Brain Surgery

An operation on the brain is thoroughly prepared, performed very accurately and with much technical effort and then closely monitored.

The aim of open surgery is to complete the removal of the tumor as completely as possible, without impairing neurological functions. To achieve this goal, numerous techniques are used today. Which includes:

  • Neuronavigation
  • Fluorescence-assisted resection with ALA (Gliolan®)
  • Function monitoring (neurophysiological monitoring, operations with awake phases)
  • Ultrasonic
  • Intra-operative imaging (MRI, CT)
  • In navigation assisted surgery, the patient must be prepared either on the eve or on the day of surgery if the operating room has a CT or MR device.

Under general anesthesia (occasionally under local anesthesia, if surgery is near the linguistic center), the head is stored according to the location of the tumor and fixed in a three-point head clamp. After a straight or arched skin incision, the bone cover is usually sawed out with the high-pressure drilling system. The hard meninges are opened.

With the navigation guidance, the tumor is roughly targeted. This is removed under microsurgical conditions. As an auxiliary instrument, the ultrasonic aspirator is often used for larger tumors. During the fluorescence-assisted resection, the patient receives a medication hours before the operation, which during surgery makes some tumors more visible under the blue light due to their fluorescence. The extent of tumor removal depends on the adjacent functional areas that should not be damaged. During operations near the major functional centers, intraoperative neurophysiological monitoring is performed to monitor the function of the sensory and motor tracts as well as the auditory pathway and other cranial nerves, such as facial, lingual, shoulder musculature, etc. during surgery. The same applies to the monitoring of speech function in local anesthesia.

After complete hemostasis and, if necessary, intraoperative imaging control (CT or MR), the hard meninges and the wound are closed. The patient is transferred to the neurosurgical monitoring ward, where he wakes up. Normally, an MR or CT scan is taken the next day or at least 48 hours after surgery to determine the outcome of the surgery. The patient returns to the general ward on the first day after the operation with uncomplicated course and can be gradually mobilized with the support of physiotherapy, so that the patient can leave the clinic after about 7 to 10 days (home, home hospital, rehabilitation clinic, etc.).

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There are numerous types of brain surgery. The type used is based on the area of the brain and condition being treated. 2020-03-12 Brain Surgery
More About Brain Surgery

Neurosurgery is quite a wide section of medicine focused on correction of diseases of nervous system with many specializations including pathologies of the brain, spine, and peripheral nerves. As the brain is the center of all nervous activity, a theme of brain diseases takes a core place in neuropathology. Brain disorders could lead to disability of all life activity, that is why so important to have diagnostics and timely treatment of any dysfunctions that are presumably related to brain diseases. In German neurological centers you can find the conditions for thorough examinations of brain associated issues.

Brain Tumors Symptoms

Brain tumors are the result of cells mutations and their origin is unknown but if not to take the immediate measure, a tumor in the brain could cause a person to become completely incapacitated. These are the main symptoms of a brain tumor:

  • Permanent headaches growing more severe from time to time;
  • Visual disturbances, including partial loss of vision and blurred vision;
  • Nausea or vomiting note related to stomach problems;
  • Movement disorders, including balance disturbances and loosing ability of limbs to move;
  • Memory problems and confusions;
  • Unmotivated personality changes;
  • Seizures, including epileptic;
  • Fatigue.

If you have any of above symptoms, it is better to have a consultation with a doctor and necessary examination to eliminate the possibility of the brain tumor. There are following modern method are used in German medical centers to reveal a brain tumor:

  • MRI
  • CT scan
  • PET Scan
  • Cerebral arteriogram
  • Electroencephalography (EEG)
  • Lumbar puncture or spinal tap
  • Myelogram

Brain Surgery in Germany

There is rather spread classification of brain tumors, among the different type of them you can find gliomas, meningiomas, acoustic neuromas, pituitary adenomas, medulloblastomas, primitive neuroectodermal tumors, germ cell tumors, craniopharyngiomas etc. But it does not matter what their name are, if you diagnosed with a brain tumor, it is almost the only way to get rid of it is surgery.

The type of surgery on the brain depends on condition of disease and its location. It is better to remove as much tumor as possible but often it could be partially non-accessible. Based on method it is possible to divide operations on brain to three main groups:

Open Brain Surgery. Open brain surgery (craniotomy) is normally performed under general anesthesia with cranium opened. To expose an operational area a surgeon makes a hole in the skull, named bone flap. The size and form of bone flap depends on a tumor location. Some cases are known when craniotomy is carried out keeping a patient consciousness. It is needed when the tumor is located in vicinity of speech center to check the patient ability to keep speech functions. The patient awakes after the skull has been opened and, while the surgeon performs removing of the tumor, he or she could read, talk or answer the questions proving, thus, their ability to coordinate mind activity. At the end of operation the hole is closed with wires or plates and stitched.

Endoscopic surgery. Nowadays, it is also possible to remove the tumor from the brain without a single hole. With endonasal surgery the tumor could be removed via a nose. A neurosurgeon input an endoscope (a telescopic tube) through nasal passages and sinuses. It is possible to reach pituitary gland and area at skull base in this way. In case, when the tumor is not accessible through the nose, the surgeon drills a small hole for introducing the endoscope to the operated region. With those minimally invasive methods it is possible to perform surgery keeping the tissues and bones with less risk of complications.

Gamma knife surgery. It is not a surgery in common understanding as there is no any real knife or other instrument. The treatment is held by radio beams focused in diseased area to kill the tumor cells. There are a few types of technologies generating such kinds of beams and one of them is known as Gamma Knife (another one is LINAC – linear accelerator). It is one time procedure and a patient does not need to stay in a hospital and could go home immediately after it has finished.

The latest progressive technologies give you a good chance to recover of the most complex brain diseases. Today, the brain tumor is not a death sentence; the neurosurgery has reached such a high stage of development that you only need to choose right treatment with help of qualified neurologist. There are a number of clinics in Germany where you could get a qualified diagnostics using MRI, CT scan, EEG, cerebral angiograms, blood tests, biopsy and any other, that needed. If you seek for advice please choose your doctor and call to apply.

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