What does a neurosurgeon do and when it is necessary to contact him - all the symptoms and studies. What is neurosurgery? The emergence and gradual development of neurosurgery

The content of the article

Brain tumors make up about 9% of the total number of all human neoplasms (I. Ya. Razdolsky, 1954) and occupy the fifth place among tumors of other localizations. According to A.P. Romodanov and N.N.Mosiychuk (1990), patients with brain tumors account for about 2% of patients with organic diseases of the nervous system. One case of brain tumor is registered annually for every 15-20 thousand people. Men and women get sick about the same. The incidence in children is slightly lower than in adults. Most often, tumors are observed between the ages of 20 and 50.

Etiology and pathogenesis of brain tumors

The nature of brain tumors is polyetiological, but has not been completely clarified for today. Among the theories explaining the mechanism of the appearance of tumors, the most popular are those that associate the appearance of uncontrolled growth with changes in the genetic information of cells. An important role here is played by hyperplasia, which occurs under the influence of various unfavorable exo- and endogenous factors (intoxication, inflammatory processes, ionizing radiation, carcinogens, hormonal disorders, prolonged trauma, and others). Disorders of embryonic development, dysontogenetic heterotopia and atypia in the structure of the brain can cause the development of the blastomatous process. The final solution to this question belongs to the future.

Classification of brain tumors

I. By localization:
-supratentorial
-subtentorial
-Dual localization:
craniospinal
suprasubtentorial
-convexitali
-basal
II. For brain tissue:
extracerebral
intracerebral
III. Origin:
-Primary
Neuroectodermal (from nerve cells - astrocytoma, glioma, glioblastoma, ependymoma, medulloblastoma, papilloma, pinealoma, neuroma)
-Secondary
3 derivatives of mesenchyme (metastatic) (meningioma, angioreticuloma, sarcoma)
3 cells of the pituitary gland (adenoma)
From the remains of the pituitary tract (craniopharyngioma)
Metastatic (in 80% of metastases of lung and breast cancer)
Teratomas and teratoid tumors
Heterotopic tumors of ectodermal origin (dermoids)

Brain tumor clinic

The clinical picture of brain tumors is due to the specificity of tumor growth, which is characterized by:
1) a general effect on the entire body,
2) the constant growth of the clinic - the disease gradient,
3) local effects on the structures of the brain. Brain tumors.
The clinical picture depends on the size, location, rate of tumor growth and the severity of perifocal edema. In the clinical picture of brain tumors, cerebral and focal symptoms are distinguished.
General cerebral symptoms indicate the presence of a tumor, focal (primary and secondary) - are important in topical diagnosis.

General cerebral symptoms

The emergence of cerebral symptoms is primarily due to an increase in intracranial pressure as a result of a gradual increase in the tumor, the development of concomitant edema - brain swelling, impaired cerebrospinal fluid circulation and venous outflow. In the occurrence of general cerebral symptoms, a certain role is played by intoxication of the body, associated both with the direct toxic effect of the tumor, and with dysfunctions of internal organs that arise when central regulation is disturbed through the growth of the tumor.
Venous congestion leads to extravasation of the liquid part of the blood and an increase in the production of cerebrospinal fluid by the choroid plexuses of the ventricles with a decrease in its absorption by crowded veins.
The most typical cerebral symptoms in hypertensive syndrome are headache, vomiting, dizziness, impaired consciousness.
Headache with tumors often of hypertensive origin, characterized by bilateralness and diffuseness, worries mainly in the morning, may be accompanied by vomiting, after which relief is possible. For meningiomas, a headache of a meningeal, vascular nature is more characteristic - periodic, mainly localized, worsening after physical and psychoemotional stress.
Central vomiting, not associated with food intake, occurs at the height of the headache. After vomiting, the patient's condition often improves, the severity of the headache decreases. Vomiting when changing the position of the head is characteristic of tumors of the IV ventricle.
Dizziness manifested by a sensation that resembles a state of light intoxication, faintness, uncertain coordination of movements. It is believed that the basis of this sensation is stagnation in the labyrinth.
Impaired consciousness manifest themselves in the form of stunning, the degree of which increases with an increase in intracranial pressure. Lability of the psyche, disorders of memory, thinking, perception, concentration are possible, delirium, hallucinations occur. Mental disorders can appear paroxysmal in the form of seizures, but more often develop gradually, when the stunning turns into stupor, and later into a coma. The pathogenesis of mental disorders in brain tumors is very complex. In some cases, they are caused by inhibition of the activity of the cerebral cortex as a result of hypertensive syndrome, in others, mental disorders are a focal symptom of a lesion predominantly of the frontal lobe.
For brain tumors with severe hypertension, visual disturbances are characteristic:
- Deterioration of visual acuity,
- Narrowing of visual fields, primarily red (an early symptom of hypertension),
- Nubilation (temporary periodic visual disturbances).
In the fundus, enlargement of the retinal veins, stagnation, and at later stages ~ atrophy of the optic discs, hemorrhages in the navkolodiskovy parts of the retina are found. The final stage of stagnant discs is their secondary atrophy. In brain tumors, atrophy of the optic discs can also be primary, associated not so much with increased intracranial pressure, but with direct compression of the optic nerves, or their overlap with a tumor. A peculiar phenomenon is observed when the tumor is localized in the area of the base of the anterior cranial fossa - Foster-Kennedy syndrome - on the side of the focus there is simple atrophy, a decrease in visual acuity to complete blindness with the development of a stagnant optic nerve head on the opposite side.
In addition to the listed main signs of an increase in intracranial pressure, meningeal symptoms, bradycardia, a decrease in pressure, especially diastole, circulatory disorders, and epileptic syndrome, which can be both local and hypertensive, are possible.

