Neurosurgery

Brain and Nerve Surgery (Neurosurgery) is developing rapidly both worldwide and in our country. The last decade of the 20th century was declared the “Decade of the Brain” in the USA, and during this period more resources were allocated to research in the neurological sciences. Genetic engineering studies are focusing intensively on extending human life and on tumor biology. Diagnostic methods are also advancing, and technology is offering remarkable services to science. Neurosurgery, too, has become very fortunate in terms of both diagnostic methods and surgical instruments and materials.

Our Brain and Nerve Surgery (Neurosurgery) department provides diagnosis and treatment for brain tumors, brain hemorrhages, brain aneurysms, spinal cord tumors, pituitary tumors, gait analysis and herniated disc treatment.

Examinations such as CT, MRI, PET, angiography, CT angiography, EEG, sleep EEG, EMG and Doppler ultrasonography make it easier to diagnose space-occupying, vessel-occluding and bleeding lesions affecting the nervous system.

Disease groups treated by the Neurosurgery department

• Brain tumors

• Brain hemorrhages

• Lumbar and cervical disc herniations

• Head injuries

• Vertebral column injuries, spinal cord tumors

• Peripheral nerve injuries and compressions

• Epilepsies that do not respond to medical treatment.

Brain Tumors

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

Tumors of neuroepithelial origin:

• Astrocytomas

• Oligodendrogliomas

• Ependymal tumors

• Mixed gliomas

• Choroid plexus tumors

• Embryonal tumors

• Meningeal tumors

• Peripheral nerve sheath tumors

• Vascular tumors

• Germ cell tumors

• Malignant lymphomas

• Locally developing tumors

• Metastatic tumors

• Sellar region tumors (craniopharyngioma and pituitary tumors)

Of these, glioblastoma multiforme, classified among the astrocytomas, is the most common tumor and is considered the most malignant. In meningiomas, which are generally considered benign, 15–20% recur; these are called anaplastic meningiomas. Medulloblastoma, a childhood tumor, is also classified among the malignant tumors. Of metastatic brain tumors, 44% 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 seizures, weakness in the arms and legs, double vision, balance disorders, vomiting, menstrual irregularities and milk discharge from the breast. CT and MRI are performed for diagnosis, and the treatment is surgical. Depending on the pathological diagnosis, it is decided whether radiotherapy, chemotherapy or immunotherapy should be added to surgery.

Brain Hemorrhages

The clinical picture usually consists of headache, vomiting and altered consciousness. In patients diagnosed by CT, cerebral angiography is performed and treatment is planned. In patients with an aneurysm, surgery is the first treatment to be considered. If there is a condition preventing surgery, or if the aneurysm is in a location or of a size that cannot be reached surgically, endovascular intervention is planned. Intervening in the aneurysm as early as conditions allow is important to prevent rebleeding and vasospasm. AVMs are treated with surgery, radiation and endovascular interventions.

Lumbar and Cervical Disc Herniations

The clinical picture arises when the nucleus pulposus located between the vertebrae herniates, usually posterolaterally. Cervical disc herniation causes neck, back, shoulder and arm pain, numbness and weakness; lumbar disc herniation causes low back pain, leg pain, numbness, thinning and weakness in the leg. In the acute phase, rest, muscle relaxants and painkillers are used. If complaints persist, an MRI is taken and, after a definitive diagnosis, physical therapy and, if necessary, surgery are performed.

Head Injuries

In head injuries, clinical pictures such as concussion, contusion, contrecoup injury and diffuse axonal injury emerge, named according to the patient's neurological status and CT findings. Intracranial hematomas that develop after trauma include acute subdural hematoma, intracerebral hematoma, epidural hematoma and SAH. Ideally, all head injuries should be followed up in centers with adequate monitoring, where the necessary respiratory support can be provided, including intubation and tracheostomy if required.

Spinal Injuries

Since the spinal cord lies within the vertebral column, vertebral fractures and injuries must be taken seriously. Depending on the findings, stabilization can be achieved conservatively with a brace. If necessary, decompression is performed followed by stabilization surgery. Rehabilitation should begin immediately after surgery to improve neurological findings. In peripheral nerve transections, interfascicular anastomosis is performed, with a nerve graft if necessary.

