What Is Brain and Nerve Surgery (Neurosurgery)?

Brain and nerve surgery (neurosurgery) is a medical specialty focused on diagnosing and treating injuries, disorders, and diseases of the brain, spinal cord, spine, and all peripheral nerves. In neurosurgery, specialists deal with the identification and treatment of brain, spine, and nerve conditions. Treatment and rehabilitation also include surgical procedures for conditions that block blood flow to the brain.

Experts in the field of neurosurgery are highly qualified in the prevention, diagnosis, and surgical treatment of disorders affecting the nervous system. These professionals can be detailed according to their areas of expertise as follows:

Brain Surgery

Brain surgery is the medical field responsible for diagnosing and treating disorders of the brain, spine, and nervous system, as well as conditions that affect blood flow to the brain. Specialists perform surgical procedures and take part in the rehabilitation process that follows treatment. They play a key role in managing conditions that impair brain function, such as brain tumors, hemorrhages, traumatic brain injuries, vascular blockages, and aneurysms.

Spine Surgery

In the field of spine surgery, degenerative spine diseases, spinal tumors, herniated discs, and spinal fractures are treated. Trauma-related damage occurring in the spinal cord or spine can place pressure on the nerves, leading to pain and limited mobility. Spine surgery aims to relieve nerve compression and may include procedures designed to stabilize the spine.

Peripheral Nerve Surgery

Peripheral nerve surgery focuses on symptoms that arise after nerve damage, such as loss of movement, pain, or numbness. Nerve entrapments, carpal tunnel syndrome, and trauma-induced nerve injuries fall under this branch of neurosurgery.

Vascular Neurosurgery

Vascular neurosurgery treats blockages, aneurysms, and abnormalities in the blood vessels that supply the brain. Conditions such as stroke, which result from a lack of blood flow to the brain, are also managed by vascular neurosurgery specialists.

Treatments within the field of neurosurgery extend beyond surgical intervention alone and continue afterward as part of a comprehensive recovery plan. Brain and nerve surgeons also oversee and guide the postoperative rehabilitation process.

What Does Neurosurgery Cover?

In the medical department of brain and nerve surgery, the diagnosis and surgical treatment of central and peripheral nervous system disorders are performed. These include spinal fractures, spinal and brain tumors, brain hemorrhages, spinal deformities such as scoliosis, head and neck injuries, congenital anomalies, trauma, vascular disorders, and stroke.

Brain Aneurysms

A brain aneurysm is a balloon-like bulge that forms in the blood vessels of the brain and can lead to sudden deterioration and life-threatening bleeding.

Arteriovenous Malformation (AVM)

An AVM is a vascular disorder in which arteries and veins appear as a tangled cluster in the brain, making them prone to bleeding.

Carotid Stenosis

Carotid stenosis is the narrowing or blockage of the carotid artery within the neck or brain. Blood clot formation can lead to stroke, and treatment must be performed within hours.

Brain Hemorrhages

This condition occurs when blood leaks into the brain tissue or the protective membranes surrounding the brain.

Cerebral Vessel Occlusion

Cerebral vessel occlusion occurs when a blockage abruptly cuts off blood flow to the brain. Known commonly as a stroke, it requires immediate treatment. Blocked vessels can be opened with endovascular techniques, blood flow can be restored with microsurgery, and pressure on the brain tissue can be relieved when necessary.

What Are the Diseases Treated by Neurosurgery?

Brain and Spinal Cord Tumors

Surgical interventions for brain and nerve tumors in both adults and children are performed using microsurgical and endoscopic techniques. Patients are evaluated by a multidisciplinary team consisting of neurosurgeons, radiation oncologists, medical oncologists, and neuroradiologists. For certain tumors, long-term chemotherapy and/or radiotherapy may be planned. Surgeries for skull base tumors, especially pituitary tumors, are often performed with the participation of ENT specialists as part of the surgical team.

Spine Disorders

Surgical treatment is applied for traumatic spine conditions such as injuries and accidents, degenerative conditions like spinal canal narrowing and vertebral slippage, and congenital spine disorders. Brain and nerve surgeons also treat conditions like lumbar and cervical disc herniations. Minimally invasive spine procedures, including micro- and endoscopic surgeries for disc herniation and spinal stabilization (instrumentation), are performed in a “Minimally Invasive Spine Center,” which also coordinates rehabilitation services and physical therapy. Non-surgical, interventional pain procedures are also provided within this discipline.

Pediatric Brain and Nerve Disorders (Pediatric Neurosurgery)

Surgical interventions are applied for congenital and acquired brain and spinal disorders in children. These include tumors, vascular disorders, hydrocephalus (accumulation of cerebrospinal fluid in the brain), and spinal dysraphism (spinal defects), which are especially common in the neonatal period.

Trauma (Head Injuries from Accidents or Assaults)

Patients with head trauma receive urgent interventions without delay, alongside intensive care management. They are also guided into physical therapy and rehabilitation programs. The primary goal is to eliminate life-threatening risks and improve quality of life. All types of trauma-related injuries, including head and spine trauma, are diagnosed, treated, and monitored by a 24/7 coordinated team of brain, spinal, and nerve surgeons in collaboration with emergency and intensive care units.

Treatment of Functional Disorders

Functional disorders that reduce quality of life, such as Parkinson’s disease and other involuntary movement disorders, are treated with interventions like deep brain stimulation. Spasticity caused by congenital conditions or severe head trauma can be treated with selective dorsal rhizotomy or baclofen pump implantation. In cases of epilepsy (seizure disorders) unresponsive to medication, epilepsy surgery is planned. The need for surgical intervention and its potential benefits for all functional disorders are evaluated by a multidisciplinary team including neurologists, psychiatrists, and physical therapy specialists.

