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Νευροχειρουργός Νίκος Μαραθεύτης
Επικοινωνία : 210 5021743
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We present to you a reallyinnovative surgery that was recently performed at the Euroclinic of Athens by our Neurosurgery team, which consists of Nikolaos Maratheftis, Director Neurosurgeon, and Evangelos Rokas, Attending Neurosurgeon, on a 38 year-old male patient diagnosed with a lesion with tumor characters in the left cerebral hemisphere. This lesion spread near particularly sensitive areas that control movement in the right hand and foot, as well as speech comprehension and speech. The lesion was deep inside the brain. The patient had a history of kidney transplantation and blood clotting disorders.
When he came to the Euroclinic of Athens, studying the patient’s file in consultation and collaboration with Dr. Stavros Kanellas, Director Anesthesiologist and Maria Saridou, Attending Anesthesiologist, we decided to perform the operation to remove this lesion, the cause of which was a glioma of possibly low malignancy.
The technique of craniotomy with the patient awake craniotomy) is an advanced neurosurgical and anesthesia technique that allows brain surgery to be performed while the patient is conscious, painless, and can speak and execute commands given by the doctors. At the same time the operation proceeds and the diseased tissues are removed from the brain.
This method requires excellent coordination of the administration of anesthetic drugs, in a delicate balance, so that the experience is not painful for the patient while at the same time he maintains his senses.At the same time, the neurosurgeon stimulates the suspicious area with a special electrode, checking whether this stimulation causes a neurological disorder such as paralysis of the hand, foot, speech disorder, patient orientation, etc.
Thus, the pathological tissue is removed from the brain as much as possible , without the slightest impact on the patient’s neurological condition.
The craniotomy on alert has been done again in Greece. In our case, however, for the first time in Greece , this technique was combined with the most advanced minimally invasive method of “mini” craniotomy.
“Mini” craniotomy is a state-of-the-art technique worldwide. The first publications on its application to a sufficient number of patients were made in 2013 and 2014 by neurosurgery centers in the USA and Israel. With this craniotomy, only a small opening is made, a hole of 2.5 cm in diameter in the skull, from where we can reach great depth and extent, without the risks involved in a normal craniotomy.
Using the neuro navigator , we direct a small special lumenused for the first time in Greece, in the affected area, and using a microscope (or an endoscope, if necessary) we remove the pathological tissue, which we send for examination. The advantage of the lumen is that the brain is not substantially compressed, while the lesion is completely removed, and the procedure is not restricted to a simple biopsy. Therefore we combine the definitive diagnosis with the treatment of the disease.
The risk of bleeding and neurological damage to the patient is minimized by the use of minimally invasive (mini) craniotomy. Especially in the case of our patient, who had disorders of the blood coagulation mechanism due to the kidney transplant he had undergone, this method was the ideal choice.
The result of the biopsy showed that it was not a tumor, but inflammatory tissue, in the context of the immunosuppression that the patient had undergone for his kidney disease. His postoperative course was excellent. He was hospitalized only for 2 days, did not suffer from pain or other discomfort, and never showed neurological damage. The swelling of the brain subsided, along with the headaches that had led him to the MRI of the brain, which had initially revealed his problem.
Indeed, thanks to these state-of-the -art techniques that our Neurosurgery team applies to the Euroclinic of Athens, we can offer the leading medical services, such as the best Neurosurgery Centers in the world. The surgeries for the removal of inaccessible brain tumors , for the removal of automatic and traumatic brain hematomas have now been done, thanks to these techniques we apply, less traumaticless traumatic, more effective and require less time of hospitalization. Even tumors that were consideredunoperative can now be safely removed. The risk of postoperative complications (bleeding, infection, neurological damage) is clearly lower with “mini” craniotomies.
It is important, in a difficult situation for our country, to know that the conditions for the provision of health services at the top level exist and flourish, thanks to the cooperation of the Administration, the Medical and Nursing staff of the Euroclinic of Athens.
Director Neurosurgeon of the Euroclinic of Athens
In modern surgery, with the help of technology and the accumulation of experience, new methods have been developed, which help surgeons perform operations that in the past were particularly traumatic, with minimal risk of surgical trauma. A typical example is spine surgeries, such as spinal fusion.
Percutaneous spine surgeries significantly reduce patients’ discomfort, pain, risks and hospitalization time. Thus, even the largest spinal fusion does not mean that the patient is required to stay in bed. Patients with spondylolisthesis, spinal stenosis, lumbar spondylosis, and vertebral fractures after injury can move without pain within a few days and are discharged from the hospital in 2-3 days. This is because neither the back muscles nor the bones and ligaments are injured, so the pain is comparatively minimal. The need for blood transfusions during spinal fusion surgeries is practically zero.
All open spinal fusions can be replaced by percutaneous ones, with the mere exception of surgeries to repair scoliosis. The time of full functional recovery is dramatically reduced by reducing the cost of health expenditures at individual and national level.
Microdiscectomyis a case of day care, while the incision in the skin is less than 2 cm. The patients do not even have to spend the night in the hospital. Thus,recovery is accelated and they are able to return to their activities.
Percutaneous kyphoplasty , for the repair of vertebral fractures (eg from osteoporosis), is also performed with daily hospitalization and immediate mobilization and relief of the patient.
