THE MAIN DIRECTIONS OF TREATMENT IN THE CLINIC:

  • Tumors of the brain – diseases of the cerebral vessels (stroke)
  • Craniocerebral injury – diseases of intervertebral disc
  • Stenosis of spinal canal
  • Tumors located near the spinal cord/spinal tumors
  • Hydrocephalus/normotensive hydrocephalus (shunt surgery)
  • Pediatric neurosurgery
  • Peripheral nerves
  • Surgery of intervertebral discs

To date, the main cause of painful changes in the back is a lack of movement. Due to incorrect loading of the spine, discs located between the individual vertebrae are damaged. At a progressive stage, these lesions can be corrected, mainly, only by an operative method. In this case, the lumbar spine is most often affected; however, the damage to the cervical and thoracic spine is increasing. Depending on the type of disease of the intervertebral discs, doctors have different methods of surgical treatment.

Tumors of the brain
Malignant diseases do not spare the brain. Most of these tumors are benign (meningiomas), while others are classified as malignant tumors (astrocytomas). In addition, this includes metastases from other parts of the body. Benign and malignant tumors should be treated promptly. Reason: since the brain is located in the cranium, the growing tumor compresses the nerve cells that are sensitive to compression and damages them. This can lead to life-threatening abnormalities. After surgery, chemotherapy or radiation therapy is often performed.

Surgery for stroke and traumatic injuries
In accidents, the brain often suffers. Since the brain is very sensitive to compression (squeezing) of the body, it reacts very strongly to edema that develops because of falls. In order to reduce the load on the brain in such a situation, the focus of hemorrhage is removed by surgical intervention. Hemorrhages in the brain that occur because of a stroke affect the brain and must therefore be removed by an operative method in cases where drug treatment is not possible.
The clinic has 35 beds in two compartments. In addition, an interdisciplinary surgical department of resuscitation and intensive care plays an important role as the main department. All neurosurgical interventions are performed primarily with the use of microsurgical techniques. As for the range of services, here the main focus is on microsurgical operations on decompression in the cervical and lumbar spine.

Diagnostics

What is astrocytoma?
Astrocytoma is a cerebral tumor originating from the brain tissue support cells. Astrocytomas are about one-third of all gliomas and develop in their middle age.

Are astrocytomas benign or malignant?
The concept of astrocytoma covers a heterogeneous group of cerebral tumors, which are prognostically absolutely different. An astrocytoma can occur at different stages of malignancy (biological nature or malignancy of the tumor). This growth and extension trend can be determined by means of special histological studies of the tumor fragment tissue and then classified depending upon availability of endothelial proliferation, nuclear pleomorphism, necroses, mitoses and other criteria according to WHO’s classification for malignancy (up to four degrees) — from benign tumors (degree I) to malignant glioblastoma (degree IV). There are astrocytomas of low malignancy (degree II) and astrocytomas of higher malignancy (degree III), as well as glioblastomas (degree IV) featuring a worse prognosis. The decision as to whether a tumor can be still classified as a tumor of degree II or whether it is a tumor of degree III already (anaplastic astrocytoma) possesses not only forecasting but also therapeutic value (post-surgical treatment). However, molecular and biological markers can determine the tumor type that is more responsive to chemotherapy and radiotherapy and therefore more favorable to treatment within degree III tumors class too.

Why is surgery a first-line treatment for these tumors?
Astrocytomas of degree II are not benign tumors in the strict sense. Although they are classified as low-malignant tumors, tumorous cells can often pass a distance to the other areas of the brain. Astrocytomas of degree II can also regenerate and develop into degree III or IV. This malignant transformation is not unusual, but rather a rule if the tumor has been reported for a very long time. Therefore, we stick to the opinion that even low-malignant astrocytomas should be completely removed using microsurgical means as far as practicable from the standpoint of morphology. It is usually impossible to completely remove the tumor by microscopic means, as almost always some cells of the astrocytoma have already moved along the pathways in the medullary area. Therefore, contrary to another opinion, we believe that even small, asymptomatic astrocytomas need to be resected as far as possible rather than observed for the first time. The new study shows that under successful, the dullest resection of the tumor, the 5-year survival rate in younger patients can make 93 %. However, within the control imaging reviews (MRI), tumor components were detected again in 50 % of patients after 5 years. Here we can also recommend vigorous treatment, i.e. the repeated total operation upon the MRI criteria.
Since the complete removal of the tumor following the imaging criteria (MRI) is very important for the patient’s prognosis, but the tumors are often located near the critical areas of the brain, there are special requirements for surgical techniques in many cases.
Navigation, MRI tractography, and present-day planning create a reduced-impact minimal access. Intraoperative imaging and microsurgical technique of the operation are aimed at the eradication of the tumor. Functional MRI (fMRI) and intraoperative complex neuromonitoring of motor evoked potentials as well as sensory potentials, and, if appropriate, also performing surgery when a patient remains conscious, can provide a high standard of safety. Owing to the combination of these methods, it is now possible to resect even large or complex tumors without complications in the form of a patient’s motor or speech deficits.
If the tumor is inoperable, a biopsy can be performed to obtain histological characteristics.
For the prognosis, the extent of the surgical oncotomy and pathology report (WHO’s degree) are particularly important.

Tumor of pituitary gland (pituitary adenoma)
The tumor of the pituitary gland originates from the pituitary body (pituitary gland), the hormonal gland at the baseline of the skull. Pituitary gland is divided into anterior (adenohypophysis) and posterior lobe (neurohypophysis).
The tumors of the pituitary gland develop from the anterior lobe and therefore are also called pituitary adenomas.

These pituitary adenomas are usually benign
In the clinical presentation, tumors are either manifested as supersecretion of hormones (neuromediators) (see hormones-active tumors of the pituitary gland) or lead, due to their increasing size, to compression of neighboring anatomical structures. Such structures include, in particular, the optic nerve (Nervus opticus) and the pituitary gland itself.
If the optic nerve is compressed by the tumor, this usually results in the so-called visual field defect (bitemporal hemianopsia), this means that patients are unable to perceive objects and people who are on the outer edge of the field of view or can do it badly.
If pituitary gland compression occurs, this may lead to the pituitary function decrease (hypopituitarism). The suffered patients often complain about the lack of physical endurance and increased fatigability. Typical alabaster-colored skin and reduced body hair may be partly observed.

Operation
Many tumors of the pituitary gland do not initially require surgery, and despite their progressive size, they can be treated medicamentally. Such tumors include, for example, very common prolactinomas. Medicamentous therapy is carried out in close cooperation with the Department of Endocrinology. If surgery is required (for example, in the case of visual impairment), it is usually performed by easy access through the nose without opening the skull. Due to the use of all modern aids such as neuronavigation and endoscopy, the operation is minimally invasive and minimally dangerous, including in the case of repeated growth of tumors (relapse). In some cases, the operation can be also carried out by a completely endoscopic method. Most commonly, the pituitary gland can be preserved.

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