Neurosurgery

Neurosurgery

The Department of Neurosurgery is staffed by highly specialised scientific staff and equipped with state-of-the-art machinery, aiming to offer high-quality diagnostics and treatment services to the whole spectrum of brain and spinal conditions.

Our skilled and experienced neurosurgeons are on duty 24 hours a day and available at all times for drastic treatment of even the most urgent incidents.

At the Hospitals of Athens Medical Group a full range of modern neurosurgery interventions is performed that involve pathologies of the brain and the entire spine.

The Neurosurgery Department treats all diseases related to the central and peripheral nervous system, such as:

  • Aneurysms
  • Benign and malignant brain tumors
  • Vascular diseases of the brain and spinal cord
  • Traumatic brain injuries
  • Degenerative vertebrae / discopathies
  • Hydrocephalus
  • Diseases of peripheral diseases
  • Congenital conditions (chiari syndrome)
  • Epilepsy Surgery

In the Department of Neurosurgery, all techniques for treating aneurysms are applied, and in particular:

  • Microsurgical aneurysm exclusion with clip
  • Endovascular coiling
  • Diversion of blood flow with stents

Patients after major surgeries remain in the Intensive Care Unit.

Microsurgical blocking of brain aneurysms with clip

Microsurgery with clip is the most established method for the treatment of aneurysms. During the microsurgical blocking of an aneurysm a metal clip is used to stop the flow of blood into the aneurysm.

Microsurgical blocking is performed with a craniotomy to create a “window” in the skull in order to approach the aneurysm in the brain. The clip is placed in the aneurysm (opening) to block blood flow and remains within the brain.

Endovascular coiling

Endovascular coiling is a more recent therapeutic option for brain aneurysms and is aimed at blocking blood flow to the aneurysm.

During endovascular coiling, a catheter is advanced through the groin upward towards the artery carrying the aneurysm. Platinum coils are then released. The coils activate the coagulation mechanism in the aneurysm and thus prevent the blood from entering into it.

A microcatheter is inserted through the original catheter. The coil is connected to the microcatheter. When the microcatheter has approached the aneurysm and has entered it, the coil is released from the microcatheter by means of an electric current.

The coil seals the opening of the aneurysm and is permanently abandoned therein. Depending on the size of the aneurysm, more than one coil may be needed to completely block the aneurysm.

The coils, which are used in this method, are made of soft platinum. They are very small and thin and their size can vary from double the thickness of the human hair (maximum) to less thick than hair (the minimum).

X-ray helps the procedure of endovascular coiling. The doctor uses the X-ray to drive the catheter to the area of ​​the aneurysm in the brain.

Endovascular coiling can be used to treat an uninterrupted aneurysm. Also, it may be used to treat a broken aneurysm in some cases, as well as in the cases of patients who are elderly or who cannot undergo surgery.

Diversion of blood flow with stents

Blood flow diversion is an endovascular technique in which instead of placing an appliance into the aneurysm, as in the case of coiling, the device is placed in the parent vessel to divert blood flow away from the aneurysm.

When diverting blood flow, a microcatheter advances near the aneurysm without having to enter the aneurysm. Then, the blood flow diverter (Pipeline Embolization Device) is released into the parental vessel.

The blood flow to the aneurysm is reduced almost immediately while the complete blocking of the aneurysm is completed between 6 weeks and 6 months after the operation.

The most common primary brain tumors are gliomas, meningiomas, pituitary adenomas, vestibular schwannomas, and primitive neuroectodermal tumors (medulloblastomas). The term glioma includes glioblastomas, astrocytomas, oligodendrogliomas, and ependymomas.

Diagnosis Of Brain Cancer

If there are suspicions for brain cancer, a neurological exam that will check vision, hearing balance and reflexes, among other things is necessary. Magnetic resonance imaging (MRI) is commonly used for the diagnosis brain tumors, including more specialized tests, such as functional MRI, perfusion MRI and magnetic resonance spectroscopy.

Other imaging tests, such as computerized tomography (CT) and positron emission tomography (PET) may be used to determine whether the cancer has spread from the brain to other parts of the body.

Collecting and testing tissue (biopsy) from the tumor is mandatory. The tissue mandatory is usually obtained after tumor resection or by stereotactic biopsy, using a needle. In the latter, a thin needle is inserted through the skull to the tumor, sometimes with the guidance of CT or MRI scanning. The tissue sample is then examined carefully in a laboratory. Specialized tests on the tissue provide valuable information about prognosis and treatment options.

Occasionally there may be low concordance between the local diagnosis and central neuropathology review. Thus, the histology should be carefully reviewed by an expert neuropathology team.

Also, molecular markers are useful additional tools for the diagnosis and treatment guidance of brain cancer.

Treatment Of Brain Cancer

At AMG we offer a range of highly innovative surgical and non-surgical procedures and techniques to treat cancer of the brain.

Patients should be evaluated and the treatment plan determined by a specialized multidisciplinary team including neurosurgeons, medical and radiation oncologists, but also an expert neuropathologist and neuroradiologist. Special consideration should be given to performance status and neurological function.

Treatment for brain cancer depends on the type, size and location of the tumor, as well as the overall health of and your preferences.

