Brain surgery

Cancer in the brain occurs like cancer in any other tissue. Organs consist of tissues, and tissues consist of cells. Cancer begins inside the cells. Cells grow and multiply when needed. When they get older, they die and new cells are replaced.

Sometimes this process starts to work abnormally. New cells begin to form when the body does not need it, and older cells do not die when they need to die. This causes excessive accumulation of cells in that tissue. This is called a tumor. Brain tumors can be benign or malignant. There are no cancer cells in benign brain tumors.

Benign brain tumors; they can usually be removed surgically and usually do not reappear. They do not spread into the brain tissue around them. However, they can cause various and sometimes very serious health problems in the related organ by pressing under the influence of mass. Unlike benign tumors in other organs, benign brain tumors can sometimes cause life-threatening conditions. A benign brain tumor can rarely turn into a malignant brain tumor.

Malignant brain tumors contain cancer cells. They grow rapidly and infiltrate into the healthy tissue around them. Although very rarely, they can sometimes spread to the spinal cord or even to other organs of the body. This condition is called metastasis.

A cancer that has formed in another organ of the body can also cause a brain tumor. Such cancers are called secondary or metastatic brain tumors. Secondary tumors in the brain are much more common than primary brain tumors. Such tumors have the characteristics of the original cancerous tissue and have the same name. For example, lung and breast cancers are brain metastases. Brain metastasis means that a cancer that develops in tissues and organs outside the brain spreads to the brain tissue and forms a tumor there. These types of tumors are also called secondary tumors. The most common tumors in the brain are this type of tumor. It is one of the leading causes of death in cancer patients.

HYPOPHIZE TUMORS

The pituitary tumor or pituitary adenoma is a benign tumor that usually occurs in the front of the pituitary gland. Pituitary tumors constitute approximately 15% of primary brain tumors. The pituitary gland is a bean-sized gland at the base of the brain, just behind the nasal root, inside a bone structure called sella tursika. From this gland, prolactin, growth hormone and adrenocorticotropic hormones are secreted. These hormones help many important functions in the body such as sexual development, bone development, muscle building, stress coping and disease prevention. Pituitary tumors disrupt this normal hormonal functioning. Some pituitary tumors do not release hormones.

Tumors made up of support cells, i.e., glia, in the brain are called gliomas. Ependimoma is a glioma. Ependymomas originate from ependyma cells that cover the cavities in the brain, that is, the ventricles. Ependimos are soft, grayish or red tumors. Sometimes there may be fluid-filled cysts or calcification in them.

BRAIN ANEURYSM

Balloon occurring in the vein is called a brain aneurysm due to the weakness of the muscle layer in one of the brain vessels. This ballooning causes thinning and weakening in the vessel wall. Intracranial bleeding that occurs as a result of rupture of the vein from this weak place is called subarachnoid hemorrhage. Such bleeding can cause stroke, coma, or death.

The exact cause of brain aneurysms is unknown. However, some factors are considered to contribute to the formation of brain aneurysms.

These factors are:

  • Hypertension
  • Smoking
  • Genetic predisposition
  • Damage to the blood vessels
  • Some infections

Not all aneurysms in the brain can bleed. Sometimes aneurysms bleed from a small vessel rupture. Then there is very little bleeding into the brain. Sometimes the rupture is too big; in this case, much more serious findings and even death may occur.

Currently available treatment options are divided into three as medical, surgical and endovascular.

MEDICAL TREATMENT OPTIONS

The only treatment for an ruptured brain aneurysm is medical therapy. The medical treatment approach is also based on smoking cessation and blood pressure control strategies. These are the factors that have been shown to be effective in the formation, growth and tear of aneurysms. Starting a diet and exercise program to control blood pressure after smoking cessation; If necessary, using drugs that lower blood pressure are effective methods to prevent tears in aneurysms. In addition, regular radiographic examinations (MRI, CT, or angiography) are important to keep track of the size and growth of the aneurysm.

