Neurosurgery is a medical specialty concerned with the surgical treatment of the brain, spinal cord, and peripheral nervous system. Neurosurgery encompasses the diagnosis, surgical intervention, and postoperative follow-up of diseases affecting the nervous system.
What is Neurosurgery?
Neurosurgery is a medical unit that treats disorders of the central and peripheral nervous systems using surgical methods. Neurosurgery focuses not only on brain operations but also on a broad anatomy encompassing the spinal cord, vertebral structures, and all nerve pathways throughout the body. Modern neurosurgery utilizes advanced imaging techniques and microsurgical methods to perform critical procedures that directly impact quality of life. Due to the sensitivity of nerve tissue, procedures in this field require millimeter precision and a multidisciplinary approach.
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What diseases does neurosurgery treat?
The neurosurgery department deals with the diagnosis and treatment of both congenital and acquired traumatic or degenerative diseases. Because the structure of the nervous system is complex, the range of diseases treated by neurosurgery is quite broad. The main diseases followed and treated by neurosurgery are as follows:
- Brain tumors: This field deals with the removal of benign or malignant tumors using microscopic methods.
- Cerebrovascular diseases: Brain hemorrhages, aneurysms (ballooning of blood vessels), and arteriovenous malformations are treated.
- Spine and spinal cord diseases: Lumbar and cervical disc herniations, spinal stenosis, and spinal dislocations are monitored and treated.
- Childhood neurosurgical diseases: Conditions such as hydrocephalus (accumulation of fluid in the brain), spina bifida, and craniosynostosis (skull deformities) are treated.
- Traumas: It covers head and spinal cord injuries resulting from traffic accidents or falls.
- Functional Neurosurgery: Deep brain stimulation (DBS) implants and surgery for resistant epilepsy are performed for the treatment of Parkinson's disease.
- Peripheral nerve surgery: It deals with nerve compressions and nerve injuries such as carpal tunnel syndrome.
What are the diagnostic methods in neurosurgery?
Neurosurgical diagnostic methods are advanced imaging and analysis techniques used to map disorders of the central and peripheral nervous systems. These tests are used to determine the precise location and severity of tumors, herniations, trauma, or vascular anomalies in the brain, spinal cord, and nerve networks.
Neurological Clinical Examination Process
The first step in the diagnostic process is a comprehensive physical and neurological examination performed by a physician. After listening to the patient's complaints, the physician performs specific tests to check the overall functioning of the nervous system. The main functions focused on during the neurological examination are:
- Motor skills control: It is an assessment of muscle strength, balance, and coordination.
- Sensory analysis: The body's responses to sensations such as heat, cold, touch, and pain are examined.
- Reflex tests: The speed and symmetry of spinal cord and brainstem reflexes are checked.
- Cognitive functions: Speech, memory, orientation, and mental state are examined.
- Examination of cranial nerves: The condition of the nerves that control vision, hearing, swallowing, and eye movements is checked.
Computed Tomography (CT)
Computed Tomography (CT) is a rapid and effective radiological method that creates cross-sectional images of the body using X-rays. It is an indispensable imaging method in neurosurgery, especially in emergency situations, for detailed examination of bone structures and detection of acute hemorrhages. CT scans allow for clear observation of the relationship between soft tissues and bone structures. Problems within the scope of brain and nerve surgery that can be detected with Computed Tomography are as follows:
- Skull fractures due to head trauma
- Acute brain hemorrhages and stroke (paralysis) conditions
- Examination of calcified (calcified) tumors
- Diagnosis of hydrocephalus (fluid accumulation in the brain) and shunt monitoring.
Magnetic Resonance Imaging (MRI)
Magnetic Resonance Imaging (MRI) is a non-invasive technique that uses strong magnetic fields and radio waves to image soft tissues in high resolution. It provides the most detailed information for brain and spinal cord surgery and is safe because it does not involve radiation. The main types of MRI used for brain and nerve surgery are:
- Functional MRI (fMR): It determines the location of critical centers in the brain, such as those for speech and movement.
- Diffusion MRI: It is used in the diagnosis of ischemic stroke and in the monitoring of nerve fibers (tractography).
- Spectroscopy MRI: By analyzing the biochemical structure of tumors, it helps differentiate between benign and malignant tumors.
- MR Angiography: It images aneurysms (bulges) and blockages in the brain blood vessels.
Electroencephalography (EEG)
EEG is a procedure that records the electrical activity in the brain using electrodes placed on the scalp. This test, which reflects the communication between brain cells as waveforms, is used especially in the diagnosis of diseases accompanied by seizures. Used before and sometimes during brain surgery, the main functions of EEG are as follows:
- Identifying the epileptic (seizure) focus before surgery.
- Investigating the neurological origins of sleep disorders.
- Monitoring the depth of brain function and state of consciousness.
Electromyography (EMG) and Nerve Conduction Tests
EMG and nerve conduction tests are electrophysiological tests that measure the condition of muscles and the peripheral nerves that control them. They are particularly used to make a definitive diagnosis in cases of lumbar and cervical disc herniations, nerve compressions, and numbness in the hands and feet. The testing process generally consists of two stages: the speed of the nerves' response to electrical stimuli and the activity of the muscles at rest and during contraction are checked using a thin needle. These methods allow for the determination of the severity and exact location of nerve damage.
Cerebral Angiography and Vascular Evaluation
Cerebral angiography is an invasive diagnostic method used to examine in detail the structure and blood flow of brain vessels. It is performed by injecting contrast material into the vein through a catheter from the groin area. The situations in which this method, which creates a road map before vascular surgery, is used are as follows:
- Detection and size determination of aneurysms (vascular dilation)
- Analysis of vascular malformations such as arteriovenous malformations (AVMs).
- Grading of carotid artery blockages
- Preoperative vascular supply mapping
Lumbar Puncture and CSF Analysis
Lumbar puncture (LP), commonly known as spinal fusion, is a procedure performed to measure the pressure and analyze the content of cerebrospinal fluid (CSF). A thin needle is inserted between the lumbar vertebrae under sterile conditions to obtain a sample of fluid. CSF analysis is critically important in some inflammatory and infectious conditions where imaging methods are insufficient. This test is used to diagnose meningitis, intracranial pressure syndromes, and some nervous system cancers.
What are the treatment methods in neurosurgery?
Today, neurosurgery has become much safer with the development of minimally invasive (closed) techniques. The treatment plan is determined individually according to the patient's age, the stage of the disease, and the severity of the symptoms. The main treatment methods applied in the neurosurgery department are as follows:
- Microsurgery: This technique involves using a surgical microscope to magnify tissues and minimize nerve damage.
- Neuronavigation: It is a GPS-like system that guides the surgeon in 3D during surgery, ensuring the safest route to the target.
- Neuromonitoring: The risk of paralysis is minimized by monitoring nerve impulses in real-time throughout the operation.
- Endoscopic surgery: These are camera-assisted surgeries performed using small incisions or natural cavities (such as the nose).
- Gamma Knife and radiosurgery: It is a treatment of some tumors and vascular problems with high-dose radiation without surgical incision.
