the cerebellum located in the lower-back area of the skull hangs down, out of the skull, and into the lower spinal canal. So it gets into a place it shouldn't be, and both the cerebellum and the spinal cord there get stuck. The patient presents with complaints such as dizziness, imbalance in walking, numbness in the arms, and electrification. If left untreated, the legs begin to harden, and it becomes difficult to walk.
Examinations and MRI are used to make a diagnosis. The treatment is surgery. A small incision is made on the lower-back part of the skull. Sometimes, in advanced cases, the back of the first cervical vertebra is also removed. This relieves the sagging cerebellum and the trapped spinal cord.
Brain and Vertebral Tumor Surgery
When it comes to tumors of the brain and spinal cord, the first and most important treatment is surgery. Chemotherapy and radiotherapy can only be used as complementary treatments.
Nervous system tumors can be benign or malignant. When a benign tumor is successfully removed through surgery, it rarely returns.
But unfortunately, this is not the case for malignant tumors. After surgery, radiotherapy and sometimes medication (i.e., chemotherapy) are given. But despite all this, the malignant tumor recurrence rate is high. Surgery is still essential. Because if we don't save the patient on time with surgery, we may lose the patient due to increased intracranial pressure.
The brain is also a frequent site of metastasis for tumors in other parts of the body. In such cases, the best method is surgery if there is only one metastasis. However, in cases where there is more than one metastasis, unfortunately, surgery is no longer an option, and patients are referred to radiotherapy.
Due to the increase in anatomical knowledge, the increase in experience in microsurgery, and the experience in opening the skull base, it is now possible to access areas that were previously inaccessible. It is possible to reach the tumor without causing damage to the surrounding tissues and to remove the tumors without causing harm to the patient.
Peripheral Nerve Surgery
We call the nerves that come out of our spinal cord and reach our hands and feet "peripheral nerves." These nerves can break, be cut, get stuck, and even develop tumors along the way. Their treatment is called peripheral neurosurgery.
Accidental incisions and ruptures aside, what we see the most in daily life is the compression of these nerves. These nerves are most commonly trapped in joints such as wrists, ankles, elbows, and knees. In such cases, patients experience pain, numbness, and loss of strength in the area where that nerve feeds. The biggest misfortune for these patients is that if they cannot see an experienced physician, their discomfort is often confused with a hernia in the back or the neck. Examinations and MRI are used to make a diagnosis.
The treatment is surgery. These mini-surgeries are performed most of the time under local anaesthesia without putting the patient to sleep; during the surgery, the nerve is saved from the place it got stuck.
Nowadays, sciatic nerve damage due to injections from the hip is also seen from time to time. In such cases, a partial or complete recovery can be achieved if it is treated within the first 72 hours and the nerve is not completely damaged. But it should be noted that sciatic neurosurgery is a major surgical procedure.
