MINISTRY OF HEALTH ANKARA CITY HOSPITAL

Neurosurgery Updated: 12 June 2020

Neurosurgery


 

Brain Surgery

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NEUROSURGERY

GENERAL INFORMATION ABOUT THE DEPARTMENT

Neurosurgery Intensive Care Unit provides service with 16 beds for level 2 ICU patients and another Neurosurgery Intensive Care Unit, provides service with 16-beds for level 3 ICU patients. NICU's are located on the first floor and the fourth floor. There are 49 rooms in total, 32 of which are single under A, B and C wings, and we have 66 beds in the wards. One of our single rooms has a special ventilation system that allows respiratory isolation. All of the rooms have sinks, baths, toilets, televisions that each patient can use separately. Fridges and sofas also provide comfort for patient companions. 3 professors, 8 lecturers and associate professors, 4 specialist academic members, 9 specialist physicians, 21 residents, 58 ward nurses, 30 operating theater nurses, 55 NICU nurses, 6 medical secretaries work in our department. Our operating theaters have modern equipment, medical devices and the highest level of safety measures and infrastructure to prevent infection.

Pre-op arrangements are completed in a multidisciplinary approach with neuropathologists, neuroradiologists, medical oncologists, endocrinologists and physicians from other branches if necessary. Also the department work coordinately for post-op rehabilitation care and medical procedures. The aim of our department is offering the best and the newest diagnosis and treatment methods for patients accompanied by evidence-based medicine and to conduct scientific research and projects to contribute to medicine in our country and to train new neurosurgeons to be in safe hands in the future.  

Diagnose and Treatment

In Neurosurgery Department, diagnosis, treatment and follow-up of brain diseases, spinal cord and spine systems are carried out while benign and malignant brain tumors (such as glial tumor, PCA tumor, meningioma), pituitary tumor (with endoscopic transnasal transsphenoidal and microscopic transnasal transsphenoidal methods) are treated. 

Hematoma surgery (epidural, subdural and intraparanchymal), aneurysm, arteriovenous malformation, cavernoma, endovascular procedures (aneurysm with endovascular method, AVM surgery,) removal of spine and spinal cord tumors (extradural and intradural tumors, metastatic tumors), spinal fracture, (cervical thoracic surgeries), vertebroplasty and kyphoplasty procedure are performed. 

Degenerative spine diseases (lumbar herniated disc surgery, cervical herniated disc surgey, spondylolisthesis surgery, cervical canal stenosis surgery, lumbar canal stenosis surgery, degenerative scoliosis surgery), spinal deformities (congenital spine problems, adult and pediatric kyphosis, scoliosis surgery, hydrocephalus (shunt surgery, endoscopic third ventriculostomy surgery) are performed. 

Consultation of pre-natal womb, newborn's intraventricular/intracranial hemorrhage, intracranial cerebro spinal fluid collection (hydrocephalus shunt surgeries, endoscopic surgeries) are conducted. 

Head and spine repairs such as meningocele, meningomyelocele, lipomeningocele, encephalocele are performed. Closed spinal dysraphism dermal sinus surgery, filum terminal, diastematomyelia/discrete spinal cord syndromes, brain, spinal cord and spinal tumors, peripheral nervous diseases (trauma, nerve cut, rupture repair are treated. Surgeries to treat nerve compression, epilepsy, pain therapy (pain surgery), movement disorders (parkinson surgery) are successfully performed.

Some sub-branches of Neurosurgery for diagnosis and treatment:

Endoscopic and functional Neurosurgery

Vascular and endovasvular Neurosurgery

Minimally invasive Neurosurgery and Advanced Neurosurgery

Pediatric Neurosurgery

Traumatic Neurosurgery

Skull base and Oncological Neurosurgery

Featured Procedures  

In Neurosurgery Department, brain tumor surgeries, spinal cord tumor surgeries with microsurgery accompanied by neuromonitor, spinal cord/spinal disease surgeries accompanied by neuromonitor are performed with the help of intraoperative ultrasound, neuronavigation and doppler microsurgery.

Units 

In The Department, there are 66 beds in total for inpatients and there are 32 beds in total for 2nd and 3rd-level ICU patients in Neurosurgery Intensive Care Unit. Pediatric Neurosurgery Outpatient Polyclinics are available in Children's Hospital of Ankara City Hospital which is the biggest hospital in Europe and our Spine Deformity outpatient polyclinic is available once a week. 

How do I get examined? 

Our polyclinics for adults are located on the B1 Floor in Neurology-Orthopedics Hospital (MH3) and our polyclinics are located on the ground floor in Children's Hospital (MH4) You can call 182 MHRS (Centralized Hospital Appointment System) to make an appointment or visit directly. 

BRAIN HEMORRHAGE AND STROKE: TREATMENT OF ANEURYSMS, ARTERIOVENOUS MALFORMATIONS - FISTULAS AND CAROTID STENOSIS 

Every year almost 10 to 20 percent of 100.000 population suffer from intracranial hemorrhage. The incidence is high particularly in patients above 55 years old as the nunmbers are much higher in the elderly population. Drinking alcohol and smoking are well known and proven risk factors. If not treated, brain hemorrhage inevitably causes death in more than 40 percent of the cases. Brain hemorrhage in young adults is usually due to head trauma, falls from height and car accidents. 