Epilepsy

Among patients with drug-resistant epilepsy, those suitable for surgery are selected and operated on after preliminary investigations and the necessary preparations. Failure of medical treatment usually results from errors in diagnosis and drug selection, as well as from problems related to the patient and their environment. While patients are being prepared for surgery, the joint work of specially trained neurology, neurophysiology, psychiatry, radiology and neurosurgery specialists is very important for surgical outcomes. Patients who have been investigated with EEG, long-term video EEG recordings and the necessary MRI examinations, and who are also found suitable on psychiatric evaluation, are treated surgically. However, severe chronic psychoses and intellectual disability are conditions that preclude surgery.

The most commonly performed surgical methods:

• Removal of the lesion causing epilepsy: lesionectomy

• Amygdalohippocampectomy

Patients diagnosed through thorough neurological examination and the most advanced investigation methods are operated on using microsurgical and state-of-the-art techniques; adequate intensive care follow-up is provided when necessary, and discharge is planned as soon as possible to speed their return to normal life.

The brain and nervous system are the main components of the complex communication network in the human body. The brain is a vital organ with complex functions that still retains its mystery. The central nervous system regulates movement, perceives sensations and controls many functions by communicating with other parts of the body. The field of brain and nerve surgery specializes in diagnosing, managing and treating problems that occur in this complex system. Brain and nerve surgeons therefore play a critical role in human health.

What Is Brain and Nerve Surgery?

Brain and nerve surgery is the medical discipline and surgical specialty that provides surgical and non-surgical management of disorders of the central, peripheral and autonomic nervous systems. Brain and nerve surgeons may provide intensive care, prevention, diagnosis, evaluation, treatment and rehabilitation. They may specialize in subspecialties such as pediatric neurosurgery, neuro-oncology or spine surgery. Brain and nerve surgeons also collaborate with many specialties, including neurologists, psychiatrists, neuroradiologists and the basic sciences.

What Are Brain and Nerve Surgery Conditions?

Brain and nerve surgeons play a role in the prevention, diagnosis and treatment of brain, spine and nerve disorders. They also treat and manage the condition of the vessels supplying the brain and conditions affecting blood flow. They may also take on rehabilitation after operations. Brain and nerve surgery conditions can be briefly described as follows:

• Parkinson's Disease: Parkinson's disease is a brain disorder that causes unwanted and uncontrollable movements such as tremor, stiffness and difficulty with balance and coordination. Symptoms usually begin slowly and worsen over time. As the disease progresses, people may also experience walking and speech difficulties, memory problems, depression, sleep disorders, and mental and behavioral changes. It is known to affect men more than women and usually appears for the first time after the age of 60.

• Multiple Sclerosis: Multiple sclerosis (MS) is the most common neurological disease that can lead to disability. It is characterized by immune system cells mistakenly attacking myelin, the protective sheath in the central nervous system. Symptoms usually appear between the ages of 20 and 40. Symptoms such as balance problems, intermittent or frequent dizziness, bladder control problems, muscle weakness in the arms and legs, muscle spasms and vision problems may develop.

• Epilepsy: Epilepsy is a chronic, non-communicable brain disease affecting approximately 50 million people worldwide. Epilepsy may develop due to brain tumors, brain trauma, birth trauma and genetic conditions. Symptoms such as loss of consciousness, movement difficulties, loss of sensation, and disturbances in mood and other cognitive functions may occur.

• Brain Tumor: A brain tumor may develop as a result of the growth of cells in or near the brain tissue. Tumors developing in tissues near the brain include tumors of the nerves, the pineal gland, the surface of the brain and the pituitary gland. Symptoms vary depending on the location and size of the brain tumor. However, general symptoms include more frequent and severe headaches than usual, nausea, blurred or double vision, problems with memory, hearing, balance and speech, confusion and a feeling of fatigue.

• Spina Bifida: It is a condition that occurs when the spine and spinal cord do not form properly. It is known as a type of neural tube defect. Under normal conditions, the neural tube, which forms early in pregnancy, closes on the 28th day after conception. However, in babies with spina bifida, part of the neural tube does not close completely. This affects the spinal cord and the bones of the spine. It can cause serious disabilities, and symptoms vary depending on whether the spinal cord and nerves are affected.

