Neurosurgery (Brain and Nerve Surgery) is an important part of the treatment of central and peripheral nervous systems (brain, medulla spinalis, nerves) diseases.
What are the diseases that can be treated with neurosurgery?
- Tumors (benign or malignant)
- Vascular problems (aneurysm, AVM, intracranial hemorrhage, cerebral vascular occlusion)
- Parkinson’s disease
- Compression on the spinal cord and nerves
The anesthesiologist has an important share in neurosurgery operations (neuroanestesiologist). While the treatment is performed by the neurosurgeon, the successful performance of this sensitive operation is provided by a specially experienced anesthesiologist.
What are the types of neurosurgery surgery?
Types of neurosurgery operations according to the classification of the American National Cancer Institute:
- Craniotomy: allows the surgeon to reach the brain by removing an adequate piece of skull, used to remove the existing brain tumor, abnormal tissue, blood or blood clot, to remove pressure after trauma or stroke, repair aneurysm or skull fracture in the vessel, or to treat another condition. The skull fragment that was removed initially is put back in place.
- Biopsy: It is the removal of a piece with a needle for detailed diagnosis in cases that form a mass determined by imaging methods. For this, the skin is opened with a small incision, the skull is pierced and a needle is entered from there, and it is the process of taking a piece for examination by a pathologist.
- Deep brain stimulation (DBS): An implantable electrical signal-generating device that uses movement disorders in Parkinson’s disease is placed in certain areas to make electrical stimulation.
- Neuroendoscopy: Endoscopy is a minimally invasive technology, which is the general name of the procedures performed with small surgical instruments accompanied by light and camera through a thin tube with a cut made in the mouth, nose or body. Neuroendoscopic surgery is the procedure of the neurosurgeon to reach the diseased area and remove the necessary tissue by entering the skull through a small incision with a neuroendoscopy tool.
Endoscopic transsphenoidal surgery (also known as endoscopic pituitary surgery) is a type of neuroendoscopic surgery, which is the surgery to remove tumors or lesions in the pituitary, located behind the root of the nose.
- Posterior fossa decompression: The posterior fossa contains the cerebellum and the part called the brain stem, aiming to eliminate the pressure caused by any mass formation. It is the elimination of pressure on the brain stem, which is the beginning of the cerebellum and spinal cord, as a result of removing a part of the skull bone and removing the problematic tissue.
- Brain aneurysm repair and thrombectomy (clot removal): The interventional procedure is usually performed by specially trained Radiology specialists. Surgical instruments such as catheters or thin metal wires to reach the brain vessels are entered through the large artery in the groin of the patient, and the problematic blood vessel is determined using contrast dye, without opening the skull. This procedure is most commonly used in patients with a blood clot in a brain artery, a brain aneurysm (a weakened and swollen area in an artery wall), or a ruptured aneurysm that causes bleeding in the brain.
- Gamma Knife: Particularly, some of the brain tumor patients localized in the center of the brainstem and brain tissue are treated with stereotactic radiosurgery used by radiotherapy specialists with equipment called Gamma Knife. However, the “knife” here is not a knife, but the operation is not surgical. This is radiosurgery, meaning an external radiation therapy that does not involve an incision and does not open the skull. The procedure is known as the Gamma Knife, the brand of specialized equipment to deliver high doses of radiation targeted at tumors or other lesions while minimizing damage to surrounding healthy tissue.
- Spinal cord surgeries: Surgical treatment of diseases known as lumbar or cervical hernias due to compression on the spinal cord and nerve outlets, stick to hernia in the discs between the spine can be performed by neurosurgeons. Neck hernia is a more difficult type of surgery, and the healing process is reduced to less than 1 day with noninvasive methods.
What is the importance of an anesthesiologist in neurosurgery?
The role of the anesthesiologist is important in every surgery, but a more specialized anesthesiologist in neurosurgery plays a critical role. Therefore, it should be worked with specially experienced anesthetists.
- The anesthesiologist learns the medical history of the patient, the diagnostic tests and the medications he uses and decides which drugs should not be taken or which drugs should be added before the surgery. It gives detailed information to the patient on this subject.
- The main purpose here is to ensure the success of the surgeon’s procedure by giving the surgeon safer and more effective anesthesia and to minimize harm to the patient.
- While the anesthesiologist monitors and controls all vital functions during the operation (ECG, Respiratory, etc.) Needs additional devices (EEG) to monitor nerve and muscle responses as well as monitor.
- The anesthesiologist can monitor cerebral blood flow, blood pressure, and oxygenation to maintain brain health levels should also follow in detail.
- Potential side effects after brain surgery, such as epileptic seizures and anti-nausea drugs, should be given in a controlled manner together with the drugs used for pain.
What kind of anesthesia is done in neurosurgery?
General anesthesia is frequently used, especially because of the high-sensitivity tumor removal, the patient must remain completely asleep and still. Some surgeries are controlled anesthesia, in other words, drugs are called sedation that blocks pain and relaxes the patient. In this case, the patient can be easily awakened, which provides “awake” surgery, which is very important for some surgeries.
What is wake-up brain surgery?
This method, which is mainly used in awake brain surgery in epilepsy and Parkinson’s surgery, is also used in brain tumor surgery located near critical brain function areas. By answering the questions of the surgeon in the awake (conscious) state, it is aimed to protect areas such as vision, movement, or speech from brain functions during treatment and to provide the most effective treatment.
During awake brain surgery, sedation and pain medication is given in a controlled manner by the anesthesiologist who monitors the patient’s blood pressure, heart rate, and oxygenation. Also, a local anesthetic is applied to the operation site.
The amount of medication is determined by the anesthesiologist to be able to remain fully awake or conscious during the entire surgery and to be awakened when necessary. It is ensured that only the patient can speak and do some muscle movements. Some patients do not remember waking moments later.
Preoperative discussions with the anesthesiologist help reduce fears for this surgery.
How can I control the pain during the recovery period?
Since the anesthesiologists are also experts in the pain associated with the surgery, they ask the patient questions about the pain tolerance during the preoperative interview and determine the most suitable medications for the patient by performing some tests. He constantly monitors the patient in the administration of drugs to be used to reduce postoperative pain.
The anesthesiologist monitors the patient closely, especially in the early stages of recovery, by controlling the neurological condition of the patient, the effects of the drugs used against pain on the patient’s breathing and oxygenation. The first 24 hours is important, especially in terms of the benefits and risks of postoperative pain relief drugs.
What is the most dangerous brain surgery?
All brain surgeries are risky because the brain controls all functions in the body. However, craniotomy operations are considered to be riskier, and the area to be operated on, especially its proximity to important functional areas such as vision, movement, memory, speech, and coordination increases the risks. Postoperative complications such as excessive fluid production, stroke, seizure, brain swelling, cerebrospinal fluid leakage will make it the riskiest surgery.