Head neurosurgery is a broad term that normally refers to all surgical interventions in the area of the brain as well as the cerebral and facial skull. The human skull can be divided into two parts: The cerebral skull encloses the brain, and the facial skull forms the face and is composed of bones that form the eye sockets, the nasal sockets and the oral cavity. The brain consists mainly of nerve tissue and is divided into different areas (cerebrum, cerebellum, diencephalon and brain stem) that perform different functions. Together with the spinal cord, the brain forms the central nervous system.

Overview

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Head and cerebral neurosurgery - Further information

What diseases are treated by the specialists for head and brain neurosurgery?

Various circumstances can make surgeries in the area of the skull necessary. Injuries, malformations or diseases of the skull or brain are often serious because they can lead to neurological complications or functional limitations for the affected person.

Injuries such as skull base injuries and craniocerebral trauma are medical emergencies and must be treated immediately. Accidents can lead to fractures of the cerebral skull and the facial skull, but also to bleeding. Other diseases that are treated by a specialist for head neurosurgery are, for example:

  • Malformations of the cerebral vessels may have to be treated surgically, as there is a risk of cerebral haemorrhage. These include vascular dilatations (aneurysms), angiomas and cavernomas. 
  • Brain haemorrhages also occur spontaneously (haematoma), due to tumors or as part of a stroke.
  • Brain tumors can occur in almost all areas of the facial and cranial skull. Whenever possible and useful, they are surgically removed. Some tumors also lead to increased intracranial pressure. 
  • Infectious diseases of the central nervous system, such as meningitis and abscesses.
  • The hydrocephalus is a fluid-filled extension of the cerebral ventricles.
  • Facial malformations include facial clefts such as the cleft lip and palate (LKG cleft), the cleft lip (harelip) and the cleft palate (Wolfsrachen).
  • In the case of cranial malformations, the skull can be so deformed that the development of the brain could be impaired.
  • Certain forms of epilepsy and other neurological diseases can be treated by brain surgery.

Which diagnostic methods are used by specialists in head and brain neurosurgery?

In addition to anamnesis and physical examination, during which symptoms and functional restrictions are recorded and assessed, special diagnostic procedures are used in head neurosurgery. 

X-rays are taken to detect bone changes, fractures and bone tumors, for example. Computed tomography (CT) and magnetic resonance imaging (MRI) are used in addition or as an alternative if brain tumors or vascular changes are suspected. The blood vessels can be visualized particularly well by coupling CT or MRT with angiography, which is then referred to as CT angiography or MR angiography. Digital subtraction angiography can also be used to detect changes in the vessels. Today, ultrasound echo-encephalography is rarely used in head and brain neurosurgery, for example after hydrocephalus surgery. Positron emission tomography (PET) can be used in the diagnosis of tumors.

Furthermore, it may be necessary to register functional currents of the brain (e.g. via an electroencephalogram, EEG) or muscles (electromyogram, EMG) or to carry out other electrophysiological examinations. 

Numerous clinical pictures with which the experts in head and brain neurosurgery are confronted are accompanied by an increase in intracranial (= inside the skull) pressure. One method of determining intracranial pressure is ventricular puncture.

Which treatment methods belong to the range of services of a head and brain neurosurgeon?

Brain surgery can be performed openly, i.e. a part of the skull is removed, or by using a minimally invasive technique. Since such surgeries have to be performed with extreme precision in order to preserve healthy brain tissue as much as possible, brain surgeries today are performed with great technical effort using surgical microscopes and computer-assisted neuronavigation. Some surgeries are performed using a laser (laser surgery).

During the awake brain surgery, the patient experiences a part of the surgery in full consciousness in order to be able to perform certain tests, in which the neurosurgeon is dependent on the patient's feedback. They are often used in tumor surgery and epilepsy surgery. 

The range of services of a head and brain neurosurgeon includes neurosurgical interventions, such as:

  • Functional neurosurgery for movement disorders, Parkinson's disease and tremor
  • Deep brain stimulation ("brain pacemaker") to treat movement disorders and neurological diseases such as Parkinson's disease, tremor, epilepsy, dystonia and obsessive-compulsive disorder. A pacemaker is inserted under the skin of the chest or upper abdomen and electrodes are inserted into certain areas of the brain. 
  • Treatment of aneurysms (brain vascular malformation) by embolisation (coiling) or the insertion of a kind of vascular clip (clipping) and angiomas (blood sponge) by surgery, embolisation or radiation (vascular neurosurgery).
  • Treatment of head injuries such as skull and skull base fractures (neurotraumatology)
  • Treatment of brain tumors and meninges using computer-controlled surgical techniques (neuronavigation)
  • Treatment of cerebral hemorrhage
  • Treatment of compression syndromes of cranial nerves
  • Treatment of cerebrospinal fluid circulation disorders
  • Treatment of deformities of the child's skull due to premature ossification of the skull sutures (synostosis)
  • Treatment of hydrocephalus (shunt operation, ventriculostomy)
  • Treatment of trigeminal neuralgia (facial pain)
  • Treatment of facial malformations

What distinguishes the specialists for head and brain neurosurgery?

Experts for head and brain neurosurgery can be specialists for plastic and esthetic surgery, specialists for neurosurgery or specialists for pediatric surgery. They are familiar with the anatomical features of the skull and its bones, the brain and the most modern diagnostic and therapeutic procedures.

Literature

  • Aumüller G, Wennemuth G (2017) Kopf – Schädel und mimische Muskulatur. Duale Reihe Anatomie. Thieme, Stuttgart
  • Frauser S, Essang C, Altenmüller D-M et al. (2014) Long‐term seizure outcome in 211 patients with focal cortical dysplasia. Epilepsia 56(1): 66-76
  • Mense S (2017) ZNS – Aufbau und Organisation. Duale Reihe Anatomie. Thieme, Stuttgart
  • Zweckberger K, Unterberg AW (2012) Neurochirurgie. In: Siewert JR, Stein HJ (Hrsg) Chirurgie. 9. Aufl. Springer, Heidelberg