Minimally invasive surgery;
Interventional procedures for chronic pain.
Cerebrovascular - aneurysms and arteriovenous malformations (AVMs), stroke;
Neurooncology (brain tumors);
functional and epileptic neurosurgery;
trigeminal neuralgia and nerve compression syndromes;
Peripheral nerve damage.
Surgery is done using small incisions (incisions) and a few stitches. During minimally invasive surgery, one or more small incisions may be made in the body. A laparoscope (a thin tube instrument with a light and a viewing lens) is inserted through one hole to guide the operation.
Endoscopic endonasal surgery is a minimally invasive technique that allows the surgeon to go through the nose and operate on areas in the front of the brain and upper spine. A thin tube called an endoscope is inserted through the nose and sinuses.
Microsurgery is used in many aspects of neurological surgery. Microvascular techniques are used in EC-IR bypass surgery and reconstructive carotid endarterectomy. Clipping of the aneurysm is performed under a microscope. Minimally invasive spine surgery uses microscopes or endoscopes. Procedures such as microdiscectomy, laminectomy, and disc replacement with an artificial one are considered microsurgery.
With the development of radiation therapy and surgical techniques, there has been a trend to use radiation therapy as a primary or secondary treatment for brain tumors. For the successful treatment of these tumors, a sufficient dose of ionizing radiation directed at the target volume ensures the destruction of tumor tissue while maintaining healthy tissue. This method of radiation therapy is possible with high-dose targeted irradiation.
There are three methods of irradiation of intracranial tumors:
fractionated radiation therapy,
stereotactic radiation therapy,
All three treat the same types of cancer, but not all of them treat the same parts of the body. While Gamma Knife can only treat brain tumors, TrueBeam and CyberKnife can treat tumors in the body.
The gamma knife was first developed in 1968. A modern gamma knife is equipped with 201 sources of the radioactive isotope Cobalt-60, built into a special "hood". Gamma Knife allows you to direct a narrow beam of rays, precisely aimed at a predetermined area of the brain where the lesion is located. Thus, the dose gradient at the periphery of the target volume is very steep, so the target receives a high dose of radiation while preserving the surrounding tissue. Treatment is planned using a stereotactically defined image database using a computer program. The treatment is usually completed in 1 day and one session. The Gamma Knife is suitable for the treatment of deep and surgically inaccessible intracranial lesions with low mortality and few side effects from radiation. It is also suitable for the treatment of lesions refractory to traditional radiotherapy. Gamma Knife is also used to treat functional disorders, pain syndromes (such as trigeminal neuralgia), arteriovenous malformations, and benign and malignant brain tumors and their remnants after surgery. Treatment is effective mainly in the field of arteriovenous malformations and tumors (meningiomas, acoustic neuromas, pituitary adenomas, and brain metastases).
The latest versions of linear accelerators are presented in the form of a robotic knife known as Cyberknife. Cyberknife is a robotic radio surgical system controlled by a computer using computed tomography or magnetic resonance imaging. The system functions thanks to the interaction between the automatic guide, the visualization system, and the linear accelerator. The guidance system includes an X-ray imaging unit with a radiation supply unit provided by a linear accelerator located on the manipulator. There is a special guidance system for the robotic arm during irradiation. Therefore, the robot knife does not require rigid attachment to the stereotaxic frame, as is the case with a linear accelerator. Therefore, the position of the patient during treatment is more comfortable compared to the gamma knife or linear accelerator. The treatment time is usually 30 to 90 minutes, depending on the type of tumor. The treatment is usually completed in one session. Sometimes a patient may receive up to five sessions of radiation therapy. In addition to intracranial tumors, the robotic knife can also be used to irradiate other organs such as the lungs, liver, prostate, kidneys, and pancreas. Another advantage of CyberKnife is the ability to treat tumors that move during breathing.
TrueBeam delivers the prescribed dose of radiation from virtually any angle. It combines imaging and beam delivery with technology that rotates around patients to accurately and accurately target tumors at great speed.
thrombolytic therapy. This procedure uses a clot-disrupting drug to dissolve the clot in a blood vessel in the brain or elsewhere in the body.
Endovascular coil. The surgeon inserts a very thin metal wire that forms a coil inside the brain aneurysm to block blood flow. A cerebral aneurysm is a bulging, weakened section of the wall of an artery in the brain. This results in abnormal expansion or swelling. Because the artery wall has a weak spot, there is a risk of an aneurysm rupturing if blood flow is not blocked. The aneurysm is treated by twisting or clipping.
Cerebral angiography. This is a radiological procedure that examines how blood flows in the brain.