Description

Brain and nerve surgery

Brain and Nerve Surgery (Neurosurgery) is developing
rapidly both in the world and in our country. The last 10 years of the
20th century were accepted as the “Decade of the Brain” in the USA,
and more resources were allocated to research on neurological sciences during
this period. He is working extensively on genetic engineering studies,
human life extension and tumor biology. Diagnostic methods are also
advancing, technology offers surprising services to science. Neurosurgery
has also become very fortunate in terms of both diagnostic methods and surgical
instruments and materials. CT, MRI, PET, Angiography, CT Angiography, EEG,
Sleep EEG, EMG, Doppler Ultrasonography examinations facilitate the diagnosis
of lesions that involve the nervous system, occupying space, vascular occlusion
and causing bleeding.

The disease groups that the neurosurgery department is most interested in

Brain tumors

Brain hemorrhages

Waist and neck hernias

Head injuries

Vertebral column traumas, spinal cord tumors

Peripheral nerve cuts, compression

They are epilepsies that do not respond to medical treatment.

Brain Tumors

10% of the tumors seen in the human body consist of
nervous system tissues. 80-90% of these develop within the cranium. The
histological classification of tumors affecting the nervous system accepted by
the World Health Organization is as follows.

Tumors of neuroepithelial origin

Astrocytoma’s

Oligodendroglia’s

Ependymal tumors

Mixt gliomas

Choroid plexus tumors

Embryonal tumors

Meningeal tumors

S. Nerve sheath tumors

Vascular tumors

Germ cell tumors

Malignant lymphomas

Locally growing tumors

Metastatic tumors

Seller region tumors (Craniopharyngioma and pituitary tumors)

Glioblastomas Multiform is the most common tumor examined
among astrocytoma’s and has been accepted as the most malignant. Generally,
15-20% of meningioma’s, which are considered benign tumors, show recurrence,
which are also called anaplastic meningioma. Medulla bluestem, which is
one of the childhood tumors, is also examined among malignant tumors. 44%
of metastatic brain tumors originate from the lung, 10% from the breast, 7%
from the kidney, and 6% from the gastrointestinal system. The most common
complaints in brain tumor cases are headache, epileptic fainting, loss of
strength in the arms and legs, double vision, imbalance, vomiting, menstrual
irregularity, milk coming from the breast. CT, MRI is performed as
examination, treatment is surgical. Depending on the pathological
diagnosis, it is decided whether radiotherapy, chemotherapy and immunotherapy
will be added to the surgical intervention.

Subarachnoid hemorrhage (SAH)

Aneurysm and AVM bleeding 80-85%

15-20% with no clear cause

Intracerebral, intracerebellar hemorrhages due to
hypertension or bleeding disorder

Subarachnoid hemorrhage (SAH)

Generally, a clinical picture is formed by headache,
vomiting and change in consciousness. Cerebral angiography is performed
and treatment is planned for the patient diagnosed by CT. Surgery is the
first treatment to be considered in patients with aneurysm. If there is
any obstacle to surgery, and if the aneurysm is in a place and size that cannot
be reached surgically, endovascular intervention is planned. It is
important to attempt the aneurysm as early as the conditions allow, in terms of
the development of second hemorrhage and vasospasm. Treatment of AVMs are
surgery, radiation, and endovascular interventions.

Waist and Neck Hernia

The clinical picture occurs as a result of the posterior
lateral herniation of the n.pulpos located between the vertebrae. Neck,
back, shoulder, arm pain, numbness, weakness in cervical disc
hernia; lumbar hernia complaints of low back pain, leg pain, leg numbness,
thinning, and weakness. In the acute phase, rest, muscle relaxant and pain
reliever treatments are applied. If the complaints are not resolved,
physical therapy and surgical intervention are performed, if necessary, after
MRI is taken and the final diagnosis is made.

Head Injuries

In head traumas, commotion, contusion, countercoup,
diffuse axonal injuries, named after the patient’s neurological status and CT
findings, appear. Post-traumatic intracranial hematomas are acute subdural
hematoma, intracerebral hematoma, epidural hematoma and SAH. It is ideal
to follow up all head traumas in centers with adequate monitoring, where
necessary respiratory support can be provided by performing intubation and
tracheostomy if necessary.

Spine Traumas

Since the spinal cord is located in the vertebral column,
vertebral fractures and injuries should be handled seriously. According to
the findings of the case, stabilization can be achieved with a corset
conservatively. If necessary, decompression is provided and stabilization
surgery is performed. Rehabilitation treatment should be started
immediately after the surgical process to improve neurological findings. In
peripheral nerve cuts, interfascicular anastomosis, if necessary, nerve graft
is placed.

Epilepsy

Among patients with drug resistant epilepsy, those
suitable for surgery are selected; It is operated after preliminary
research and necessary preparations. Failure of medical treatment results
from mistakes made in genetic diagnosis and drug selection, and problems
related to the patient and his environment. While the patients are
preparing for surgery, the joint efforts of neurology, neurophysiology,
psychiatry, radiology, and neurosurgeons trained on this subject are very
important in terms of surgical results. Patients who are investigated with
EEG, long-term video EEG records, necessary MRI examinations, and who are
suitable for psychiatric methods are treated surgically. However, severe
chronic psychosis and mental retardation are obstacles to surgery.

The most common surgical methods

Removal of the formation causing epilepsy; lesionectomy

Amygdala – hypokamgectomy

Patients diagnosed with serious neurological examination
and the most advanced research methods are operated with microsurgical and the
most modern techniques, adequate intensive care follow-up is provided if
necessary, and their return to normal life is accelerated by planning their
exit as soon as possible.