Neurosurgery is a medical procedure that used to mendiagnosis or treatdisease involving the nervous system. Neurosurgery not only could performed on the brain butalso on the spinal cord and peripheral nerves found in all parts of the body, such as the face, hands, and feet.
Neurosurgical procedures are performed by neurosurgeons. The type of neurosurgery performed may vary, depending on the disease to be diagnosed or treated. The range of diseases that can be diagnosed or treated also varies, ranging from congenital abnormalities, head injuries, tumors, infections, to strokes.
Neurosurgery Techniques
There are many different neurosurgical techniques and methods that can be used to diagnose and treat neurological diseases. Some of them are:
1. Brain surgery or craniotomy
At a craniotomy, the doctor will open and remove a small part of the skull bone so that medical procedures can be performed on the brain. The part of the skull that is removed is called bone flap or skull cap. A craniotomy is performed under general anesthesia so that the patient is unconscious during the operation.
After the skull bone is cut and bone flap After being appointed, the doctor can perform various medical procedures, both for diagnosis and for treatment.
As a medical procedure, craniotomy can be used for various purposes, such as removing tumors, removing brain abscesses, repairing broken skull bones, and removing blood clots.
2. Awake brain surgery(AWS)
Operatively, AWS is similar to neurosurgery craniotomy. The difference is, in AWS patients are not given general anesthesia, but only local anesthetics and sedatives are given. Thus, the patient is relaxed, but still conscious and able to respond to the doctor during the procedure.
AWS is usually done to treat brain tumors or epileptic seizures, especially if the part of the brain causing the seizure is located close to the center of vision, limb movement, or speech center.
During surgery, the doctor will ask questions or ask the patient to do something. This is so that the doctor can ensure that the neurosurgery is performed in the right location.
3. Microsurgery or microsurgery
Microsurgery is a neurosurgical technique performed with the aid of a microscope to repair peripheral nerves in damaged organs. The use of a microscope in micro neurosurgery aims to allow doctors to see very fine nerve structures, so that nerve repair can be more optimal.
4. Installation ventriculoperitoneal shunt (VP Shunt)
VP shunt is a tool in the form of a special channel that is connected from the brain to the abdominal cavity. This tool is installed through a surgical procedure and serves to reduce the buildup of cerebrospinal fluid in patients with hydrocephalus.
5. Neuroendoscopy
Neuroendoscopy is performed using a special instrument in the form of a camera tube (endoscope) that is inserted into the inside of the skull through a small hole in the skull, nose, or mouth. This method allows doctors to examine parts of the brain that are difficult to see with a regular craniotomy.
Neuroendoscopy can be used to diagnose tumors, take tissue samples, or remove tumors.
6. Stereotactic radiosurgery (SRS)
SRS is a neurosurgical method that differs somewhat from other methods, in that it does not require an incision in the skin. SRS uses radiation that is focused on specific points in the brain to destroy tumor cells in the brain, while avoiding the surrounding healthy tissue as much as possible.
The radiation emitted will damage the DNA of tumor cells and make these cells die. The type of radiation used in SRS can be in the form of X-rays, gamma rays, or protons.
Neurosurgery Indications
Based on the disease that can be diagnosed or treated, neurosurgical procedures are divided into several groups. The following are groups of neurosurgery and the diseases of the nervous system that can be diagnosed or treated:
Tumor neurosurgery
Tumor neurosurgery is a surgical procedure that aims to diagnose and treat tumors in the nervous system, such as gliomas, meningiomas, acoustic neuromas, pineal tumors, pituitary tumors, and tumors at the base of the skull.
Vascular neurosurgery
This neurosurgical procedure is used to diagnose and treat neurological diseases caused by abnormalities in the blood vessels of the brain, such as strokes, brain aneurysms, and AVMs.
Functional neurosurgery
Functional neurosurgery is a neurosurgical procedure that can diagnose and treat neurological diseases caused by disorders of the functioning of the nervous system, such as spinal pain, trigeminal neuralgia, heart disease carpal tunnel syndrome, epilepsy, and facial twitching (hemifacial spasm).
Traumatic neurosurgery
Traumatic neurosurgical procedures are used to treat neurological diseases of the brain and spine resulting from injuries, such as cerebral hemorrhage, subdural hematoma, epidural hematoma, and spinal fractures.
