Neurosurgery (Brain Surgery)

Diagnostic methods before a neurosurgical operation

Neurologists and neurosurgeons prescribe examinations that help to recognise diseases of the nervous system and their degree of severity.

Computed tomography (CT) is an imaging test that uses X-rays. A computer can create and process cross-sectional images by taking tomograms of specific body regions. For example, computed tomography of the skull plays a prominent role in acute stroke diagnosis. It can quickly decide whether the cause of the stroke is a cerebral haemorrhage or a cerebral infarction due to lack of blood.

CT angiography can be used to visualise blood vessels by injecting an X-ray contrast medium containing iodine into a vein. This procedure is used when there is a suspicion of a narrowing (stenosis) or blockage of an artery supplying the brain. It is also helpful for diagnosing vascular malformations (aneurysms, angiomas).

Magnetic resonance imaging (MRI) is a procedure that enables imaging of individual body sections using tomograms or cross-sectional images. In contrast to computed tomography, MRI does not work with X-rays but with a magnetic field. The most accurate and technically advanced test is emission tomography. With its help, a neurosurgeon can analyse lesions at the cellular level. It makes it possible to detect alarming changes early in their development.

MRI-supported neuronavigation is a computer-assisted surgical procedure that the neurosurgeon uses to orientate himself with millimetre precision during an operation on the brain or spinal cord. In combination with microsurgery, neuronavigation improves the accuracy of a neurosurgical procedure and increases patient safety.

In electroencephalography (EEG), the electrical activity of the cerebral cortex (so-called brain waves) is derived from the surface of the skull and recorded. The EEG is beneficial for diagnosing seizures in the brain (epilepsy). With the help of electromyography, the specialist can obtain electrical muscle activity from either the surface or the interior of a muscle. The EMG examination allows the doctor to determine whether, for example, the cause of paralysis (paresis) is due to damage to the power or to the nerve that supplies it. Electroneurography is used to measure the speed of nerve conduction. It is significant for the neurosurgeon in case of nerve damage.

Treatment options in modern neurosurgery

It is noteworthy that interventions on the brain were performed for a long time by opening the skull. Today, however, in most cases, such operations are performed without trepanation. Moreover, in countries such as Israel, Germany, Turkey, Spain and Poland, microsurgical endoscopic procedures have been practised for more than 15 years - they perform transsphenoidal interventions (through the nasal cavity).

Innovations most affected the technique of surgical interventions. Today, navigation systems are more actively used, and doctors perform computer-assisted operations.

One of the most promising areas in neurosurgery is stereotactic radiosurgery. It is especially popular in the treatment of brain tumours. To do this, surgeons use CyberKnife and GammaKnife, which are available in leading clinics abroad. The essence of stereotactic radiosurgery is that instead of a surgical scalpel, beams of radio waves are used, which are directed into the tumour at precisely specified coordinates. As a result, ionising radiation destroys the malignant neoplasm while not affecting healthy brain tissue.

The problem of preserving the function of the brain and the constant desire to minimise the amount of surgical intervention has always been one of the most important tasks in neurosurgery, which led to the emergence of entirely new directions in epilepsy surgery. Neurosurgeons began to use fundamentally different methods as an alternative to resection, one of which is DBS surgery (deep brain stimulation). It is based on the implantation of electrodes in specific brain structures, through which an electric current of low voltage and high frequency is supplied.

Neurosurgery does not stand still, and foreign doctors and scientists are constantly looking for new and effective methods for treating incurable diseases of the nervous system. And the achievements obtained at the moment testify to new technologies' great potential and progressiveness.