Brain, Nerve and Spinal Cord Surgery

BRAIN, NERVE AND SPINAL CORD SURGERY (NEUROSURGERY)

The Department of Brain, Nerve and Spinal Cord Surgery (Neurosurgery) is the medical specialty that deals with the diagnosis and surgical treatment of structural, traumatic, infectious, or tumor-related diseases affecting the central nervous system (the brain and spinal cord), peripheral nerve pathways, and the autonomic nervous system.

Daviva Health Group Department of Brain, Nerve and Spinal Cord Surgery provides healthcare services to our pediatric (children) and adult patients at international standards with modern technological infrastructure and a multidisciplinary treatment approach. In our department, personalized surgical strategies are applied with a focus on preserving neurological function and minimizing risk rates.

Which Conditions Does It Treat? (Clinical Areas of Interest)

In our neurosurgery department, the diagnosis, follow-up, and surgical treatment of the following diseases are carried out using advanced diagnostic methods and modern microsurgical techniques:

• Brain and Spinal Cord Tumors: Tumorous formations that develop in brain tissue or within the spinal canal, either benign or malignant.
• Pituitary Gland Tumors: Adenomas of the pituitary gland, which is located at the center of the endocrine system and can cause hormonal disorders or vision loss.
• Skull Base Tumors: Complex lesions such as acoustic neuroma (vestibular schwannoma) and meningioma that develop at the skull base near vital vascular and nerve structures.
• Cerebrovascular Diseases: Vascular pathologies with a risk of bleeding, such as brain aneurysms and vascular malformations.
• Spine and Disc Diseases: Herniated discs of the lower back and neck, spinal stenosis, and spondylolisthesis that significantly reduce quality of life.
• Spinal Deformities and Traumas: Spinal curvatures such as scoliosis and kyphosis, as well as spinal fractures due to accidents or osteoporosis.
• Functional and Movement Disorders: Parkinson's disease unresponsive to medication, essential tremor, dystonia, and resistant epilepsy cases.
• Pediatric Neurosurgical Diseases: Congenital or acquired brain and spinal cord diseases of childhood, hydrocephalus, and spina bifida (open spine).
• Peripheral Nerve Entrapments: Nerve compression syndromes such as carpal tunnel (wrist) and ulnar tunnel (elbow) syndromes.
• Chronic Pain Syndromes: Trigeminal neuralgia, which presents with sudden and severe pain in the facial area.
• Normal Pressure Hydrocephalus: Seen especially in older adults; a significant surgically treatable condition characterized by the triad of gait disturbance, urinary incontinence, and forgetfulness (dementia).

Diagnosis and Testing Methods

Effective treatment begins with a flawless diagnostic process. In our department, modern medical imaging technologies are used to maximize the accuracy and safety of surgical planning:

1\. Advanced Neuroradiological Imaging Methods

• High-Resolution MRI (Magnetic Resonance Imaging): Used for detailed mapping of tumors, herniations, and spinal cord diseases.
• Functional MRI (fMRI): Applied before surgery for critical brain tumors to precisely identify the location of vital centers such as speech, movement, and vision.
• MR Spectroscopy (MRS) and Perfusion MRI: Help analyze whether tumors are benign or malignant and assess tissue tumor burden at the cellular level before biopsy.
• Tractography (DTI - Diffusion Tensor Imaging): Visualizes vital nerve fiber pathways (tracts) in the brain in 3D, helping prevent damage to these pathways during surgery.
• Computed Tomography (CT) and CT Angiography: Provides rapid evaluation of acute brain hemorrhages, head trauma, and vascular structures.
• Dynamic and Flexion-Extension Spine X-rays: Detects the movement of bone structures in spondylolisthesis (vertebral slippage) and spinal instability.

2\. Interventional and Neurovascular Diagnostic Methods

• Digital Cerebral Angiography (DSA): The gold standard in diagnosing aneurysms and vascular lesions.
• Spinal Angiography: Used to map complex vascular malformations within the spinal cord (AVM, dural fistula).

3\. Advanced Neurophysiological Tests

• EMG (Electromyography): Performed to determine the degree of peripheral nerve entrapments such as carpal tunnel and to identify which nerve root is affected in disc herniations of the lower back/neck (radiculopathy).
• EEG (Electroencephalography) and Video-EEG Monitoring: Used especially in patients with resistant epilepsy to precisely locate the seizure focus (the brain area where the focus starts) before surgery.
• Evoked Potentials (EEP - SEP, MEP, VEP, BAEP): Detect functional damage by measuring the electrical conduction speed of spinal cord, hearing, and visual nerve pathways.

4\. Nuclear Medicine and Metabolic Imaging

• PET/CT (Positron Emission Tomography): Used to evaluate the metabolic activity of brain tumors and to distinguish recurrent tumor from radiation damage (radionecrosis).
• DatSCAN (Dopamine Transporter SPECT): Applied before functional neurosurgery (deep brain stimulation) to make a definitive diagnosis of Parkinson's disease and differentiate it from other parkinsonism conditions.

