Neurosurgery: Specialists in the Head, Brain, and Spine

Common conditions treated by neurosurgical clinics include:

• Nerve tumors and brain metastases
• Gliomas
• Pituitary tumors
• Cerebrovascular diseases (e.g., cerebral aneurysms) and other nerve disorders (e.g., trigeminal neuralgia)
• Spinal disorders
• Herniated disc

Other areas of expertise for neurosurgeons include skull base surgery, minimally invasive neurosurgery and neuroendoscopy, functional neurosurgery and stereotaxy, neurotraumatology and intensive care medicine, as well as pediatric neurosurgery, which addresses the specific characteristics and malformations of the pediatric skull and central nervous system (e.g., hydrocephalus, skull deformities, meningoceles).

State-of-the-art imaging techniques (e.g., computed tomography, magnetic resonance imaging (MRI), angiography) are frequently used for the precise planning and execution of neurosurgical procedures.

Neurosurgery deals with disorders of the central and peripheral nervous systems that can be treated surgically @ romaset /AdobeStock

Corpus callosotomy

A neurosurgical procedure in which the corpus callosum is punctured to allow cerebrospinal fluid (CSF) to drain. This reduces intracranial pressure.

Cerebral shunt (cerebrospinal fluid shunt)

A medical device (usually a tube) used in neurosurgery to divert excess cerebrospinal fluid from the brain’s ventricles to another part of the body. This is intended to reduce intracranial pressure to a normal level.

Usually, a thin plastic tube is inserted from the head under the skin into another body cavity (e.g., the abdominal cavity or the atrium of the heart), into which the accumulated cerebrospinal fluid can drain. A cerebral shunt is implanted, among other things, to treat hydrocephalus (abnormal enlargement of the cerebrospinal fluid-filled spaces in the brain).

Callosotomy

A neurosurgical procedure now rarely used as a last resort for treating epilepsy, in which the corpus callosum—which connects the two hemispheres of the brain—is surgically severed.

The condition of the brain following this severing is referred to as “split brain.” This procedure can reduce the frequency of tonic, atonic, and secondary generalized tonic-clonic seizures.

Denervation

A neurosurgical procedure in which nerve pathways between an organ and the brain, or between a region of the cerebrum and its neural connections, are completely or partially severed.

Epilepsy Surgery

A well-established and recognized neurosurgical procedure for treating focal epilepsy, performed in specialized centers.

In this procedure, the area of the brain responsible for the epileptic seizure is removed. Electrocorticography allows the triggering nerve tissue to be pinpointed with great precision. By temporarily implanting electrodes under the skull or into the brain, precise information can be obtained about the origin of the seizure and about possible effects of the surgery on memory function.

Epilepsy is the most common neurological disorder @ Tunatura / AdobeStock

External Ventricle Drainage

In neurosurgery, external ventricular drainage refers to the drainage of cerebrospinal fluid (CSF) from the ventricular system (cavity system) of the brain.

Guglielmi Detachable Coil (DGC, coiling, endovascular aneurysm occlusion)

In neurosurgery, this is a straight, soft, and very fine platinum coil typically used to occlude aneurysms of the cerebral arteries; it is advanced through a microcatheter inside a blood vessel to the aneurysm and placed within the aneurysm.

There, it resumes its spiral shape and forms a coil.

Hemispherectomy

A rarely performed neurosurgical procedure in which one hemisphere of the brain is removed. It is used to treat the most severe cases of epilepsy.

Capsulotomy

A very rarely performed neurosurgical procedure in which the fiber tracts of the internal capsule (a specific region of the cerebrum) are severed using stereotactic techniques (the patient’s head is firmly secured in a frame). The procedure is used for treatment-resistant psychiatric disorders (e.g., severe obsessive-compulsive disorder or depressive disorders).

Craniectomy

A neurosurgical procedure in which portions of the skull roof are removed. This neurosurgical operation creates space for the increased volume in cases of elevated intracranial pressure. The removed bone flap can be reimplanted later.

Craniotomy

A standard neurosurgical procedure in which the skull is opened.

Laminectomy

A neurosurgical procedure performed on the spine in which the lamina and the spinous process of one or more vertebrae are removed. On the one hand, this creates space for spinal cord or intervertebral disc surgery; on the other hand, it relieves pressure on the spinal cord when pressure is too high (e.g., due to a tumor in the spinal canal).

Microvascular Decompression (Jannetta Procedure)

A neurosurgical procedure in which pathological connections between arteries and cranial nerves in the posterior fossa are removed. To do this, the skull is first opened (trepanation), the pathological vessel-nerve connections are identified, and they are eliminated by inserting a cushion of muscle tissue or small Teflon sponges between them.

