What is Neurosurgery?

Neurosurgery is the surgery concerning the central and peripheral nervous system, its adjacent structures, the skull and spine. Like all medical specialties, it has exclusive areas (aneurisms, brain tumours…) and areas that are shared with other specialties (e.g. surgery of the spine or peripheral nerves).

All in all, science in general -and medicine in particular- are advancing more and more every day. This means that diseases that were traditionally treated in a particular way, like craniotomy and clipping for aneurysms, have now other methods of treatment (in this case, endovascular embolisation of aneurysms); and results in that the primary task of every medical doctor, and especially any neurosurgeon, is not only to be an excellent professional but also, and above all, never to become obsolete by performing a right but outdated medicine.

In order to achieve this and to allow us to offer patients the treatment modality that provides the best results for them at that particular moment, a continuing medical education is required. Some techniques that were prevalent at a time are now obsolete and sometimes even forbidden, and thus constant training and studying are essential.

In addition, changes used to take decades but now take months, and so it is easier to fall behind and become anachronistic without a daily effort to keep up. The introduction of the microscope, the endoscope, the neuronavigation, and minimally invasive surgery are challenges that the practitioner must know how to respond to and adapt to, with regular attendance to training courses that update their knowledge.

Mr. Vanaclocha, to the left, and Mr. Martínez-Leon, to the right, inserting a full lumbar discal prosthesis
Another major challenge in recent years has been the creation of multidisciplinary teams that address the disease from multiple angles, enriching the treatment possibilities. The close work with oncologists and radiotherapists for the treatment of brain tumours is now well established, as it too the collaboration of the various branches of neurology for the treatment of epilepsy, abnormal movements (Parkinson’s disease), or spasticity. Furthermore, recent years have opened other interesting combinations, such as the work with vascular surgeons for the anterior approach to the spine, or with ENT surgeons for endoscopic treatment of the pathology of the base of the skull. Once again, cooperation and integration have been the keys, as opposed to prominence and individuality.
Mr. Vanaclocha, to the left, and Mr. Martínez-Leon, to the right, inserting a full lumbar discal prosthesis

 

Why brain surgery?

Neurosurgery arises from the peculiar characteristics of nervous tissue.

On one hand, it requires a very thorough knowledge of anatomy. It is not enough just to know the external appearance of the brain, the cerebellum, or spinal cord; above all, a detailed and three-dimensional view of the distribution of connecting fibres within the nervous system is essential: in this way we can get between the tracks without harming them, instead of going through them and consequently destroying them.

Image of 3-Tesla MRI in coronal section of the nerve pathways
Image of 3-Tesla MRI in sagital section of the nerve pathways
Image of 3-Tesla MRI in coronal section of the nerve pathways

Image of 3-Tesla MRI in sagital section of the nerve pathways

The lack of supportive connective tissue makes the central nervous system very soft and easily damaged if subjected to the smallest pressure or stretch, which would be well tolerated by other organs or tissues. 

Another key feature in the nervous system which makes it unique, especially the central nervous system, is its response to injury. Inflammation and oedema in any other organ would not cause major problems, but just swelling and pain. However, the nervous system is confined to a space with fixed volume and so the inflammation and oedema result in a dangerous increase in pressure, which impedes the arrival of arterial blood. If allowed to expand, the inflammation and oedema will block completely blood flow to the brain and result in the consequent death of the patient since the damaged neurones will be unrecoverable.

Finally, we must consider that the human nervous tissue has a very low capacity for regeneration, unlike the bone or liver that can regenerate itself. The worst example is the total paraplegia/tetraplegia of the spinal cord: once it is established, it is permanent.

Mr. Vanaclocha, in a surgical procedure of the spinal column
To perform surgical procedures in nervous tissue special instruments and equipment are required, as well as a special surgical skill: the bleeding vessels of the brain and spinal cord, for example, are so thin that you cannot tie or burn them as in other parts of the human body; so special clips and a bipolar coagulation system, which is much more precise and delicate, is required.
Mr. Vanaclocha, in a surgical procedure of the spinal column
 

In addition, the brain has almost no energy reserves, such as carbohydrates (glycogen, glucose) or fat. This means that, unlike in limbs, a tourniquet cannot be placed to operate on the patient without any bleeding. To work with constant blood flow is absolutely essential and mandatory: if it is stopped beyond 3-5 minutes it causes irreversible neuronal damage which can result in death or a vegetative status.

What We Offer

A team committed to continuing medical education and a hospital with high-technology equipment to ensure the best possible treatment for our patients.

Surgical microscope
Endoscopy array
Neuronavigation
Surgical microscope

Endoscopy array
Neuronavigation

Intra-operative CT
Ultrasonic aspirator
CO2 Laser
Intra-operative CT

Ultrasonic aspirator

CO2 Laser

Intraoperative electrophysiological monitoring
Laser for the photodynamic therapy
Intraoperative electrophysiological monitoring

Laser for the photodynamic therapy

Video EEG
Radio frequency pulse generator
Ozone generator
Video EEG
Radio frequency pulse generator
Ozone generator

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