Focal symptoms

Focal symptoms are divided into primary focal symptoms and secondary focal symptoms - in the neighborhood and at a distance.
Primary focal due to the direct effect of tumors on the brain structures at the site of localization. Secondary focal due to the displacement (dislocation) of the brain and ischemic disorders.
Primary focal symptoms are manifested by disorders of the function of those parts of the brain on which the tumor has a direct effect: these are motor, sensory, olfactory, auditory, visual, speech disorders. So, with damage to the frontal lobe (posterior parts of the inferior frontal gyrus - Broca's center), motor aphasia is characteristic.
With damage to the temporal lobe - auditory hallucinations, sensory aphasia (the posterior part of the superior temporal gyrus of the dominant hemisphere - Wernicke's center).
Amnestic aphasia occurs when the lower and posterior parts of the parietal and temporal lobes are affected. It is difficult for patients to name an object, although they understand its purpose well.
Semantic or semantic aphasia develops when the process is localized at the junction of the parietal, temporal and occipital lobes of the left hemisphere in right-handers.
Epileptic seizures(convulsions, seizures) are most characteristic when the tumor is localized in the temporal lobe. Quite often, seizures for a long time are the first and only clinical sign of the disease, so their appearance should always raise the suspicion of the presence of a tumor. Epidemias can be small (petit mal), local (Jacksonian epilepsy), generalized seizures with loss of consciousness. Some of the features of attacks make it possible to judge the localization of the process. So, seizures preceded by hallucinations or motor auras are observed with a tumor of the frontal lobe, sensitive hallucinations - in the parietal, olfactory, auditory, complex visual - in the temporal, simple visual - in the occipital lobe.
Secondary focal symptomatology is divided into symptoms "in the neighborhood" and at a distance.
Secondary focal symptomatology is caused by displacement, pressure (dislocation) of parts of the brain or its trunk to the protrusions of the skull, tentorium of the cerebellum, crescent ridge, or impaired blood supply when the tumor compresses the vessels of the brain.
The most dangerous for life in case of volumetric processes of the brain (tumor, hematoma, abscess, etc.). There are dislocation syndromes that can be caused by such types of brain invasion:
1) lunar wedging under the falx;
2) temporo-tentorial;
3) cerebellar-tentorial;
4) wedging of the cerebellar tonsils into the cervico-occipital-dural funnel.
At the same time, against the background of progressive impairment of consciousness, there is an increase in headache, vomiting, bradycardia, arterial hypertension, an increase in oculomotor disorders, autonomic disorders, an increase in pyramidal disorders, tonic convulsions, arrhythmia, an increase in the frequency of breathing with a violation of its rhythm up to a stop, a decrease in blood pressure, clinical death.

Diagnosis of brain tumors

Based on neurological examination data and additional research methods.

Craniography

Craniography (survey in 2 projections and sighting) reveals a number of changes:
1) Craniographic signs (symptoms) are caused by an increase in intracranial pressure (intracranial hypertension):
a) osteoporosis of the back of the sella turcica;
b) thinning of the bones of the skull, deepening of digital impressions - in older children, young people;
c) seam divergence - in young children.
With a prolonged course of hypertensive syndrome, there may be a thinning of the Blumenbach slope (clivus os occipitalis), an increase in the vascular pattern, the threshold of the wings of the main bone.
2) Direct focal craniographic symptoms:
a) calcification (echinococcus, cysticercus, toxoplasmosis, planar hematomas, brain tumors can be zvapnuvatisya);
b) thinning and destruction of the bones of the skull (complete and incomplete destruction) - as a result of the action of dermoid tumors;
c) hyperostosis (thickening of the bone: needle, planar, mushroom - typical for benign tumors of the bones of the skull and meningiomas);
d) strengthening of the vascular pattern as a result of:
- Increasing the caliber of existing vessels,
- The appearance of newly formed vessels with an atypical course and branching.
3) Indirect focal craniographic symptoms are the result of displacement by the volumetric process of "physiological" zvapnen:
a) the pineal gland;
b) the dura mater, including the sickle process;
c) choroid plexuses;
d) vessels.
4) Craniographic symptoms of endocrine disorders, which are characteristic of tumors of the diencephalic region (changes in the bones of the skull with symptoms of acromegaly).

Echoencephalography

Echoencephalography (EchoEG) allows you to detect the displacement of the median structures of the brain when the tumor is located in the cerebral hemispheres. The displacement of the M-echo in such cases can reach 10 or more millimeters. In tumors of subtentorial localization, displacement of the M-echo, as a rule, does not occur, however, other indirect signs of a tumor can be detected on echoencephalograms, namely, signs of increasing hypertension, as indicated by an increase in the size of the ventricles.
In electroencephalography (EEG), the main characteristic feature of brain tumors is the appearance of foci of bioelectric activity, which often correspond to the location of the tumor. sometimes near these foci zones of insanity are revealed. With severe hypertensive syndrome, general changes in bioelectrical activity may prevail over focal ones.

Pnsvmoencephalography and pneumoventriculography

Pnsvmoencephalography and pneumoventriculography can reveal displacement (dislocation) of the ventricles of the brain and cisterns, a change in their shape (deformation), an increase in the size (hydrocephalus) of the ventricles of the brain and subarachnoid space.

Lumbar puncture

Lumbar puncture for brain tumors may be of little information. At certain localizations of tumors (subtentorial), there is a real danger of causing penetration of the brain structures. With lumbar puncture, an increase in the pressure of the cerebrospinal fluid is predominantly detected. Protein-cell dissociation (an increase in the amount of protein with normal cytosis) is more typical for neuromas of the auditory nerve and basal meningiomas, although it is also observed in other types of brain tumors. In malignant tumors, pleocytosis can reach several hundred cells. sometimes tumor cells can be found in the cerebrospinal fluid.

Angiography

In angiography, the most important signs of a brain tumor are the displacement of the vessels and their main branches, the appearance of new vessels, and a change in the duration of the angiography phases is also noted. Angiography is crucial for identifying the sources of blood supply to the tumor, helps in making a topical diagnosis and determining the histostructure of the tumor.

CT scan

The most informative in the diagnosis of brain tumors is computed tomography (CT) - a method of layer-by-layer examination of brain structures based on the different ability to absorb X-rays and magnetic resonance imaging (MRI). The latter method is based on the phenomenon of nuclear magnetic resonance, for the discovery of which in 1946 and. Parzell and F. Bloch received the Nobel Prize.
These methods allow you to obtain an image, the quality can be compared with a histological section, while studies can be carried out in any plane of the brain. The sections show not only structural and pathological changes, but also physicochemical and pathophysiological processes of both the entire brain and its individual structures. With MRI, it is possible to carry out not only a functional study of the brain itself, but also to perform magnetic resonance angiography, which does not require puncture of the arteries. MRI allows you to build a three-dimensional reconstruction of the area under study, to highlight the vasculature and even individual nerves passing in the subarachnoid space, all this creates optimal conditions for early detection of brain tumors, planning the volume and characteristics of surgical intervention and postoperative control.