What Are the Diagnostic Methods in Neurosurgery?

Neuronavigation

In brain, spinal, and nerve surgeries, operations are performed using a neuronavigation system that provides three-dimensional imaging. This method is used in brain tumors, brain tumor biopsies, spine and spinal cord surgeries, and Parkinson’s surgery. Neuronavigation involves using images taken before or during surgery to guide the procedure. Preoperative MRI scans of the patient are transferred to the neuronavigation system, allowing anatomical or physiological images to be used during surgery. Real-time neuronavigation helps visualize risk areas in the brain or spinal cord, enabling precise planning. This technology allows highly accurate access to targeted areas in the brain and spine while minimizing damage to healthy tissue.

Neuromonitoring

During surgeries involving tumors in sensitive brain regions, aneurysms or AVMs, spinal cord tumors, and delicate spine procedures such as scoliosis correction, electrodes are placed on the patient’s face, arms, and legs after anesthesia. These electrodes continuously monitor nerve signals. Any drop in signal alerts the surgeon to the proximity of sensitive areas, significantly reducing the risk of postoperative paralysis of the face, arms, or legs.

Intraoperative Ultrasonography

During surgery, a radiologist uses an ultrasound device to locate brain or spinal cord tumors and verify how much has been removed. This technique is especially valuable for tumors that are difficult to distinguish from surrounding tissue, ensuring maximal removal.

Endoscopy

Endoscopy provides a wide field of view through a small surgical corridor, particularly useful for pituitary tumors, intraventricular tumors, and hydrocephalus procedures. It also serves as a minimally invasive alternative to microsurgery for common spine problems like herniated discs.

Gliolan Fluorescence Technique

Before surgery, the patient is administered Gliolan, a substance that makes the tumor appear in a different color. Using a surgical microscope with a special filter, normal brain tissue and tumor tissue are distinguished by color. This technique maximizes tumor removal while minimizing damage to healthy brain tissue, reducing the risk of neurological deficits.

Awake Craniotomy

For tumors near the speech center or motor areas responsible for arm and leg movements, the patient is kept awake during surgery. This allows surgeons to monitor speech and motor functions in real time, preventing damage and improving surgical outcomes.

Intraoperative CT (O-Arm)

During surgery, computed tomography can be performed to visualize progress in real time. This is especially useful in spinal screw placement surgeries. O-Arm technology provides 3D imaging, minimizing error during screw placement, reducing disease recurrence risk, and allowing smaller incisions. It also decreases radiation exposure and lowers the risk of infection.

What Are the Surgeries Performed in Neurosurgery?

Surgeries in the field of brain and nerve surgery (neurosurgery) are determined and performed according to the specific conditions affecting the spinal cord, brain, and nerves. Common procedures include brain tumor surgeries, epilepsy treatments, and Parkinson’s disease surgeries. The main types of surgeries performed in brain and nerve surgery (neurosurgery) can be listed as follows:

Brain Tumor Surgeries

Surgeries to remove malignant or benign tumors in the brain are performed by neurosurgeons. During the operation, the tumor is removed completely, and in some cases, a margin of surrounding tissue may be excised to prevent the spread of cancer. Microsurgical techniques can be used to enhance precision during the procedure.

Skull Trauma Surgeries

Trauma to the head caused by blows, traffic accidents, or falls may require surgical intervention. These procedures often involve removing accumulated blood, relieving pressure within the skull, or repairing broken bones.

Epilepsy Surgery

When epilepsy cannot be controlled with medication, surgery may be necessary. The operation targets the specific brain region causing seizures, potentially severing nerve connections to reduce or prevent epileptic episodes.

Aneurysm and Vascular Surgery

Abnormal expansion of brain blood vessels and aneurysms can pose life-threatening risks. Ruptured aneurysms can cause severe brain bleeding. Surgical intervention is performed to repair these vascular anomalies and prevent complications.

Spine Surgery

Surgeries for the spine include removing herniated discs, stabilizing the spine, and excising spinal tumors. Conditions such as cervical and lumbar disc herniations, which can compress nerves and reduce quality of life, are treated under spine surgery.

Spinal Cord Tumor Surgeries

Surgical procedures remove tumors around the spinal cord and spine. Tumors in the spinal cord can compress nerves, causing weakness, pain, or limited movement. Surgery aims to relieve these symptoms.

Hydrocephalus Surgeries

Hydrocephalus is a condition in which excessive cerebrospinal fluid accumulates in the brain, causing pressure. Surgery diverts the fluid to reduce pressure and protect brain function.

Peripheral Nerve Surgery

This includes interventions for nerve damage, nerve compressions, and cysts or tumors in the nerves. Peripheral nerve surgery is also used for conditions like carpal tunnel syndrome that cause pain and restricted movement.

Functional Neurosurgery

Surgeries for movement disorders such as spasticity or dystonia may involve implanting devices that send electrical signals to the brain, improving the patient’s quality of life.

Parkinson’s Disease and Movement Disorder Surgeries

When medication is insufficient, surgery may be performed to treat movement disorders. Deep Brain Stimulation (DBS) involves placing electrodes in specific brain regions to deliver regular electrical impulses, reducing symptoms such as tremors and muscle rigidity.

These surgical procedures are planned and tailored based on the patient’s condition, the necessity of the operation, and the surgeon’s area of expertise.