Medical Units

What is Brain and Nerve Surgery (Neurosurgery) ?

Brain and Nerve Surgery (Neurosurgery) has been accepted as a separate branch of science in the early 20thcentury in the west and as an independent specialty in our country about 50 years later. However, it has developed 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 devoted to the researches in neurological sciences during the period. Genetic engineering studies are extensively focused on tumor biology and extending human life. Additionally, diagnostic methods have been developing and technology offers astonishing services to science. Neurosurgery has become very fortunate both in terms of diagnostic methods and surgical instruments and materials.

We can list the groups of diseases that neurosurgery department is most interested in as follows;

• Brain Neoplasms
• Cerebral Bleeding
• Herniated Disk and Cervical Disc Hernia
• Head Trauma
• Vertebral colon trauma, myeloma
• Peripheral nerve cuts, compression
• Epilepsies that do not respond to medical treatment.

Brain Neoplasms

10% of the tumors in the human body are composed of nervous system tissues. 80-90% of them develop in the cranium. The histological classification of tumors involving in the nervous system and accepted by the World Health Organization is as follows.

Tumors of neuroepithelial origin:

• Astrocytomas
• Oligodendrogliomas
• Ependymal tumors
• Mixt gliomas
• Tumors of the choroid plexus
• Embryonal tumors
• Meningeal tumors
• Nerve sheath tumors
• Vascular tumors
• Germ cell tumors
• Malignant lymphomas
• Locally developing tumors
• Metastatic tumors
• Cellar Region Tumors (Craniopharyngioma and pituitary neoplasms)

Among these, Glioblastoma Multiforme is the most common tumor examined under astrocytomas, and considered to be the most malignant. There is 15-20% recurrence in meningiomas which is often considered as benign tumors and these are called anaplastic meningioma. Medulla blastom which is one of childhood tumors is also examined among malignant tumors. 44% of metastatic brain tumors originate from lung, 10% from breast, 7% from kidney, 6% from gastrointestinal system.

The most common complaints in brain tumor cases are headache, epileptic fainting, decreased arm and leg strength, double vision, balance disorder, vomiting, menstrual irregularity, and breast milk.

CT, MRI are performed for the diagnosis and the treatment is surgical. According to the pathological diagnosis, it is decided whether radiotherapy, chemotherapy and immunotherapy should be added to surgical intervention or not.

Cerebral Bleeding
l. Subarachnoidal Hemorrhage (SAH)
Aneurysm and Arteriovenous Malformationbleeding 80-85%
Unknown cause 15-20%
2. Intracerebral, intracerebellar hemorrhage due to hypertension or bleeding disorder.

SAH

Syndromes are headache, vomiting, and change in consciousness. The patient is diagnosed with CT and cerebral angiography and treatment is planned. Surgery is the first treatment for the patient diagnosed with aneurysm. If there is an obstacle for surgery, and if the aneurysm is in an unreachable and large in size, endovascular intervention is planned. Early intervention to the aneurysm is important to prevent the development of second bleeding and vasospasm.
The treatments of Arteriovenous Malformation are surgery, radiation and endovascular interventions.

Herniated Disk and Cervical Disc Hernia
The syndrome usually occurs as a result of herniation of n. pulposusto between vertebrae to posterior. In case of neck hernia, neck, back, shoulder, arm pain, numbness, weakness occurs and in case of herniated disc, low back pain, leg pain, numbness, thinning and weakness in the leg are among the complaints. In the acute period, rest, myoresolutive, painkiller treatments are applied. If the complaints do not disappear, after the MRI and the definitive diagnosis, surgical intervention is performed if necessary.

Head Trauma

Commutio, contusio, contrcoup, diffuse axonal injuries, which are named after evaluating the patient's neurological status and CT findings, arise in case of head traumas. Posttraumatic intracranial hematomas are acute subdural hematoma, intracerebral hematoma, epidural hematoma and

SAH.

It is ideal to monitor all head traumas in the centers where adequate monitoring and 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 considered seriously. According to the findings of the case, stabilization can be achieved conservatively with corset.
If necessary, decompression is provided and stabilization surgery is performed.

Rehabilitation treatment should be started immediately after the surgical procedure in order to improve neurological findings. Interfacicular anastomosis and, if necessary, nerve grafting are applied in peripheral nerve cut.