Radioisotope scanning

Radioisotope scanning - the method is based on the ability of radioactive isotopes introduced into the body to accumulate in the tumor in greater quantities than in the surrounding tissues, which is recorded using special counters. The method allows to identify in about half of the cases (a tumor and to clarify its location.

Brain Tumor Treatment

Treatment of brain tumors is predominantly surgical. In benign tumors, microsurgical treatment is performed (likuvannya. In malignant tumors, a combined treatment is used - surgical in combination with chemotherapy, radiation and immunotherapy.

Surgery

With most extracerebral tumors (meningiomas, schwanomas, pituitary adenomas), it is possible to completely remove the tumor and avoid relapses. The operational risk depends on the patient's condition, concomitant diseases, the size and location of the tumor, and the complexity of the operation. Resection of large tumors is associated with significant damage to healthy areas of the brain, which affects the neurological status and the final result of treatment. A high risk is typical for the localization of tumors located in the cavity of the third ventricle, the region of the hypothalamus, trunk, foramen magnum, and tumors closely connected to the main vessels - the carotid artery or the sinuses of the brain.
To remove brain tumors, various approaches are used to the affected areas of the brain, mainly using craniotomy. Tumors of the pituitary gland in most cases are removed by transsphenoidal access. In connection with the advent of endoscopic technology, it became possible to remove intraventricular tumors through a special tube inserted into the ventricular system through a small milling hole. In cases of inoperable tumors, in order to reduce the clinical manifestations of the tumor and relieve the severity of the hypertensive syndrome, decompressive trepanation is performed. In cases of occlusive hydrocephalus and the impossibility of eliminating the cause of its occurrence, various types of shunting operations are used (ventriculoperitoneal shunting, ventriculocisternal (Thorkildsen operation), etc. The use of magnifying optics and microsurgical instrumentation made it possible to visualize previously inaccessible structures and dramatically reduce the incidence of surgical complications and postoperative mortality. In cases of an unfavorable location of the tumor, in order to prevent trauma to vital brain structures or the appearance of a gross neurological deficit, subtotal removal is used, when the tumor is removed almost completely, leaving only a part of it in the functionally important areas of the brain. , which are characterized mainly by infiltrative growth, complete removal is impossible without significant traumatization of intact brain structures and the phenomenon of pronounced neurological deficit. In such cases, partial removal is possible, since intracranial pressure is significantly reduced, which increases the effectiveness of subsequent radiation and chemotherapy.

Radiation therapy

Irradiation of tumor tissues with X-rays in doses of more than 50 Gy stops the continuous growth of tumors such as medulloblastomas, ependymomas, metastases of breast and lung cancer. Serious attention is paid to the use of gamma knife telecobalt therapy. Radiation therapy is indicated for partial removal of tumors. However, most tumors are insensitive to radiation therapy.

Chemotherapy

For a drug effect on the growth of tumors, various drugs are used that have the ability to penetrate the blood-brain barrier, concentrate in tumor tissues and suppress their growth. In the treatment of malignant gliomas, the greatest efficiency was observed in nitrosourea derivatives (carmustine, lomustine, etc.). After administration of the drug, leukopenia and thrombocytopenia are observed, the blood picture returns to normal within 3-4 weeks after administration of the drug. Re-administration of the drug is carried out only with the normalization of blood counts. Today, combined radiation therapy is used with frequent intraventricular administration of chemotherapy drugs (methotrexate, cytarabine) using an Ommaya reservoir, placed subgaleally and connected to the lateral ventricle (intrathecal chemotherapy

Neurosurgery is a highly specialized branch of surgery that studies and deals with the surgical treatment of diseases of the central and In a broader sense, these concepts mean diseases of the brain and spinal cord, as well as traumatic lesions of the nerves. In addition, consultation with a neurosurgeon will be needed in the case of vascular pathologies of the central nervous system and hydrocephalus, which is most common in children.

The emergence and gradual development of neurosurgery

Neurosurgery emerged as a separate area from neurology in the 1920s, which was dictated by the complexity of the treatment of polytrauma and the conduct of wars. During its inception, science was concerned with a rather limited range of diseases; in addition, diagnostics and methods of surgical treatment were very modest. However, at the end of the last century, there was a sharp breakthrough in the development of the industry, which was due to the widespread use of microscopic optics and contrast minimally invasive examination methods. Currently, neurosurgery is a specialty that has good prospects and is constantly evolving.

The nervous system and the needs of neurosurgery

The nervous system is a large number of conductors and centers of analysis that work as a whole. Therefore, for the correct restoration of their integrity, an accurate and low-traumatic comparison is necessary, which is possible only with the use of microscopy. Contrast examination allows to clearly visualize structural and functional changes in the vascular wall of the brain and spinal cord, which is inaccessible for conventional X-ray and ultrasound. It is these new studies that allow the specialist to timely identify and correctly treat aneurysms, thrombosis and congenital brain defects.

Diseases of neurosurgery

The doctor issues a referral for a consultation with a neurosurgeon in the case when there is a suspicion of benign or malignant neoplasms in the central nervous system. Benign tumors include meningiomas, dermoid, hemangioblastomas, colloid cysts, astrocytomas, neuromas. Malignant tumor formations are represented by various forms of astrocytomas and glioblastomas. In the case of purulent processes, and in particular brain abscesses and purulent meningitis, the help of a neurosurgeon is also needed. Brain neurosurgery has become especially widespread in the 21st century, and its more subdivision is neurovascular surgery, which treats aneurysms and hemorrhages, narrowing and pathological vasodilatations, thrombosis and arteriovenous malformations.