Pediatric neurosurgery
Pediatric neurosurgery is a neurosurgical procedure to treat neurological diseases in infants and children, such as hydrocephalus, brain tumors in children, spina bifida, cranial dysraphism, and craniosynostosis.
spinal neurosurgery
Spinal neurosurgical procedures are used to treat chronic spinal conditions, such as spinal cord tumors, tuberculous spondylitis, herniated nucleus pulposus, and spinal deformities (eg scoliosis, lordosis, or kyphosis).
Warning Neurosurgery
There are several things that need to be done before undergoing neurosurgery, namely:
- Tell your doctor if you are pregnant or planning a pregnancy.
- Tell your doctor if you are allergic to any medicines, including tranquilizers and other substances, such as latex.
- Tell your doctor if you have had any previous surgery.
- Tell your doctor if you have a history of bleeding disorders.
- Tell your doctor if you are taking any medicines, including herbal products and supplements. The doctor may ask the patient to stop taking certain medications a few days before the procedure.
- Tell your doctor if you have any medical implants in your body, such as aneurysm clips, pacemakers, artificial heart valves, and neurostimulators or stent.
- Tell your doctor if you have consumed a large amount of alcohol in the last few days.
- Quit smoking before surgery to speed up recovery.
Neurosurgery Preparation
Neurosurgical preparation may vary, depending on the type of procedure to be performed and the patient's health condition. But generally, at the beginning the doctor will conduct a thorough medical examination to ensure the patient's condition is safe for surgery.
Doctors can also carry out supporting examinations with CT scans, MRIs, MEG scans, or PET scans. This examination aims to visually detect abnormal tissue, bleeding, abscess, cyst, or tumor on the inside of the brain or other nerve organs.
The patient also needs to undergo an examination to determine the anesthetic to be used for the procedure. This is because each neurosurgical technique may require the use of different anesthetics. For example, craniotomy and VP . placement shunt requires general anesthesia, whereas AWS can be performed only with local anesthesia.
In addition, in surgical procedures that require incisions, such as craniotomy, AWS, and micro-neurosurgery, the doctor may ask the patient to stop taking blood-thinning medications, such as aspirin, to reduce the risk of bleeding during the procedure.
Patients may also be given antibiotics before undergoing surgery, to prevent infection. Some of the other things the patient may need to do are:
- Washing using antiseptic shampoo, when going to undergo a craniotomy
- Remove cosmetics and remove all worn jewelry, including dentures, contact lenses, glasses, wigs (wigs), and artificial nails
- Change clothes with special surgery clothes that have been provided by the hospital
Neurosurgery Procedure
Patients who are ready to undergo neurosurgical procedures will be taken to the operating room. The patient may be asked to sit, supine, or face down on the operating bed, depending on the neurosurgical technique being performed.
Next, the doctor will give the patient an anesthetic. Patients who are given general anesthesia will be placed on a breathing apparatus. During the operation, the patient's blood pressure, heart rate and body temperature will be continuously monitored.
Most neurosurgery procedures require making an incision in the skin (incision). The location of the incision varies, depending on the type of surgery. A more complete explanation is as follows:
Craniotomy and AWS
In craniotomy and AWS, an incision will be made in the head area followed by an opening of the skull bones. The area of the skull that is opened is adjusted to the need for medical procedures that have been evaluated before surgery.
After the skull is opened, the doctor will take action according to the patient's disease, such as removing a tumor, removing a blood clot due to a stroke, or removing a brain abscess.
Patients undergoing AWS will be asked a variety of simple questions by the doctor during the procedure. The goal is for doctors to make sure the surgery is done at the right location. In addition to questions, the patient may also be asked to move certain body parts.
Peripheral neurosurgery
In peripheral neurosurgery, an incision will be made in the area of the body that has peripheral nerve disorders. After the incision is made, the doctor will make repairs to the motor or sensory nerves that are problematic using the help of a microscope.
Neuroendoscopy
In a neuroendoscopy, the doctor will make an incision inside the nose followed by cutting a small portion of the bone around the nose. This incision serves as an access to the endoscope tool into the brain through the nose.
Next, the doctor will perform medical actions according to the patient's needs, such as removal of a pineal tumor, pituitary tumor, or a tumor at the base of the skull.
VP Shunt
Incision made in the VP pemasangan insertion procedure shunt to treat hydrocephalus and increased pressure in the brain is done behind the ear.