Minimally Invasive Endoscopic Neurosurgery

A diagnostic procedure in neurosurgery in which an encephaloscope or ventriculoscope is used to examine the ventricles (internal cavities of the brain) or pathological cavities in the brain (e.g., an abscess).

Neurolysis

A surgical technique in neurosurgery in which microsurgery is used to remove constrictions of a nerve (often caused by scar tissue adhesions) and thereby relieve the pressure exerted on the nerve.

Neuronavigation

A computer-assisted surgical procedure used in neurosurgery to plan brain surgeries and facilitate spatial orientation during the procedure. Neuronavigation precisely locates and displays the surgical site currently being treated and the surgical instrument on three-dimensional image data of the patient obtained through computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound.

Neurotomy (nerve section)

In neurosurgery, neurotomy refers to the complete or partial transection of a nerve (denervation) without loss of nerve tissue.

Nucleotomy

In neurosurgery, nucleotomy refers to the surgical procedure performed for a herniated disc, in which protruding portions of the intervertebral disc are removed from the spinal canal or spinal nerve root canal.

The herniated portions of the intervertebral disc press on the nerves of the spinal cord, which can lead to muscle paralysis and sensory disturbances of the skin, as well as urinary and fecal incontinence.

Ommaya Reservoir (Rickham Reservoir)

An Ommaya reservoir is a catheter system that is implanted into the ventricular system of the brain in neurosurgery and is frequently used for local chemotherapy of brain tumors.

Psychosurgery

A branch of neurosurgery that encompasses both surgical procedures on the brain to treat severe mental disorders (e.g., schizophrenia, obsessive-compulsive disorder) and the neurosurgical treatment of severe forms of other conditions (e.g., Parkinson’s syndrome, Tourette syndrome, epilepsy).

Stereotactic brain surgery

A minimally invasive neurosurgical procedure in which the patient’s head and the medical instruments are secured in a rigidly bolted frame.

Stereotactic brain surgery is often combined with real-time imaging using computed tomography (CT), magnetic resonance imaging (MRI), and computer-assisted instrument guidance. This enables precise, largely damage-free manipulation within the brain.

This neurosurgical procedure is used for

• the diagnosis of deep-seated lesions,
• the collection of tissue samples,
• the removal of brain tumors (oncological stereotaxy) and vascular malformations in the brain, as well as
• the treatment of movement disorders (e.g., tremor, Tourette syndrome, Parkinson’s disease) and certain forms of chronic pain (functional stereotaxy).

Thalamotomy

A stereotactic brain surgery performed in neurosurgery as a last resort, in which specific areas of the thalamus are deactivated through coagulation.

This neurosurgical procedure is used for severe, otherwise untreatable pain (in the arms, neck, or face), Parkinson’s disease, or other types of pain originating in the thalamus.

Deep Brain Stimulation (DBS, “brain pacemaker”)

A neurosurgical procedure designed to correct disease-related dysfunctions. In this neurosurgical procedure, thin electrodes are implanted into the brain and connected via cables placed under the skin to a pulse generator (located on the chest or in the upper abdomen).

Electrical impulses are delivered to the target region in the brain via the pulse generator and the electrodes, which can either stimulate or deactivate this region, depending on the frequency of the impulse.

Deep brain stimulation is used, for example, to treat Parkinson’s disease @ Teeradej /AdobeStock

Deep Hypothermia (Hypothermic Cardiac Arrest)

A procedure occasionally used in neurosurgery during brain surgery or to protect the brain during procedures on the aorta, in which the human body is intentionally cooled (hypothermia).

This allows blood flow to the brain to be reduced or temporarily halted entirely during brain surgery.

Trepanation

Trepanation is a surgical procedure in which bony or otherwise enclosed spaces are mechanically opened. In neurosurgery, craniotomy (surgical opening of the skull) is a form of trepanation.

The skull can be opened either by drilling a hole or by sawing out a piece of bone.

If the piece of bone removed from the skull is used to close the surgical wound, this is referred to as osteoplastic trepanation. In osteoclastic trepanation, the surgical wound is closed by other means (e.g., using metal or plastic implants).

Awake craniotomy

A neurosurgical procedure in which the patient is briefly awakened during surgery (after the skull has been opened). This neurosurgical procedure is used, for example, in tumor surgery and epilepsy surgery to determine how much brain tissue can be removed without causing neurological deficits.

Cingulotomy

A radical surgical procedure performed as a last resort on the human brain, in which the cingulate gyrus (the cingulum) is permanently severed, resulting in irreversible changes to the patient’s psyche. This neurosurgical procedure is used to treat the most severe mental illnesses (e.g., OCD).