Quite often, patients with discogenic radiculitis, spinal cord compression and stenosis, and spinal hernias are admitted to the neurosurgery department. If a nerve fiber breaks or even bruises, it is also necessary to visit a neurosurgeon. and the spine are part of the polytrauma, therefore, in case of such injuries, in addition to the traumatologist, a specialist in the field should be involved

neurosurgery. A relatively new division in brain neurosurgery is functional and stereotactic surgery. She effectively treats epilepsy, tremor, and neuralgia of the fifth and ninth pairs of cranial nerves.

Congenital malformations of the brain and spinal cord are also treated by a neurosurgeon, however, of a pediatric profile. This includes hydrocephalus, the surgical treatment of which is carried out in children almost more often than all other pathologies of the central nervous system.

When should you see a neurosurgeon?

Here is an indicative symptomatology that will allow the patient to figure out whether there is a need to visit a specialist. Spine neurosurgery most often has

dealing with spinal hernias, which, depending on their location and size, have different symptoms. So, in particular, with a hernia of the cervical spine, pain in the shoulder, dizziness, and frequent changes in blood pressure are noted. With the localization of a hernial protrusion in the thoracic region, the patient mainly notes a constant pain syndrome in the sternum and symptoms of intercostal neuralgia. If you have a hernia of the lumbar spine, then numbness of the toes, aching pain in the legs, difficulty in walking and turning the body is more often observed. Traumatic brain injury has relatively stable symptoms and is more often manifested by loss of consciousness, nausea, headache, discoordination of movements and tinnitus. Brain neurosurgery is often faced with this pathology. Traumatic injuries of the extremities with impaired nerve function mainly manifest as numbness or discoloration of the skin of the segment, which is innervated by this conductor. Tumor pathologies can usually have a variety of symptoms, so CT and MRI take an important place here.

Neurosurgery. Operations

Surgical interventions in this area of surgery can be divided into radical and palliative. The term "radical" means that with their help it is possible to completely cure the patient. This, in particular, applies to most traumatic injuries, spinal

hernias and some vascular pathologies. Palliative interventions aim to relieve symptoms but do not address the underlying problem. Such operations include interventions for malignant tumors and some types of hydrocephalus.

Neurosurgery, like cardiac surgery, is a high-precision industry that uses modern technology and the latest examination methods. This need for accuracy is due to the complexity of the structure and the powerful blood supply to the central parts of the nervous system. Therefore, a neurosurgeon must carry out high-precision manipulations in order to prevent possible complications and their consequences.

Neurosurgery specialist training

After completing a six-year study at a medical university, a student who has expressed a desire to become a neurosurgeon must complete an internship that lasts 2-3 years, or a residency (in Western Europe and America) for 6 years. Such a length of study is due to the complexity of both the discipline itself and the difficult methods of treating diseases of the brain and spinal cord. During the course of specialization, the physician must master the methods of correct diagnosis and be able to determine the tactics of treatment, which is especially urgently needed in neurosurgery. Physicians also need to be proficient in practical skills. This is achieved by personally conducting operations in the learning process.

Neurosurgery in our country

The rapid development of medicine, especially microscopic optics, contributed to the opening of neurosurgical departments not only abroad, but also in our country. In large cities, there are a number of neurosurgical clinics that are adapted to provide highly specialized care for various groups of patients. In modern neurosurgical institutions, effective treatment of epilepsy, neuralgia of the trigeminal and glossopharyngeal nerves is carried out by the method of stereotaxis. In addition, some reconstructive interventions after injuries and tumors are being actively studied, and neurosurgery of the spine has reached significant development.

Here are some valuable tips from neurosurgery. These are recommendations that may be needed both for a healthy person and for a patient in the neurosurgical department. In particular:

Always follow the safety rules and use personal protective equipment during various games or public events. The motorcycle rider should always wear a helmet to prevent severe brain injury.
An athlete's training must take place according to a pre-planned program and take into account the characteristics of his body. The load on individual muscle groups should be intense, but not to allow a state of "overtraining" or significant exhaustion.
Healthy sleep should be on average 8 hours.
The effectiveness of rehabilitation after injury or removal of a hernia depends to the greatest extent on the patient, namely on his compliance with the doctor's recommendations. Planned, however, regular exercise therapy and physiotherapy sessions gives the best results.

Brain surgery is a daunting performance for every person. Is this fear justified? Is brain intervention actually associated with a higher risk than heart surgery, for example?

Brain operations

The risk of neurosurgical therapy does not depend on the type of organ, but on the severity, type and stage of the disease. Even today, death can be caused, for example, by advanced inflammation of the appendix. On the other hand, a well-prepared complex operation on the brain in its deep structures, where the "millimeter error" popular among unknowing people can lead to lifelong consequences, usually goes quite normally.

Brain trauma

This is a serious socioeconomic problem, and the increase in traumatic brain injury requires improvement in both diagnostic and therapeutic procedures. This is a group of diseases that includes both fatal injuries and damage to the nervous system, requiring immediate surgical intervention. Most often, brain injuries are caused by a high-energy mechanism (accidents, falls, dangerous sports, etc.). To prevent head injuries, we recommend the use of protective equipment (helmets, seat belts, child seats).

Types and related types of brain surgeries:

Concussion. The easiest type of TBI, characterized by a short-term disorder of consciousness, the inability to remember the events during the trauma. Vomiting is often associated with concentration disorder. The condition does not require surgery.
Fracture of the skull. The fracture is divided into 2 types:
- simple fracture, usually not causing serious problems;
- a depressed fracture that requires surgery to straighten the cranial bone.
Epidural and subdural bleeding. These are serious and life-threatening conditions. Bleeding under or above the cerebral membrane causes pressure on the brain, impairing its function. The purpose of the operation is to eliminate high blood pressure, to treat the bleeding site (often from damaged blood vessels or bones). The procedure must be carried out immediately, delay means a risk to the patient's health or life.
Brain contusion. The brain moving at high speed in the cranial cavity can injure the bone. Edema appears in the affected area, therefore, an increase in volume. The goal of treatment (medical or surgical) is to reduce the pressure inside the brain.
Fracture of the base of the skull. These fractures are most common with facial injuries. There is a risk of infection in the intracranial space, so surgery is necessary.

Brain tumors

(Latin: tumor), tumors, arise from a population of cells that have lost control over their division and growth. Tumors are divided into:

benign - meningiomas, low-grade glial tumors, cysts, etc.;
malignant - anaplastic astrocytoma, glioblastoma.

