Our department provides medical care for diseases related to brain disease such as brain tumors, skull base tumors, cerebrovascular disease, pediatric malformations, spinal tumors, and severe head injuries. One of our major strengths is the ability to treat a variety of patients who require neurosurgical intervention.
Unruptured cerebral aneurysm: (Figure 1)
A balloon-like bulge in a cerebral artery is called a cerebral aneurysm. Aneurysms are found in 2-6% of adults. In most cases, it happens to be found by undergoing MRI or CT of the brain or by receiving a brain dock. The annual rupture rate is said to be 0.5-3%. Risk factors with high rupture rates are thought to be large aneurysms, the occurrence of posterior circulation, irregular shapes, multiple aneurysms, smokers, patients with hypertension, and the elderly. There are three options for treating unruptured cerebral aneurysms. A: Careful follow-up, B: Aneurysmal neck clipping by craniotomy and C: Endovascular surgery to fill the aneurysm with a coil from inside the cerebral blood vessel using a catheter. Our department considers and provides the safest method that is most suitable for the patient among the three options.
Carotid artery stenosis:
Carotid artery stenosis is one of the atherosclerotic diseases caused by hypertension, diabetes, dyslipidemia, etc., and stenosis is caused by plaque in the blood vessel wall.
Severe stenosis and soft plaques increase the risk of stroke and require surgery.
There are two treatment options, carotid endarterectomy (CEA) and carotid artery stenting (CAS). CEA is a method of removing plaque in carotid artery by dissecting the neck, and CAS is a method of endovascular surgery in which a stent is used to dilate the stenosis. We choose either treatment method according to the patient's medical condition and imaging findings.
Cerebral arteriovenous malformation (AVM):
Cerebral AVM is one of the congenital diseases that occur in the blood vessels of the brain. Normally, blood in the brain flows from arteries through capillaries to veins. In contrast, cerebral AVM lack capillaries. Arterial blood flows directly into the veins through an abnormal mass of blood vessels called nidus. This condition puts pressure on the walls of the veins, making them more prone to bleeding. Treatment of cerebral AVM is determined by considering the size and location of nidus and the structure of blood vessels. In order to reduce nidus, we treat by combining multiple treatment methods such as surgical removal, endovascular treatment, and radiation therapy.
Meningioma: (Figure 2)
Meningioma is the most common brain tumor, accounting for more than 20% of primary brain tumors. Due to its slow growth, it is said to have been asymptomatic for several years.
In recent years, CT and MRI have become widespread, and the chances of finding a brain tumor without any symptoms have increased. Meningiomas are common in middle-aged and older women, and their symptoms and surgical procedures vary depending on where they occur. Our department uses intraoperative monitoring and neuro-navigation system to prevent damage to important nerves and eloquent areas during surgery. In addition, depending on the tumor location, the tumor is removed using the skull base surgical techniques.
The brain is made up of neurons and glial cells that support neurons. A brain tumor called a glioma originates from glial cells and grows. It accounts for about 25 to 30% of primary brain tumors and is one of the typical brain tumors. Gliomas are pathologically divided into 4 grades according to the WHO classification. The most benign ones are grade I, the most malignant ones are grade IV, and the middle ones are grades II and III. Gliomas grow to infiltrate the surrounding brain and are a mixture of normal brain tissue and tumor cells. Therefore, it is difficult to remove it completely by surgery, so chemotherapy or radiation therapy is added. Glioblastoma has an average survival time of more than one year and a five-year survival rate of several percent. In our department, even after performing basic surgical tumor resection and radiation and chemotherapy, we consider re-surgery and add anti-cancer drugs depending on the individual patient. We select treatments that emphasize the quality of life.
Pituitary adenomas are the third most common primary brain tumor. The frequency of occurrence is non-functional adenoma (40%), prolactin-producing adenoma (30%), growth hormone adenoma (20%), and adrenocorticotropic hormone-producing pituitary adenoma (5%). In particular, non-functional adenomas cause bitemporal hemianopia when they grow, requiring surgery. In our department, we generally perform trans-nasal surgery under neuro-endoscopy.
Among spinal tumors, spinal intradural extramedullary tumors are the most commonly encountered. Typical cases are schwannoma and meningioma. Both are benign tumors and surgical removal is the first choice. In our department, experienced specialists in spinal tumor surgery perform careful surgery equipped with intraoperative monitoring.