These methods utilize technologies such as robotic navigation, neuronavigation, surgical microscope and endoscope, as well as a number of advanced surgical tools and equipment , such as the ultrasonic osteotomy. Surgeons who know these techniques, can offer patients the surgical care of the 21st century in Greece , with the exact same quality characteristics as in the most advanced medical countries in the world.
|Open spine surgery.||Percutaneous surgery
See how small the skin opening and the overall surgical injury are
Kyphoplasty surgery to repair a vertebral fracture
|Patient with spondylolisthesis between 4th and 5th lumbar vertebrae||Rehabilitation with percutaneous spinal fusion and implant in the disc. The spondylolisthesis has been redone.|
Neuropathic pain can be treated with the use of radiofrequency. Examples of such diseases are postherpetic neuralgia and trigeminal neuralgia.
An example of non-neuropathic pain that can be treated with radiofrequency is back pain due to degeneration of the vertebral joints, as well as selected cases of neck pain.
The use of radiofrequency is not indicated when the pain is of central etiology, i.e. the nervous system damage is located in the brain or the spinal cord.
The radiofrequencies are applied via an electrode to the active tip of a special needle, using a continuous electric field, which causes the controlled production of heat through the friction of ions. When this heat (60-90 ° C, depending on the indications) acts on a target nerve, it provokes its selective destruction and modification, with the aim of stopping the transmission of painful signals to the spinal cord and brain, thus pain relief.
The electric radio frequency field is generated by a special radio frequency generator and is applied to the target through a special needle with an active non-insulated tip. An electrode connected to the generator enters into this special needle. The generator has an indication screen and provides detailed information regarding the various parameters of the operation.
The operation is performed under local anesthesia and twilight anesthesia, with X-ray guidance (C-arm). The patient does not need to spend the night in the hospital and can go home just a few hours after the end of the operation (day care).
After all the antiseptic measures have been taken, a special needle is directed with absolute precision towards the target. We use radiographic guides, taking multiple profile, face and oblique shots, so that the needle and the electrode can navigate between the sensitive structures and away from blood vessels, the spinal cord, the dura mater and the internal organs (eg the lungs, in medial nerve access).
When the final correct position is confirmed radiographically through various shots, a contrast agent is administered to erase the contour of the nerve and its extension into the spinal canal (in case the surgery is performed inside the spine). The special electrode is then connected to the radio frequency generator.
An aesthetic test with nerve stimulation follows, using specific intensities (μA), voltages (mV) and frequencies (Hz), in order for the active tip of the needle to be placed as close to the target as possible (ie to the sensory area of the nerve). Once this is achieved and the measurements of the above parameters and tissue resistance (Ω) are satisfactory, a motor testing follows and the patient’s response to this type of stimulation is observed to ensure that the active needle tip is at a safe distance from the motor nerve that is not a target. This is a particularly delicate process if we consider that the tip of the electrode is usually 1.4 mm in diameter, while the diameter of the nerve can range from 2-5 mm. The target nerve is obviously in close proximity to the motor branch and its artery and vein, so absolute certainty is required before the treatment application, in order to avoid complications.
The electrode is then heated in a controlled selected temperature, for a few minutes (1 to 2.5 minutes, depending on the therapeutic protocol) exerting its therapeutic effect. The rise in temperature is not painful for the patient because during thermocoagulation the anesthesiologist administers twilight anesthesia and systemic central analgesia. In most cases, applying heat to a sensory nerve would be particularly painful, without continuous anesthesia. A typical operation takes 30-90 minutes, as thermocoagulation of more than one sensory branch may be required. Access may also be difficult due to anatomical abnormalities in the area (eg significant osteophytes, or anatomical variants).
Radiofrequency therapy is a safe and effective method of treating several chronic painful syndromes. If the pain is significantly reduced with the first application of radiofrequency then the treatment can be repeated more times. There is strong clinical evidence that radiofrequency therapy is effective in treating trigeminal neuralgia, radicular nerve pain, and spinal pain (Lord 2002). In a large study, 92.5% of patients with trigeminal neuralgia reported excellent or good relief after treatment of the trigeminal ganglion with traditional radiofrequency (Chen 2001).
The denervation of the facet joints in the lumbar and cervical spine, with the application of radiofrequency in the medial nerve branch is documented by large studies (RCT studies). A recent review for the invasive treatment of chronic spinal pain by the American Society of Interventional Pain Physicians (ASIPP) concludes that denervation of the lumbar and cervical joints of the spine is highly effective in a short period of time (3-6 months) and moderately documented for a long period of time (>>1 year).
After treatment, patients are usually relieved of the need for continuous analgesic treatment and all the possible side effects and ineffectiveness it may bring, while fully returning to their activities without any restrictions.
Especially in the case of denervation of the facet joints in the lumbar and cervical spine, the absence or reduction of pain (i.e. backache or neck pain), allows other therapeutic actions to be performed (i.e. physical therapy for muscle strengthening) which have a continuous and long-lasting effect as far as the reduction of pain episodes is concerned.
With the endoscope we can use a special fiber optic microcamera to see inside the tissues and direct special tools for biopsies and to investigate anatomical abnormalities, opening new drainage channels of the cerebrospinal fluid (eg 3rd ventriculostomy), opening of brain cysts , removal of pituitary tumours, removal of cerebral hematomas, and even the surgical treatment of aneurysms. Special training of neurosurgeons is required as far as the techniques of the endoscope are concerned. The more the progress and development of the equipment, the more neurosurgical diseases are treated with endoscopic methods, in combination with other techniques, such as neuronavigation.