- complex, requiring cooperation between a neurosurgeon, oncologist, histologist, neurologist, rehabilitation specialist.

The first step is to remove part of the skull bone. It is necessary to remove all or part of the tumor. Today, modern methods are used for these purposes (magnetic resonance, neuronavigation, modern surgical microscopy), and argon coagulation is used to stop bleeding. For some - deeply rooted - tumors, a biopsy is performed (taking a sample of tumor tissue for histological examination, which is important to determine the correct cancer treatment). Malignant tumors after the work of a surgeon require treatment by an oncologist. Subsequent chemotherapy reduces the risk of new growths.

The goal of the surgery is to shrink or remove the tumor that is causing pressure on the brain. On the morning of the operation, the head is shaved (partial shaving can be done). During the procedure, part of the bone is opened; the hole serves as a way to penetrate the area where the tumor is located. After its removal, the surgical wound is restored. The procedure takes about 4 hours.

There is a risk of cerebral edema, bleeding (about 3%), rarely inflammation. These complications can be associated with limb movement disorders or general complications (eg, pneumonia, bleeding disorder). After the intervention, the patient is treated in the intensive care unit. After discharge from the hospital, the patient undergoes outpatient and home treatment.

An alternative to surgical treatment is, in exceptional cases, irradiation of the tumor.

Metastases

Metastases, as a secondary type of tumor, are the most common intracranial tumor. They are found in 20-40% of adult patients with malignant diseases; in the sectional material, their share is up to 50%. About 20% of cancer patients die precisely because of metastases. Mostly, breast cancer, lung cancer, melanoma, and Gravitz's tumor metastasize to the brain.

The treatment of patients with metastases is complex and multidisciplinary. Neurosurgery on the head is an important part of it. Correct technical implementation is essential for the success of surgical therapy. An important role is played by the patient's clinical condition, prognosis of the underlying disease, the type of primary tumor, and radiological data.

Surgical resection is recommended for patients with solitary brain metastases in an accessible location, especially with a larger tumor that causes significant pressure on the environment, or with controlled extracranial disease.

The therapeutic procedure for patients with multiple metastases is individual, and the treatment is usually controversial. Surgical therapy is considered in patients with radiosensitive primary tumors. The advantage of resection is cytoreduction or even complete removal of the tumor, reduction of ICP, obtaining material for histological and molecular diagnostics, and the possibility of additional targeted treatment.

Resection of brain metastases is performed using an operating microscope with proper preoperative planning of the procedure based on MRI. In these cases, the standard procedures are supplemented with functional magnetic resonance or diffusion tensors. Intraoperative electrophysiology is also used to monitor important structures, or preoperative imaging, such as ultrasound.

Hydrocephalus

Cerebral chambers are usually filled with cerebrospinal fluid. Cerebrospinal fluid (CSF) circulates in the cerebral chambers and spinal canal and is constantly renewed. Under certain conditions, a barrier to the flow of liquid can arise, and its production itself can be increased. This leads to an increase in the volume of the cerebral chambers, the appearance of symptoms of high intracranial pressure (headache, vomiting, disturbance of consciousness).

Brain surgery is aimed at eliminating the cause of the block. One of the options is artificial drainage (the introduction of a drainage tube into the cerebral chambers with an outlet in the abdominal cavity).

The type of drainage depends on the cause and magnitude of hydrocephalus (obstruction in the natural flow of fluid, impaired intracranial absorption). In children, most often (in 98% of cases), fluid from the intracranial region into the abdominal cavity is removed using various types of ventriculoperitoneal drainage. With obstructive types of hydrocephalus, minimally invasive endoscopic surgery can be used.

The operation is performed under general anesthesia and takes about 1 hour. Complications can be biological or technical.

The most serious biological complications are infections (3-20%), which are divided into several types in terms of severity - from local to general septic conditions. Other complications include epilepsy, subdural hematoma (4-20% in adults, 3-6% in children).
Technical complications of drainage are represented by obstruction, disconnection of the connector, kinked or ruptured catheters, etc.

The success of therapy depends on the correct diagnosis and indications (especially in normotensive hydrocephalus in adults).

With active types of hydrocephalus, conservative treatment is ineffective, drainage surgery is the only possible and often life-saving solution.

Surgical treatment does not have an equally effective alternative substitute.

Transnasal pituitary adenoma surgery

The transnasal approach used in most pituitary adenoma operations is aimed at eliminating or at least reducing the process in the area. Intervention into the brain is carried out from the right nostril. After the procedure, a tampon is inserted into the patient's nose for 48 hours (he has to breathe through his mouth). Sometimes a spinal tap is needed. After treatment, the patient usually spends 1 day in the intensive care unit.

Transnasal surgery is considered a relatively safe intervention, the most acceptable for a person temporarily and cosmetically. Possible complications, occurring in a minimal percentage (up to 5%) of cases, include inflammation of the nasal cavity, postoperative bleeding, or leakage of cerebrospinal fluid from the nose. In addition, hormonal dysfunction of the pituitary gland may occur. Less commonly, the eyes are damaged (visual impairment).

An alternative to surgical treatment is, in exceptional cases, irradiation of the pituitary adenoma.

Plastic surgery of the damaged meninges

The aim of the intervention is to prevent the risk of post-traumatic inflammation of the meninges in the future. During the procedure, a portion of the skull bone is removed to allow penetration into the affected area. The operation takes approximately 4 hours.

Risks include swelling, bleeding, inflammation, and olfactory distress. Surgical treatment has no alternative, equally effective, replacement.

Surgery for aneurysms, malformations and other vascular problems

The procedure for performing vascular brain surgery depends on the type of problem.

Bulge of a vessel (aneurysm)

The wall of the cerebral vessel can weaken under the influence of external or internal factors. The site of weakening is prone to the formation of bulges (aneurysms). The risk of an aneurysm is that it can burst and become a source of intracranial bleeding (hemorrhagic stroke). This creates a condition that poses a direct threat to human life. It is necessary to quickly determine the location and size of the bulge, to choose the optimal treatment.

The principle of therapy is to remove the bulge from the circulation, i.e. in preventing further bleeding from it. This can be done in 2 ways.