5\. Special Laboratory and Other Examinations

• CSF (Cerebrospinal Fluid) Analysis and Tap Test (Lumbar Puncture): In the diagnosis of Normal Pressure Hydrocephalus, fluid is withdrawn from the lower back and improvement in the patient's clinical condition and walking is observed; it also serves as a liquid biopsy for detecting meningitis and tumor cells.
• Neuro-Ophthalmologic Tests (Visual Field and OCT): Used to objectively measure the pressure and damage that pituitary and skull base tumors cause to the optic nerve.
• Neuronavigation-Assisted Planning: Aims to reduce the margin of error to zero by determining the three-dimensional coordinates of the lesion before surgery.
• Intraoperative Neuromonitoring (Neuromonitor / IONM): A system that monitors the status of motor and sensory nerve pathways in real time, especially during spinal cord tumors, scoliosis, complex spine surgeries, and delicate brain operations. Throughout surgery, the patient's nerve conduction is continuously measured, providing immediate feedback to the surgeon; thus, the risk of postoperative paralysis and permanent damage is minimized.

Treatment and Surgical Methods

Our fundamental philosophy in the operations performed at our hospital is based on the principles of "function-preserving, safe, and minimally invasive surgery". Thanks to our technological infrastructure, operations are completed with much smaller incisions, without damaging healthy tissues, and our patients' recovery times are shortened.

1. Brain Tumor and Skull Base Surgery

In the removal of benign or malignant tumors, neuronavigation, neuromonitoring (monitoring nerve functions during surgery), and microsurgical techniques are used together. In skull base tumors, endoscopic methods are preferred according to the anatomical region, thereby preserving brain tissue to the maximum extent.

2. Endoscopic Pituitary Surgery (Transnasal Approach)

In the surgical treatment of pituitary adenomas, the tumor is removed using endoscopic methods (transsphenoidal) entirely through the nose, without opening the skull. This method offers the patient high comfort and a rapid discharge process.

3. Minimally Invasive Spine Surgery (Microdiscectomy and Endoscopy)

Lumbar and cervical disc surgeries are performed under advanced microscopes or endoscopic cameras. This microscopic/endoscopic approach, which does not damage surrounding tissues and muscles, minimizes postoperative pain and allows the patient to stand up on the same day.

4. Spinal Stenosis and Spine Stabilization

In spinal canal stenosis operations, compressed nerve roots are released (decompression). When necessary, instrumentation (plate/screw applications) supported by neuroradiological imaging is performed to preserve the mechanical strength of the spine.

5\. Functional Neurosurgery, Neuromodulation and Pain Surgery

Functional neurosurgery methods are applied in the surgical management of movement disorders, treatment-resistant neurological/psychiatric conditions, and chronic pain syndromes:

• Deep Brain Stimulation (Brain Pacemaker - DBS): Used to control movement disorders such as Parkinson's disease, essential tremor, and dystonia. It is also applied as an option in the treatment of certain psychiatric conditions such as Obsessive-Compulsive Disorder (OCD) and major depression that do not respond to medication.
• Spasticity Surgery: Baclofen Pump (Intrathecal Baclofen Pump) implantation or selective dorsal rhizotomy surgeries are performed to reduce severe muscle contractions (spasticity) due to cerebral palsy, stroke, or spinal cord injuries.
• Chronic Pain Surgery: In chronic pain that cannot be controlled with medical treatment and occurs in conditions such as cancer pain or failed back surgery syndrome, Spinal Cord Stimulation (SCS) and targeted pain surgery methods are used.

6. Pediatric Neurosurgery (Children's Brain Surgery)

For our pediatric patients aged 0-18, in accordance with the delicate anatomy of the nervous system; shunt surgery or endoscopic ventriculostomy in hydrocephalus treatment, and spina bifida repairs are carried out in coordination with pediatrics and pediatric neurology clinics.

7\. Brain Hemorrhage Surgery (Neurovascular Emergency Interventions)

Brain hemorrhages are emergency conditions in which time is critical, occurring within brain tissue or between the membranes of the brain (epidural, subdural, subarachnoid) due to trauma, high blood pressure, aneurysm (balloon) rupture, or vascular malformations:

• Hematoma Evacuation: Blood collections (clots) that threaten vital functions by compressing brain tissue are safely drained using craniotomy (opening the skull bone) or minimally invasive microsurgical methods.
• Intracranial Pressure (ICP) Management and Decompressive Craniectomy: In cases where intracranial pressure rises excessively due to bleeding and edema, the temporary removal of part of the skull bone is performed to relieve the brain, and intracranial pressure monitoring is meticulously applied.
• Aneurysm Clipping: To eliminate the risk of rebleeding from bleeding aneurysms (balloon-like bulges), vessel closure (clipping) operations are performed with microsurgical methods and a high success rate.

8\. Spine Tumors and Their Surgical Treatment

Spine tumors are benign or malignant masses that develop in the vertebral bones, spinal cord tissue, or nerve roots emerging from the spinal cord. In our clinic, spine tumors are treated with modern methods that preserve the patient's mobility and neurological health:

• Microsurgical Resection (Tumor Removal): Tumors within or around the spinal cord are removed to the maximum extent under the microscope, with advanced microsurgical techniques and neuromonitoring (nerve function monitoring), without damaging healthy nerve tissues.
• Spinal Reconstruction and Stabilization: To correct the destruction caused by the tumor in the bone tissue or the instability that occurs in the spine after surgical cleaning, the spine is reconstructed with advanced instrumentation (plate and screw systems) supported by neuroradiological imaging.
• Minimally Invasive Palliative Approaches (Vertebroplasty/Kyphoplasty): Especially to relieve severe pain caused by metastatic tumors in the vertebral bone and to prevent fractures, the vertebral bone is strengthened from within by injecting bone cement under local anesthesia.