• Carpal Tunnel Syndrome: Also known as median nerve compression, it is a condition that causes numbness, tingling or weakness in the patient's hand. Symptoms result from pressure on the median nerve, which runs along the arm and continues through the carpal tunnel in the wrist into the hand. The median nerves control the movement of the thumb, index, middle and ring fingers. Symptoms include pain, numbness, burning and tingling in the fingers.

• Hydrocephalus: It is a condition in which fluid accumulates in cavities deep within the brain called ventricles. Excessive fluid accumulation increases the volume of the ventricles and puts pressure on the brain. Hydrocephalus can occur at any age but is most common in infants and in adults aged 60 and over. Healthy cerebrospinal fluid levels can be restored with surgical procedures. Symptoms include a larger-than-normal head, a bulging or tense soft spot on the top of the head, nausea, seizures, problems with muscle tone and strength, and eyes fixed downward.

• Scoliosis: It is a condition in which the spine curves sideways. Symptoms such as low back pain, back stiffness, pain and numbness in the legs due to nerve compression, fatigue due to muscle tension, and breathing difficulties due to an upper spinal curve may develop.

• Brain Hemorrhage: A brain hemorrhage develops when an artery in the brain ruptures and local bleeding occurs in the surrounding tissues. This bleeding kills brain cells. 13% of strokes are caused by brain hemorrhage [9]. Symptoms of brain hemorrhage include weakness in the arms and legs, sudden severe headache, seizures, and difficulty swallowing, reading and writing. Other symptoms include an abnormal sense of taste, loss of consciousness and coordination, hand tremor and loss of motor skills.

• Meningitis: Also known as inflammation of the meninges; infection can also develop in the fluid and membranes surrounding the spinal cord. Infections may develop due to viral, bacterial, parasitic and fungal causes. Symptoms such as sudden high fever, skin rash, stiff neck, sensitivity to light, and decreased appetite and thirst may develop.

• Cerebrovascular Diseases: Cerebrovascular diseases can occur in many vessels, including the arteries, the carotid artery and the vertebral arteries. Some of these diseases include venous malformation, carotid stenosis, brain aneurysm, transient ischemic attack, stroke and brain hemorrhage.

• Cranial Nerve Palsies: Cranial nerves are nerves that run directly from the brain to the head, face and part of the trunk. There are 12 pairs of cranial nerves; some are associated with special senses such as sight, smell, hearing and taste, while others control muscles and glands. Partial weakness in the areas where the cranial nerves function can cause palsy. Cranial nerve palsies can restrict eye movements and cause strabismus and double vision.

What Are the Symptoms of Brain and Nerve Surgery Conditions?

There are many conditions that fall within the scope of brain and nerve surgery. Although symptoms vary depending on the type, location and severity of the condition, general symptoms can be listed as follows:

• Fever,

• Severe and unusual headaches,

• Dizziness,

• Nausea and vomiting,

• Seizures,

• Loss of consciousness,

• Disorders of balance, coordination, focus, memory and movement,

• Changes in personality, behavior and mood,

• Speech, swallowing and vision disorders.

How Are Brain and Nerve Surgery Conditions Diagnosed?

When diagnosing brain and nerve diseases, the patient's history is taken and a physical examination is performed first. During the physical examination, neurological findings are evaluated, including motor, sensory, reflex and cognitive functions. Based on the data obtained from these examinations, the patient may be referred for other necessary tests. Procedures that may be used for diagnosis include:

• Biopsy: Small tissue samples needed for laboratory analysis are taken by healthcare professionals. These tissue samples can help determine whether a brain tumor is cancerous.

• Electroencephalography (EEG): Tests the brain's natural electrical activity and function.

• Evoked Potential Tests: They enable the diagnosis of neurological conditions. It is a non-invasive procedure that records the brain's electrical activity and responses to certain stimuli. It is most often used to diagnose multiple sclerosis.

• Imaging Tests: Computed tomography (CT), magnetic resonance imaging (MRI) and positron emission tomography (PET) scans provide detailed images of the brain. In this way, brain activity, diseases or damaged areas can be detected.

• Laboratory Tests: Blood, urine, stool or spinal fluid tests may be requested. Some genetic tests may also be helpful in diagnosis.

• Mental Function Tests: They allow memory, thinking and problem-solving abilities to be evaluated.

• Neurological Examination: Changes in balance, coordination, hearing, eye movement, speech and reflexes are evaluated.

How Are Brain and Nerve Surgery Conditions Treated?