1st method - surgical installation of the clip. This is a kind of "clothespin", located at the base of the aneurysm, due to which it cannot burst.
The second method - endovascular - includes filling the bulge with spirals that ensure its closure. This method is suitable for the treatment of aneurysms, the location of which is inaccessible for direct surgery. The spirals enter the bulge using a special device inserted into the vascular system through a vessel in the groin.

Arteriovenous malformations

This is an abnormal congestion of blood vessels between the cerebral artery and vein. Its danger lies in the risk of bleeding, which can have serious consequences for a person. The goal of surgical and endovascular treatment is to remove abnormal blood vessels from the bloodstream.

During the intervention, the skull is opened, penetration into the area where the vascular anomaly is located, the vascular anomaly is closed or removed, thereby preventing possible bleeding. After the procedure, the surgical wound is restored. The operation takes about 4-6 hours.

An alternative to surgical treatment is an endovascular procedure.

Carotid endarterectomy

During a person's life, atherosclerotic deposits and plaques are formed in the blood vessels, gradually closing the vessels. If this occurs in the region of the cervical (carotid) artery, the blood supply to the brain is compromised. The next complication is the risk of tearing off part of the plaque that clogs the arteries in the brain, which causes ischemic stroke.

Carotid endarterectomy consists of opening the artery, removing plaque and restoring its patency. It is recommended not only for patients with a history of stroke, but also as a preventive measure. The procedure is carried out using a microscope under local anesthesia, i.e. the patient is conscious. In some cases, general anesthesia is advisable; in this case, continuous monitoring of the patient's neurological functions (also called electrophysiological monitoring of evoked potentials) and the patency of the cerebral artery is necessary.

Carotid endarterectomy can be performed as an emergency in case of sudden occlusion of the cranial artery. This will help prevent serious injury or death.

Microvascular decompression of the head nerves

Vascular pressure on the brain nerves can cause problems that develop with age. As a rule, we are talking about trigeminal neuralgia (acute pain in the center of the face) or facial hemispasm (uncontrolled jerking in half of the face). Microvascular decompression of the head nerves consists in removing the nerve contact with the vessel, which is deflected and fixed in a new position with a special glue.

Extra-intracranial anastomoses

It is a microsurgical procedure aimed at improving the blood supply to the brain, usually by closing the cervical artery, followed by an inadequate supply of GM blood. The indications are based on a study of the cerebrovascular reserve. The intervention itself consists in connecting the artery supplying the soft tissues of the head with the cerebral artery, providing a "new" blood flow to the organ.

Endoscopic brain therapy

Brain endoscopy is an intervention in which an endoscope, an instrument with a camera, is inserted into the brain to see structures and perform therapeutic procedures. Purpose of endoscopy:

visualization of the state inside the brain;
performing a biopsy - taking a tissue sample for further examination;
creating an opening for the outflow of cerebrospinal fluid.

The endoscope is inserted through a drilled hole in the skull. The intervention lasts about 2 hours and is performed under general anesthesia. The head is usually not completely shaved; shaving near the insertion site of the endoscope is sufficient.

Complications are rare, presented mainly by bleeding at the insertion site of the endoscope. After surgery, you may experience headache responsive to pain relievers. Dizziness sometimes appears. The period of stay in the hospital after the procedure is 7 days, usually until the stitches are removed.

Surgical treatment has no effective alternative replacement.

Stereotactic brain surgery

Stereotaxis is a therapeutic method when the doctor does not directly see the structures on which the operation is performed. The structure of the brain is pre-focused mainly in accordance with planning magnetic resonance; the exact target is achieved using a computer and a stereotaxic device.

The purpose of stereotaxis is to conduct a biopsy, drain fluid (blood, pus), and insert an electrode or therapeutic substance into the brain. In the case of treatment of movement disorders by inserting an electrode, the operation is performed under local anesthesia, because the patient must cooperate. It takes 1-2 hours. A complete shave of the head is not required; it is sufficient to shave around the electrode insertion point.

Complications may include poor sampling (i.e., no diagnosis is possible) or bleeding when the electrode is inserted. After the intervention, a headache that reacts to analgesics is possible. Postoperative hospitalization is about 7 days, usually until stitches are removed or biopsy results are obtained.

Brain surgery for epilepsy

Approximately 30% of patients with epilepsy continue to suffer from seizures despite taking medication for the so-called. pharmacoresistance. In these cases, the appropriateness of neurosurgery should be considered.

Surgery removes the seizure portion of the brain without affecting the surrounding areas. The success of the therapeutic method depends on the site operated on. After the procedure in the temporal region, up to 70% of patients get rid of seizures, with operations in other areas, the success is lower.

There are patients whose illness is serious, and the attacks are severe, often associated with falls and injuries. However, sometimes it is impossible to carry out an operation to eliminate them. In other cases, a surgical technique can be used that interrupts the pathways that spread the seizures from one hemisphere of the brain to the other, which can change the course of the seizures.

In particularly severe cases of epilepsy, where there is no hope of combating the disease with antiepileptic drugs or surgery, vagus nerve stimulation can be used. It is the 10th brain nerve, which affects the work of several organs of the abdominal and thoracic cavities, transmitting sensations from the intestines to the brain. The vagus nerve is stimulated with a device similar to a pacemaker. It is placed under the skin under the left collarbone.

Vagus nerve stimulation is only effective for some patients whose disease cannot be treated. The method helps to reduce the number of attacks or shorten their duration.

Unique stereotactic surgery

A unique treatment option for epilepsy is the stereotactic treatment of medial temporary epilepsy (seizures spread from the internal structures of the temporal lobe). The most common cause of this type of epilepsy is hippocampal sclerosis. The disease occurs as a result of brain damage during childhood, for example, with prolonged periods of fever, meningitis.

Stereotactic surgery is intended for patients with distinct, limited epileptic localization, where removal of the lesion means treatment of the disease. This is an intervention using a special electrode, through which the surgeon performs targeted thermal destruction of the tissue that is the cause of epilepsy. The results of this method are comparable to those of open neurosurgical surgery, but with minimal patient burden.

Is brain transplant possible?