Spontaneous brain hemorrhage usually occurs with sudden and severe headache, loss of consciousness and drop attack. The most common reasons of spontaneous brain hemorrhage are cerebral aneurysms, arteriovenous malformations and fistulas. Vascular problems and hypertension as well as diabetes-mellitus exacerbate the risk, morbidity and mortality of these vascular problems. Thus, strict control of diabetes, daily salt intake and hypertension and also avoidance of alcohol and cigarette strongly helps to control the disease. 

Stroke is another common intracranial problem in the elderly population that is possible to be associated with carotid stenosis or similar atherosclerotic diseases. Treatment of stroke should be associated with strict control of risk factors as well as treatment of carotid stenosis. Carotid stenosis can be treated by open surgery or endovascular carotid stent deployment. Carotid stenting is a universal guideline in the majority of carotid stenosis cases with major risk factors such as cardiac problems, diabetes-mellitus and severe hypertension. 

Nevertheless, surgical removal of atheromatous plaque is a radical treatment which can be performed under local and general anesthesia. Carotid stenting significantly reduces morbidity and mortality in patients with 70% stenosis or more. The Diagnosis of intracranial vascular pathologies is usually made by cerebral angiography. 

Aneurysm treatment may be performed via open brain surgery (clipping) or endovascular treatment methods through femoral artery. The assessment and the decision of the treatment depends on patient’s general condition, age, associated systemic risk factors and technical availability.

Arteriovenous malformations may be treated via open surgery, endovascular treatment or gamma-knife surgery or a combination of those. In selected cases and AVMs amenable for resection, endovascular treatment is an important measure which decreases the risks of surgery and decreases the amount of blood loss during surgery. Gamma-knife surgery is a good alternative treatment particularly in deep localizations and cases with symptoms independent from hemorrhage. Arteriovenous fistulas are simply treated by endovascular methods. Pialor dural arteriovenous fistulas are commonly encountered in young ages and usually treated with endovascular measures. In selected cases of dural arteriovenous fistulas, surgical measures may be an alternative to surgical treatment. 

1. Cerebral aneurysm treatment: 

Cerebral aneurysms which need endovascular treatment are usually treated by primary coiling, stent assisted coiling, flow diverter treatment or combination of these modalities. Depending on the presence of subarachnoid hemorrhage, the decision may differ and some patients may need several sequences in treatment. The treatment is usually performed with a long guiding catheter inserted into related vasculature from femoral artery. The procedure described below also necessitates the use of a distal guiding catheter, microcatheter and 1 or 2 micro-guide wire.

a. coil embolization: each aneurysm may need 4 to 20 coils depending on the diameter of the aneurysm
 
b. stent-assisted coil embolization including stent deployment in addition to coiling 

c. flow diverter treatment of aneurysms: The treatment may or may not include additional coiling or stent use depending on the site, location and 
difficulty of the access of the aneurysm. A flow diverter may be defined as a tightly-braided intracranial stent. 

2. Cerebral Arteriovenous Malformation (AVM) or AV (arteriovenous) fistula treatment: 

AVM treatment includes treatment of AVM with a liquid embolic agent Onyx or Squid which are the only brands in the world. AVM treatment may be performed in these cases with or without bleeding. The treatment may also necessitates glue (N-butyl cyanoacrylate) Treatment also includes AV fistula and it may also be carried out with aneurysm coils and glue in these cases. The treatment is usually performed with a long guiding catheter inserted into related vasculature from femoral artery. The procedure described below also necessitates the use of a distal guiding catheter and a very tiny detachable tip microcatheter + micro-guide wire for each vessel. Averagely, 2 to 8 vials of liquid embolic agent (Squid or Onyx) are necessary for each AVM depending on the lesion size. The procedure also necessitates 2 to 6 microcatheters + microguidewire set for each treatment. If AVM size is greater than 3 cm, then the treatment may need 2 or more sequences. 

3. Craniospinal tumor embolization or spinal AVM-AV fistula: 

This embolization procedure is usually performed with a long guiding catheter inserted into related vasculature from femoral artery. The procedure described below also necessitates the use of a distal guiding catheter, microcatheter and 1 or 2 micro-guide wire. Polyvinyl alcohol, glue or liquid embolic agents (Onyx or Squid) may be preferred depending on the vascularization of tumor.
 
4. Carotid artery stenting: 

The treatment is usually performed with a long guiding catheter inserted into related vasculature from femoral artery. The procedure described below also necessitates the use of a microcatheter, microguidewire, carotid filter protection and pre-dilatation or post-dilatation balloon. 

5. Diagnostic cerebral and spinal angiography: 

The procedure includes the use of two types of diagnostic catheter, a femoral sheath, a guidewire and some connecting high pressure lines.


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