Brain and nerve surgery conditions can be treated with many procedures. The most commonly used treatment methods are as follows:

• Biopsy: A procedure in which, after potential abnormalities are detected, an incision is made in the skull and a needle is inserted to remove brain cells or tissue.

• Craniotomy: A procedure in which part of the skull is removed to take out a brain tumor, abnormal tissue, blood or clots. After surgery, the piece of skull is put back in place.

• Craniectomy: Similar to a craniotomy, a craniectomy is a procedure in which the surgeon accesses the brain by removing part of the skull but does not replace it during the same operation because of concerns about pressure in the brain. The skull piece is replaced during a second operation called cranioplasty.

• Deep Brain Stimulation: Medical devices are implanted to deliver electrical stimulation to certain areas of the brain. It is often used for movement disorders such as Parkinson's disease.

• Neuroendoscopy: It is a minimally invasive technique. A thin tube called an endoscope is passed to the brain tissue through the mouth, the nose or small incisions in the skull. The endoscope has a light and a camera at its tip, and the operation is performed with instruments passed through it. It can be used to remove brain tumors and lesions near the pituitary gland, just behind the bridge of the nose.

• Stereotactic Radiosurgery: It is a non-invasive treatment option for spinal tumors. The tumor is targeted very precisely using narrow radiation beams. In this way, pain and tumor control can be achieved.

• Endovascular Surgery: A procedure in which a small incision is made in the patient's groin and a thin, flexible tube is inserted into a blood vessel. The catheter is advanced to the brain without opening the skull. There, blood clots can be removed or aneurysms repaired.

• Laser Ablation: A procedure in which a laser probe passed through a small hole in the skull allows the surgeon to remove tumor and epileptic tissue.

Frequently Asked Questions

What Is the Difference Between Neurology and Brain and Nerve Surgery?

Neurology is a medical specialty that aims to diagnose and treat conditions affecting the nervous system, which consists of the brain, spinal cord and nerves. Physicians specializing in neurology are called neurologists. Neurologists do not perform surgery. Brain and nerve surgeons, on the other hand, can diagnose and treat nervous system disorders with surgical and non-surgical procedures. Neurologists may refer patients to a brain and nerve surgeon when surgery is deemed necessary.

Which Department Treats Nerve and Vascular Diseases?

The neurology and brain and nerve surgery departments deal with the diagnosis and treatment of nerve and vascular diseases.

Does Brain and Nerve Surgery Require an EMG?

An electromyography test (EMG) may be requested to measure how well the muscles respond to nerve signals from the brain.

What Complaints Does Brain and Nerve Surgery Deal With?

Brain and nerve surgery can address many complaints, including stroke, certain types of chronic pain, head, neck and spine injuries, brain and spinal cord tumors, cerebral aneurysms, neurological disorders and movement disorders.

What Operations Does Brain Surgery Perform?

Operations such as biopsy, decompression, endovascular surgery, deep brain stimulation, laser ablation, neuroendoscopy, craniotomy and craniectomy can be performed.

Which Department Deals with a Blood Clot in the Brain?

A blood clot in the brain is managed by brain and nerve surgery.

What Tests Does Brain and Nerve Surgery Request?

Tests such as complete blood count, urinalysis, stool and spinal fluid tests, biopsy and angiography may be requested.

How Is a Nerve Compression Test Performed?

Electromyography (EMG) and a nerve conduction study can be performed to measure the transmission of nerve signals to the muscles. EMG measures how much electrical activity muscle contraction produces. A nerve conduction study evaluates the flow of electrical current through the peripheral nerve before it reaches the muscle. These two tests are usually performed together.

How Can You Tell If You Have a Pinched Nerve?

Pain, numbness or tingling occurs in the area of compression, and symptoms such as reduced limb mobility, inability to grasp or hold objects, and muscle loss may appear. Tests such as EMG and a nerve conduction study can also be performed.

When Do Symptoms of a Brain Hemorrhage Appear?

Symptoms of a brain hemorrhage develop suddenly and gradually worsen.

Brain and nervous system health is extremely important, and early diagnosis of any problem is vital. If you are experiencing symptoms specific to brain and nervous system diseases, it is recommended that you consult a physician. Symptoms can often develop suddenly and worsen quickly, so specialist support should be sought without delay. Early diagnosis and treatment of brain and nervous system diseases can improve quality of life.