After the incision is made, a catheter will be inserted from the head and then connected to the abdominal cavity. This catheter serves to reduce the buildup of cerebrospinal fluid by draining the fluid into the abdominal cavity.
Stereotactic radiosurgery (SRS)
Especially in the SRS procedure, no incision is needed. This procedure uses a machine that will emit a beam of radiation that is focused on a tumor in the brain and serves to destroy the tumor without damaging other brain tissue.
In the process, the patient will be positioned supine on the SRS machine. During the SRS procedure, the patient will remain conscious, but will be given a sedative.
spine surgery
In spinal surgery, the patient will be asked to face down. An incision will be made in the part of the spine to be operated on.
The next course of action depends on the patient's condition. For example, to treat a herniated nucleus pulposus, the doctor will remove part or all of the spinal cord that is pinching the nerve.
After the surgical procedure is complete, the skin incision will be sutured and covered with a bandage. In surgery that opens the skull, bone flap will be reassembled using special plates, cables, or sutures.
After Neurosurgery
After the procedure, the patient will be given treatment to restore the condition. Treatment can be carried out in the ICU or in a regular inpatient room.
The length of recovery time varies for each patient, depending on the type of neurosurgical procedure performed, the anesthetic given, and the severity of the neurological disease suffered. During the recovery period, the patient's blood pressure, blood oxygen levels, heart rate and respiratory rate will also be continuously monitored.
Patients undergoing brain surgery procedures, such as craniotomy, need to lie down with the head higher than the rest of the body. The goal is to prevent the buildup of fluid and blood flow in the head, and to avoid swelling of the head and face.
Doctors can also give medicines to prevent fluid buildup in the head, high blood pressure, and brain swelling. This is important to support the patient's healing process.
In patients undergoing craniotomy, the doctor will also check the patient's brain function by looking at the following things:
- Movement of the eye and pupil by shining a flashlight into the eye
- Movement of hands and feet
- Hand and leg strength
- Patient orientation, by asking a few simple questions, such as name, date, and where the patient is
During the initial recovery period, the craniotomy patient will still be placed on a breathing apparatus. The patient will be trained to breathe after the breathing apparatus is removed. This breathing exercise works so that the patient can use his lungs back to normal and prevent pneumonia.
The doctor will also give medicines to support the recovery process and relieve side effects due to the procedure that may appear. These drugs can be:
- Dexamethasone, to relieve inflammation
- Antibiotics, to prevent complications due to bacterial infections
- Blood thinners, to prevent blood clots
- Anticonvulsants, to prevent seizures
After the condition improves and stabilizes, the patient will be allowed to go home and undergo outpatient treatment. But beforehand, the doctor will first make a schedule for periodic checks.
The doctor will also explain about other treatments that the patient should do while at home, such as:
- Keep the stitches clean and dry
- Taking pain relievers to treat headaches that may arise when breathing, coughing, or doing physical activity
- Do breathing exercises regularly to prevent pneumonia
- Increase the amount of physical activity on a regular basis, but still avoid lifting heavy objects for a few weeks to prevent tearing of the seams
- Do not drive a vehicle until authorized by a doctor
Neurosurgery Complications
Every type of neurosurgical procedure carries a risk of complications, both during and after surgery. The following are complications that can arise from each type of neurosurgery:
Neuroendoscopy
- Headache
- Nauseous
- Throw up
- Swelling in the brain
- Cerebrospinal fluid leak
- Bleeding
- Infection at the surgical site
- Eye movement disorders
- Weakness on one side of the body
Stereotactic radiosurgery (SRS)
- Feeling weak and tired, especially a few days after undergoing SRS
- The scalp becomes red, especially at the location where the radiotherapy device is attached
- Hair loss
- Swelling in the brain or at the site of tumor treatment, which is characterized by symptoms such as headache, nausea, and vomiting
KraniOtomi
- Blood clotting
- Bleeding
- Infection
- Seizures
- Swelling in the brain
- Pneumonia
- Unstable blood pressure
- Weak muscles
- Cerebrospinal fluid leak
Awake brain surgery(AWS)
- memory loss
- Impaired limb coordination
- Balance disorders
- stroke
- Meningitis
- Visual disturbance
- Seizures
- Difficulty speaking and learning
- Muscles feel weak
VP shunt
- Infections of the brain or ducts VP shunt
- Brain hemorrhage
- Swelling and formation of blood clots in the brain
- Brain tissue damage