Surgery

Surgery is commonly the initial approach for the treatment of brain cancer as well as for obtaining tissue for diagnostic purposes. If the location, the type and the size of the tumor allows it, surgery is carried out for the removal of as much of the brain tumor as possible.

Some tumors are small and easy to remove, whereas in other cases the separation of the tumor from the surrounding tissue poses risks. Thus, the surgeon removes as much of the tumor as is safe for the patient.

Tumour resection improves the prognosis for brain cancer patients, but carries risks, such as infection, bleeding and compromising of neurological functions.

Radiation therapy

Radiation therapy or radiotherapy involves the use of energy sources, such as x-rays to destroy cancer cells and prevent the tumor from growing. It may be used before surgery or after surgery, often combined with chemotherapy. If the cancer has metastasized to other organs and areas of the body, radiation therapy may help relieve symptoms. The Hospitals of Athens Medical Group offer cutting-edge radiation therapy technologies.

Chemotherapy

Chemotherapy is a very common treatment for cancer and it involves the use of drugs to kill cancerous cells by interfering with the cell’s ability to grow or reproduce. Chemotherapy may be used by itself, or in combination with other treatments such as radiation or surgery to treat cancer.

Targeted drug therapy

Targeted drug treatments focus on specific abnormalities present within cancer cells in the brain. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Some types of brain cancer can be treated with targeted therapy, whereas clinical trials promise the development of new drugs for more treatment options.

Rehabilitation

Rehabilitation is an important part of complete treatment plan for brain cancer, because brain tumors may affect motor skills, speech, vision and thinking of the patient. Depending on your needs, your personal doctor may recommend physical therapy, occupational therapy and speech therapy.

The hospitals of Athens Medical Group have a special Department for Endovascular Neurosurgery – Interventional Neuroradiology.

It is a surgery or radiology branch that has rapidly developed during the last 25 years, aiming to treat vascular diseases of the Central Nervous System (brain and spinal cord).

The principal characteristic of embolization is that it approaches the brain vessels through their own lumen (intravascularly) and not externally like in conventional surgery by conducting craniotomy.

This kind of internal access combined with HD angiographs, 3D imaging, micro-catheters, state-of-the-art micro-wiring and continuously advancing embolization materials enable the intravascular treatment of many diseases of the brain and spinal cord, with excellent results and very low complications rates.

The conditions predominantly treated with Endovascular Surgery are:

  • brain aneurysms, either ruptured with subarachnoid hemorrhage or unruptured
  • AV malformationsfistulas of brain and spinal cord (and all over the body)
  • arteriovenous fistulas of the dura mater, traumatic or automatic, arteriovenous fistulas of head and neck
  • stenoses of intracranial vessels (carotid, middle cerebral artery, basilar artery, etc.),
  • extracranial vascular stenoses, ( carotid, vertebral, subclavian artery, etc )
  • ischemic stroke (acute or non-acute ) because of cerebral vessel occlusion, (Stroke Unit)
  • vascular tumors of the head, neck and spine as a preoperative or palliative therapy (meningiomas, schwannomas, paragangliomas, hemangioblastoma, angiofibromas) hemangiomas of the head, neck and spine as a single or supplementary therapy
  • nosebleeds or others hard to control hemorrhages of the head and neck
  • Petrous Sinus sampling with or without renal sampling
  • Superficial lesions, such venous angiomas, hemangiomas etc.

Cerebral Aneurysms

Brain aneurysms occur in cerebral arteries points wherein the wall has either a structural defect or receives additional pressure from blood flow. They are not congenital anomalies, but they do develop over a number of years in an artery that has some of the abovementioned predisposing factors. They are usually shaped like a bag that develops on the wall of the artery.

A brain aneurysm has a risk of rupture and internal bleeding (subarachnoid hemorrhage, intracerebral hematoma, etc.), which usually have serious repercussions for the patient and death. This is why when a ruptured aneurysm is diagnosed it should be treated the soonest possible.

Aneurysms were traditionally treated with craniotomy and their eventual exclusion with one or more special clips. This is a very serious surgery associated with significant risks. This is why today it is replaced by embolization a modern minimally invasive method, with excellent results and a very low complication rate.

Embolization is not conducted with craniotomy, but through the insertion of a thin micro-catheter through the femoral artery right inside the aneurysm sac. Then, special embolization coils are guided inside the aneurysm, until the sack is completely unclogged and the bloodstream stops.

The results of aneurysm embolization are excellent, with very low complication rates and involve minimal patient discomfort. Thus, on a global level, the first choice for the treatment of brain aneurysms is embolization while craniotomy remains a second choice for only a small percentage of cases that cannot be treated with embolization, for technical or anatomical reasons.

Arteriovenous Fistulae of the Brain and the Spinal Cord

In general, these diseases are abnormal vessel connections, between arteries and veins. There are several types, depending on the angioarhitectural characteristics of these vessel connections.

When they are diagnosed, they must be treated with one or more embolizations and selective micro-catheterization of the feeding arteries.

Our experienced team of specialists studies the patient files and then proposes the most appropriate treatment plan (if there is a need for more than one embolization).

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