Neurosurgery

Neurosurgery

Our accumulated experience in complex brain surgery allows us to offer our patients treatments with a wide margin of safety and a controlled postoperative period. At Neurovist we have the latest technology and a highly qualified staff to achieve the best results for each patient.

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Brain surgery

Neurosurgery is the medical specialty that is responsible for the management of diseases of the nervous system that require surgical treatment.

Much of this surgical activity is represented by cerebral neurosurgery, which addresses complex pathologies such as brain tumors, neurovascular problems such as cerebral aneurysms or arteriovenous malformations, cerebral hemorrhages, Chiari malformation, hydrocephalus, or pathology of pain such as trigeminal neuralgia.

Brain tumors

Brain tumors originate when a group of brain cells or other intracranial structures begins to grow independently and disorderly, forming a tumor or mass that induces a clinical symptomatology by compression of neighboring structures or by an increase of normal intracranial pressure. In many cases tumors are detected by performing imaging studies prescribed for other reasons.

Description

Brain tumors originate when a group of brain cells or other intracranial structures begins to grow independently and disorderly, forming a tumor or mass that induces a clinical symptomatology by compression of neighboring structures or by an increase in normal intracranial pressure. In many cases tumors are detected when performing imaging studies prescribed for other reasons.

These tumors can have a benign behavior, as in the case of meningiomas and neuromas, which maintain a slow and progressive growth, usually displacing adjacent structures without invading them. These lesions originate from the cerebral (meninges-meningiomas) or nervous (neurinomas) layers, and can also appear at any level of the spine.

The treatment of these injuries is surgical if they acquire an important size and produce symptoms. In some cases, follow-up can be done in consultations and adapt the treatment according to the clinical and radiological evolution.

Primary brain tumors (gliomas) have a malignancy character, and appear from the transformation of brain tissue itself. Its growth is much faster and more aggressive, infiltrating brain structures from a distance.

In these cases, the first stage in the treatment is surgery, with the objective of removing as much tumor tissue as possible, which has an influence on the patient’s prognosis.

Oncologic patients can develop brain metastases when the primary tumor (lung, breast, colon, etc.) sends malignant cells that nest and grow in other organs, including the brain. Nowadays, many of these patients can be offered a neurosurgical treatment to remove the lesion.

Aneurysms

Brain aneurysms are acquired dilations of the cerebral vessels in the form of a small balloon, which at a certain moment can be broken, causing severe cerebral hemorrhage. Neurosurgical treatment consists of excluding the aneurysm from the circulation by placing a small clip that closes the blood flow to it. If a good clip is achieved, this treatment is definitive.

Description

Brain aneurysms are dilatations acquired from the cerebral blood vessels in the form of a small balloon, which at a certain moment can rupture, producing a serious cerebral hemorrhage.

The neurosurgical treatment consists of excluding the aneurysm from the circulation by placing a small clip that closes the flow of blood to it. If a good clipping is achieved, this treatment is definitive.

Endovascular treatment consists of filling the aneurysm with metallic filaments through a catheterization, a procedure in which a puncture is made in the inguinal region, introducing a catheter that reaches the lesion.

Arteriovenous malformations are vascular lesions characterized by a ball of vessels irrigated by one or several arteries and drainage veins that evacuate the blood. They are lesions with a high risk of bleeding, so treatment is usually indicated. These malformations can cause epileptic seizures due to irritation of the adjacent cerebral cortex.

In many cases, these aneurysms and malformations are detected when carrying out routine imaging studies, in patients who come for other symptoms at the consultation of another specialist.

Complementary tests include a CT angiogram, a brain MRI and a cerebral arteriographic study in which contrast is injected into the cerebral vessels in order to adequately analyze the morphology of possible vascular lesions.

The neurosurgical treatment consists of removing the malformation by progressively closing the arterial contributions of the same and finally the drainage veins.

Treatment

The neurosurgical treatment of brain lesions is carried out by means of a craniotomy, a technique by which the area where the pathology is located and reached through a window that we make in the cranial bone.

The types of craniotomies are very varied depending on the type of injury that we want to address, and contrary to what may seem, are usually interventions well tolerated by the patient and a postoperatively quite comfortable, since usually only required in this period a conventional analgesia type paracetamol, dexketoprofen or metamizol.

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Chiari malformation

The Chiari type I malformation, also known as Arnold-Chiari, is due to a compromise of space in the posterior cranial fossa, where vital structures such as the cerebellum and the brainstem are housed. In its natural evolution can cause neurological sequelae by involvement of structures of the spinal cord.

Description

The type I Chiari malformation, also known as Arnold-Chiari malformation, is a frequent reason for consultation in Neurosurgery. The main symptom of the patients is the headache of onset in the second or third decade of life, which may be accompanied by weakness and sensory alterations in the upper limbs.

It consists of an alteration of the posterior cranial fossa in which there is an obstruction of the circulation of cerebrospinal fluid through the foramen magnum of the skull.

It is accompanied by a herniation or descent of part of the cerebellum (cerebellar tonsils) through the foramen magnum of the skull.