SURGICAL TREATMENT OPTIONS

The first "clip" application in surgical treatment of brain aneurysms was done in 1937. The increase of clip types in the 1960s and the introduction of microsurgical methods in neurosurgery have made surgical treatment the gold standard position in brain aneurysms. Despite this, surgical clipping surgeries are among the major and difficult surgeries. Clipping is done by craniotomy (removal of a part of the skull). Brain and cerebral vessels are accessed via a craniotomy and aneurysm is found. After that, the aneurysm is carefully separated from the surrounding brain tissue. At this stage, a small metal (usually titanium) clip is applied to the neck (base) of the aneurysm. These clips have a spring mechanism and, when inserted, cut the blood flow into the aneurysm.

ENDOVASCULAR TREATMENT OPTION

The use of endovascular techniques in the treatment of brain aneurysms began in the 1970s. However, with the development of the material used in the 1980s and its approval in the USA in 1995, this technique started to be used more widely. The purpose of endovascular bow application is to eliminate the aneurysm as in surgical clips. The long-term indication that this treatment is successful is that the aneurysm does not reappear. Re-opening of the blood path in the aneurysm or regurgitation of the aneurysm after treatment is considered treatment failure. A soft spring made of platinum is used for the procedure. This bow is carefully advanced to the brain through one of the large arteries in the groin and placed in the aneurysm inside the brain. The spring placed inside the aneurysm disrupts the blood flow here. As a result of the slowed blood flow, a large blood clot forms here. The aneurysm that is clogged with the formed clot closes and cannot tear and bleed. The long-term persistence of endovascular bow application, which is a more preferred method compared to neurosurgery in terms of intervention, is not yet known. In addition, not all aneurysms are suitable for spring application.

WHAT ARE THE PROBLEMS THAT MAY COME?

The most dangerous situation that can occur during both clipping and bow application is the rupture of the aneurysm and bleeding into the brain. Although it is not known exactly how often this incident occurred, a rate of 2-3% can be mentioned for both processes. Bleeding into the brain by rupture of the aneurysm. This can lead to stroke, coma, or death. Intervention to aneurysm rupture, which may occur during both procedures, can be performed more easily during open brain surgeries. Because the bleeding area can be seen more easily during this procedure and it can be intervened more easily for bleeding control. Strokes that may develop due to decreased blood flow and thus decreased oxygenation may occur during clipping or spring application as another dangerous condition. The extent and distribution of this stroke depends on the location of the aneurysm. Issues such as how long the procedure will last, the risks that may occur, how long after the procedure can be returned to normal life depend on the size of the bleeding and the patient's medical condition. Therefore, the situation of each person should be discussed separately and discussed with their physician.

WHO DOES SUBARACNOID BLEED?

This type of bleeding is usually 1 in 10,000. Approximately 5-10% of all strokes occur due to subarachnoid hemorrhage. It is mostly seen in 20-60 age group. It occurs slightly more in women than in men. In a small part of subarachnoid hemorrhages, there is no arterial tear. These types of bleeding occur spontaneously and usually occur in perimeseencephalic spaces in the brain. The chances of healing this type of subarachnoid hemorrhage are very high. This type of bleeding is thought to be from vein or thin capillary vessels. The most common finding in subarachnoid hemorrhages is sudden onset headache. This headache is often referred to as the “worst pain experience ever”. There may have been a feeling of bursting in the head before the pain. Pain in the whole head is usually more severe in the back. Nausea and vomiting may also accompany headache. In addition, blurring, decreased attention and consciousness disorders that can progress to coma can be seen. Visual impairments, double vision, blind spots in vision, or sudden vision loss in one eye may also occur. The neck is painful and stiff. Light can irritate the eyes. There may be neck and back pain. The person can transfer. One area of ​​the body may not be moved or senses in that area may be lost. Personality disorders, confusion, irritability may occur.

Vascular Diseases


Celebral hemorrhage

Brain hemorrhage means bleeding into the brain due to rupture of one of the arterial vessels in the brain. When there is bleeding, the brain inside the skull, which is an inelastic structure, remains under the pressure created by the liquid that fills in it, it is crushed and accordingly various findings appear. There are two types of brain hemorrhage, which are bleeding into the brain (intracerebral) and under the brain membranes (subarachnoid), that is, around the brain.