Various brain damage leads to serious human diseases, because its natural regeneration is very difficult. Current regenerative medicine attempts to replace or heal damaged or dead cells in the brain tissue with stem cells capable of replacing some of the missing parts of the tissue, producing substances that are important for the restoration of the whole body. Attempts to transplant (transplant) the brain have so far failed. Obstacles include the laborious nature of the procedure, the inability to naturally restore brain nerve fibers, which stands in the way of restoring neural connections when implanting foreign tissue.

One of the main problems is the lack of donors or organs of sufficient quality for transplantation, and the limited survival of organs after transplantation. A brain transplant

The surgical discipline that has developed into a separate medical branch is called neurosurgery. Her interests include diseases of the nervous system that require surgical intervention. These are pathologies, both central and peripheral.

The main goal of neurosurgery is to accurately diagnose and provide effective surgical intervention for any lesions of the central nervous system and PNS.

History of neurosurgery

It is generally accepted that neurosurgery is a relatively young field of medicine, which became independent no more than a hundred years ago. At the beginning of the 20th century, only a few, very experienced and skillful surgeons dared to operate on the brain, although ancient memorials claim that such surgical interventions took place in the distant past.

In the period from the 10th to the 11th century, in Kievan Rus, unknown healers tried to repeat a similar practice. This is confirmed by archaeological finds from the middle of the 20th century. The remains of people with traces of a similar operation were buried on the territory of Belaya Vezha (an ancient Slavic city).

Speaking about the development of domestic neurosurgery, we can mention the Russian military hospitals of the 18th century, which were fully equipped with instruments for craniotomy. Russian surgeons were aware of the technique of the operation and skillfully applied it, which even helped to heal very complex brain injuries.

The famous commander Kutuzov in 1774, during a serious battle near Alushta, was wounded by a bullet in the head, which slipped right through. Somewhat later, 14 years later, he received a second severe brain injury, which was dealt with by the surgeon E.O. Mukhin (teacher of N.I. Pirogov). And although that neurosurgery can hardly be called perfect, Mukhin managed to do everything possible to save Kutuzov from death, and at the same time preserve his health and military abilities.

A capable student Mukhin Pirogov continued his practice and laid the foundations of modern neurosurgery.

The first domestic department of neurosurgery was opened at the end of the 19th century with the participation of Academician V.M. Bekhterov. But the growth of neurosurgical knowledge and the region itself is associated with Burdenko and Polenov.

Types of neurosurgical operations

All surgical interventions on the organs of the nervous system can be divided into:

Radical operations are operations during which pathological formations in the brain are removed or the normal anatomical appearance is restored (reconstruction in case of skull fractures). It is used for hematomas, abscesses and brain tumors.
Palliatives are interventions that guarantee not a cure for the patient, but a relief of symptoms that worsen his general condition. For example, with an inoperable tumor, a new pathway can be created for the outflow of cerebrospinal fluid that fills the ventricles of the brain.

If we talk about the urgency of surgical intervention, then they are:

Scheduled - performed if necessary, surgical treatment as indicated by a doctor;
Emergency - traumatic hematoma, acute occlusion of the cerebrospinal fluid and impaired circulation of cerebrospinal fluid can be a compelling reason for urgent intervention.

Types of neurosurgical operations:

Stereotaxic surgery is an advanced type of surgery that is applied to the brain without craniotomy. Instead, it is accessed by making a small milling hole. Then a special instrument is introduced into a precisely defined area of the brain.
Endoscopic - these are interventions that are carried out using endoscopes, characterized by their rigid and flexible structure. They are actively used to operate the ventricles of the brain.
Radiosurgical is the impact on the affected area of the brain by spatial orientation and clearly directed radiation.
Endovasal is a surgical method used for vascular diseases of the brain. With the help of special catheters, various occluding devices are introduced into the vascular system, and this happens under X-ray control.

Neurosurgical methods of instrumental research

When to contact

Consultation with a neurosurgeon is mandatory for those people who have suspicions of the appearance of tumors or other formations in the spinal cord or brain. Also, the patient can be referred to a similar specialist for examination for osteochondrosis and vertebral hernia.

Patients diagnosed with epilepsy, infectious lesions of the nervous system or abnormal development of its organs must urgently visit.

Modern neurosurgery

The field of knowledge of modern neurosurgery is very extensive. The current problem among patients today is osteochondrosis and vertebral hernia. Fortunately, scientists have found a minimally invasive version of point surgery using endoscopy.

Cases of strokes are no less common among the population; for this, specialists have developed vascular surgery, which has made it possible to successfully reconstruct disorders in cerebral circulation.

One of the significant achievements is considered the possibility of surgical treatment of epilepsy.

Neurosurgical diseases

All neurosurgical pathologies are divided into 3 types of diseases:

The pathological process is caused by damage to neurons in the brain tissues;
Pathological process, accompanied by a change in the vascular system of the brain;
A pathological process that leads to damage to the meninges.

But, unfortunately, in some cases there may be the simultaneous presence of several groups of pathological changes in the structure of the nervous system.

Common neurosurgical diseases:

More about neurosurgery

A neurosurgeon is a narrow specialist whose duties include the identification and surgical treatment of pathologies of the organs of the nervous system. The work of this specialist is associated with great risks and responsibility: an untimely response to a particular lesion of the central nervous system can have disastrous consequences for the patient. Surgical treatment of such ailments is not always a guarantee of a complete cure for patients.

Sections of neurosurgery

The discipline in question deals with the study of nervous abnormalities, in the treatment of which it is mainly used surgical intervention.

Neurosurgery, according to medical qualifications, has several areas:

Neurooncology. Specializes in the invasive elimination of malignant neoplasms that are localized in the brain or spinal cord.
Vascular neurosurgery ... Deals with the issues of surgical treatment of arteriovenous aneurysms; hematomas that have formed inside the skull; arteriosinus anastomoses, etc.
Neurotraumatology ... He is in charge of the elimination of the consequences of a bruise / fracture of the skull, vertebra.
Psychosurgery ... It is a collection of operational techniques used to treat mental illnesses. Surgical intervention is performed on the brain, and its consequences are irreversible.
Pediatric neurosurgery ... He is engaged in the treatment of nervous diseases in patients under the age of 18.
Spinal neurosurgery ... This branch of neurosurgery is faced by those who are diagnosed with various kinds of disorders in the structure and functions of the spinal cord and spine.
Functional neurosurgery ... This includes all surgical procedures that are aimed at normalizing the functioning of the central nervous system. The main tasks of this branch of neurosurgery is the invasive treatment of hyperkinesis, epilepsy, and chronic pain.