This malformation can have a secondary repercussion on the spinal cord known as syringomyelia, in which a cystic cavity originates in the center of the spinal cord that ends up damaging the medullary nerve tissue, producing progressively disabling neurological symptoms.

Treatment

The surgical treatment used in these patients is the decompression of the posterior fossa to expand the space of the same and improve the circulation of the cerebrospinal fluid. Sometimes it is also necessary to treat syringomyelia.

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Trigeminal neuralgia

Trigeminal neuralgia manifests as an intense pain in the form of discharges that is usually distributed on one side of the face, most often in the areas of the cheek and jaw. The most favorable cases can be treated medically, but in cases with poor response to medication, the neurosurgeon should be consulted in order to evaluate the neurosurgical treatment of choice in these patients and obtain very satisfactory results.

Description

Trigeminal neuralgia is a type of facial pain that occurs in the form of discharges of very intense pain in the distribution of one or more branches of the trigeminal nerve, responsible for collecting the sensitivity of the face. It is typically unilateral and does not associate other neurological deficits.

In the majority of patients, it is caused by the nerve’s involvement in its exit from the brain through a loop of a cerebral artery or a vein.

It is an extremely invalidating pathology for patients, which greatly limits their social, family and even food, since the pain starts with any small stimulus such as smiling, chewing or brushing their teeth.

The treatment is initially medical, with one or several drugs and assessing the patient’s clinical response. It is important to note that medical treatment fails in up to 75% of patients, so these patients require a neurosurgical procedure.

Treatment

The most effective neurosurgical treatment in trigeminal neuralgia is microvascular decompression, which consists in the release and isolation of the nerve directly from the structures that compromise it.

Neurovist professionals are very familiar with this surgical technique, which we consider safe and very effective in selected cases.

This intervention is carried out through a small wound behind the ear, where we can explore the area of the nerve that we are interested in examining. It can be performed in a wide range of ages, it presents a low rate of complications in experienced hands, and hospital discharge is usually quite early.

The functional result of this treatment is excellent in many of the patients, even in the long term.

In cases of atypical facial neuralgia, percutaneous radiofrequency techniques may be indicated that obtain very satisfactory results.

Hydrocephalus

When circulation of cerebrospinal fluid in the nervous system is hampered, there is a picture of hydrocephalus, which translates clinically with a decrease in the patient’s level of consciousness, which can even reach coma. Hydrocephalus may manifest more severely in older adults as a form of cognitive impairment, which usually reverses after neurosurgical treatment.

Description

Our brain has cavities inside called ventricles where cerebrospinal fluid circulates, at the same time bathes and protects the brain and spinal cord.

Hydrocephalus occurs when the circulation of this fluid is hindered by obstruction or by anomalies in its resorption, producing a dilation of the ventricular cavities that leads to an increase in normal intracranial pressure. This increase in pressure in the head can produce headache and neurological symptoms, and when it appears acutely can endanger the patient’s life.

A common cause in childhood is the congenital stenosis of the aqueduct of Sylvius, and in the elderly the normotensive hydrocephalus, also called chronic hydrocephalus of the adult.

Treatment

The treatment of hydrocephalus is carried out by means of a small intervention, a bypass of cerebrospinal fluid (valve), in which a catheter is placed in the cerebral ventricles that leads the excess fluid to the peritoneum (ventriculoperitoneal shunt), towards the pleura, or intravascular.

The liquid flow is regulated by a valve connected to a catheter. At present, these valves are programmable, that is, once they have been implanted in the patient, we can modify their parameters to adapt them to the needs of the patient.

An important aspect is that patients carrying bypass valves can perform a completely normal activity, without restrictions.

Another possibility of surgical treatment is endoscopic ventriculostomy, by which another natural route of circulation of the cerebrospinal fluid is created and which therefore does not require the placement of external devices such as the valve. This technique is used mainly in the stenosis of the aqueduct of Sylvius.

How is brain surgery?

The neurosurgical treatment of the cerebral lesions is carried out by means of a craniotomy, technique by which the area where the tumor is reached through a window that we realize in the cranial bone.

The types of craniotomies are very varied depending on the type of injury we want to address, and contrary to what may seem, are generally interventions well tolerated by the patient and with a fairly comfortable postoperative, since it is usually only required in this period a conventional analgesia type acetaminophen, dexketoprofen or metamizole.

A very frequent question of the patients is: are they going to shave my head?

At Neurovist we perform the surgical wounds hidden in the hair and without shaving the head in any case, with this we get an excellent cosmetic result in all cases.

At the end of the intervention the patient is awakened in the operating room, and later, by protocol, he / she is transferred to the ICU where he / she stays for about 24 hours.

An early postoperative control test (cranial CT or brain magnetic resonance imaging) is performed and after its evaluation the patient is transferred to the plant, where he initiates the mobilization, and we advise him to wander around the room.

The hospital stay is variable depending on each patient and the type of intervention, the average is usually 3-4 days.

The first postoperative check in outpatient clinics is scheduled 15 days after surgery.