What does a neurosurgeon treat?

In the event that the patient is worried about disorders associated with the work of the central nervous system (back pain, frequent migraines, muscle weakness) - first of all, he needs to be treated to the local therapist.

The specified specialist, after examination, studying the medical history, taking standard tests, will determine - To which doctor should such a patient be referred:

To a neurologist. This doctor deals with the conservative treatment of pathologies of the nervous system. This name of the doctor's profession is a relative innovation: at the end of the last century, the same specialist was called neuropathologist.
Neurosurgeon ... Deals with ailments associated with the work of the organs of the nervous system, which require surgical intervention. The work of this specialist is fraught with great responsibility: the life of the patient will depend on the actions and degree of response of the doctor.

The neurosurgeon is engaged in the diagnosis and surgical treatment of many pathologies, the main of which are:

Abnormalities in the structure of the brain, skull, which are congenital.
Deviations in the work of the spinal column, which are characterized by the presence of neurological syndromes.
Regular pain that has developed against the background of errors in the functioning of the peripheral and / or central nervous system.
Fractures of the skull, spine, as well as the consequences of such injuries: intracranial or spinal hematomas, hemorrhages, etc.
Deformation and dysfunction of blood vessels located in the brain / spinal cord.
Meniere's syndrome.
Inflammatory phenomena in the meninges.
Pathologies, whose essence is in insufficient blood supply to the brain, which can only be eliminated through invasive techniques. An example of such pathological conditions are intracerebral hemorrhages, ischemic strokes.
Malignant and non-malignant neoplasms in the nerve sheaths, pituitary gland, eyes, at the base or in the middle of the skull, inside the spinal column.
Muscle weakness, general loss of strength associated with malfunctions of the vestibular apparatus.
Pathologies of the brain, spinal cord - regardless of the patient's age.

What symptoms should you contact a neurosurgeon with - all cases

The patient can be examined by the specified doctor in the direction of other specialists in the following cases:

To determine the strength and nature of the skull injury. After examining the patient, carrying out diagnostic measures, the neurosurgeon makes a decision on the expediency of the operation.
With oncological diseases spinal cord or brain.
In the case of a differentiated diagnosis of pathologies that relate to the work of the components of the brain.
In the presence of congenital anomalies associated with the organs of the nervous system.

Patients with gunshot, stab, chopped and other wounds, as a result of which the structures of the nervous system were affected, need urgent help from a neurosurgeon.

Consultation with a neurosurgeon may be required in the presence of the following pathological conditions:

Frequent migraines.
Sudden fainting that has occurred several times.
Various tics (for example, twitching of the right or left eyelid).
Unreasonable memory lapses.
Tremor of the limbs, other parts of the body.
Epileptic seizures.
Sudden onset of muscle weakness that affects coordination of movements.
Numbness of the toes against the background of regular pain in the lower extremities. Pain can be localized in different areas: thighs, lower back, legs, feet. Such complaints may indicate that the patient has a hernia of the lumbar spine.
Regular jumps in blood pressure, which are combined with numbness / pain in the upper extremities, severe dizziness. Such phenomena are a characteristic feature of cervical hernias.
Constant pain in the chest area can be a manifestation of a thoracic hernia. Often people whose body is in a forced position for a long time complain about such discomfort. This pathology often occurs against the background of scoliosis.
Nausea and vomiting, disorientation in space, blurred consciousness, ringing in the ears and some other conditions that occur after a strong blow to the head. The listed symptoms are the basis for immediate hospitalization.

Studies that a neurosurgeon can prescribe for accurate diagnosis and treatment

An examination by a neurosurgeon begins with a survey, during which this specialist finds out the stage of development of the pathology.

General inspection includes checking the following conditions:

Skin reaction to external stimuli.
The nature of the mobility of muscles and joints.
Reflexes.
Oculomotor reactions.

There is a whole range of diagnostic measures that make it possible to study the state of the organs of the nervous system.

1. Hardware methods:

Application computed tomography to identify various errors in the work of the brain: pathological neoplasms, atrophy of the cerebral cortex, accumulation of fluid in the brain structures, etc.
. Provides the opportunity to obtain detailed information about the state of the nerve structures.
Lumbar puncture (lumbar puncture) in order to collect cerebrospinal fluid to study its characteristics: consistency, color, amount of protein and sugar, the level of erythrocytes and leukocytes. During this diagnostic procedure, you can also determine the level of intracranial pressure, identify harmful microorganisms in the cerebrospinal fluid.
Echoencephalography. The main diagnostic tools in this technique are ultrasonic waves. With their help, it is possible to identify the level of displacement of the structures of the brain with extensive hematomas or due to the development of hydrocephalus.
Electroencephalography. Neurosurgeons practice this method when diagnosing epilepsy, encephalopathy, and insomnia. Through electroencephalography, it is possible to record the electrical activity of the brain structures.
Study of the structure and condition of the blood vessels of the brain using X-ray equipment and contrast agents. This method is referred to as cerebral angiography.
Myelography. According to the principle of operation, the method under consideration is similar to the previous procedure, however, the object of research here is the spinal cord. Myelography is very indicative in the diagnosis of intervertebral hernias.
Positron emission tomography... Facilitates the receipt of important information in the case of epilepsy, stroke, brain cancer.
Electromyography (EMG). It is used to study the level, nature, degree of damage to the neuromuscular system. By means of EMG, it is possible to identify the exact localization of the pathological process, as well as the area of its distribution.
Ultrasound and Doppler Scanning of Blood Vessels used when there is suspicion of arterial stenosis, blockage and dissection.

2. Laboratory methods

General analysis of blood and urine.
Biochemical examination of blood samples. The main components that are of interest to the neurosurgeon will be urea, sodium, potassium, bilirubin, total protein, etc.
Testing blood for clotting time.
Revealing prothrombin index and / or fibrinogen.