WHAT HAPPENS IN THE BRAIN (INTRASEREBRAL) INSIDE THE BRAIN?

In this type of bleeding, one of the small arteries inside the brain is ruptured. In this case, there is pressure on the brain tissue in the region where the bleeding occurs and dysfunctions occur in the body region that is managed by that part of the brain. The most common cause of bleeding into the brain is high blood pressure. With years of effect of high blood pressure on small vessels, the vessels become weak and tend to rupture. The most effective way to prevent such brain hemorrhages is to keep blood pressure within normal limits.

WHAT HAPPENS UNDER THE DAMAGES OF THE BRAIN (SUBARAKNOID)?

In such bleeding, one of the large arteries at the base of the brain is ruptured. In this case, the flowing blood also spreads to the entire circumference of the brain and into the cerebrospinal fluid. The cause of most subarachnoid hemorrhages is rupture of an aneurysm that exists within the brain. The walls of these aneurysms are thin and therefore tend to tear. These aneurysms exist in some people, others do not. The reason for this is unknown. Some people have aneurysms from birth, but they do not tear for life. But the consequences of aneurysm rupture are often very serious. About half of patients with aneurysm bleeding are lost. Another cause other than aneurysm is arteriovenous malformations.

WHO DOES SUBARACNOID BLEED?

This type of bleeding is usually 1 in 10,000. Approximately 5-10% of all strokes occur due to subarachnoid hemorrhage. It is mostly seen in 20-60 age group. It is slightly more common in women than in men.

WHAT ARE THE SYMPTOMS AND FINDINGS OF SUBARACNOID BLEEDING?

The most common finding is sudden onset headache. There may have been a feeling of bursting in the head before the pain. Pain in the whole head is usually more severe in the back. Nausea and vomiting may also accompany headache. In addition, blurring, decreased attention and consciousness disorders that can progress to coma can be seen. Visual impairments, double vision, blind spots in vision, or sudden vision loss in one eye may also occur. The neck is painful and stiff. Light can irritate the eyes. There may be neck and back pain. The person can transfer. One area of ​​the body may not be moved or senses in that area may be lost. Personality disorders, confusion, irritability may occur. As a result of the neurological examination to be performed by the physician, it will be revealed that the patient has a condition that compresses the meninges. As a result of the examination, neck stiffness, the presence of neurological disorders in various parts of the body and bleeding during eye examination helps to diagnose brain hemorrhage.

How does stroke occur?

When the blood flow to the brain is interrupted in any way, brain cells cannot take the oxygen and nutrients necessary for them. If this problem is not resolved within a very short time, permanent brain damage will occur. Brain cells cannot regenerate after dying, and damage remains permanent. Any blockage in the blood vessels inside the brain or neck prevents blood flow to the brain, causing the brain to be deprived of the oxygen and nutrients it needs. The problem in this case is that there is not enough blood flow. Conversely, having too much blood also creates problems. Any tearing that may occur in the blood vessels inside the brain causes brain bleeding; this usually causes irreversible damage to sensitive brain tissue and is more lethal.

There are two types of stroke: ischemic stroke and hemorrhagic stroke. Ischemic stroke is a more common type of stroke and occurs when blood flow to the brain is interrupted. Hemorrhagic stroke occurs when there is bleeding inside or around the brain. The following factors increase the risk of stroke in a person: smoking, high blood pressure, diabetes, a history of heart disease, high blood cholesterol level, taking birth control pills. The signs and symptoms of stroke can be very different. But all the findings suddenly appear. Signs and signs that should suggest a stroke are: very severe headache, confusion, confusion of people, location and time, numbness in the legs or face in any arm, weakness or inability to move, sudden disruption of speech, loss of vision, loss of balance or coordination. inability to do the skills that want. Approximately 30% of stroke patients have a history of transient ischemic attacks. The signs and symptoms of transient ischemic attacks are approximately the same, but these symptoms often disappear within a few minutes. Regardless of the findings, this attack is called transient ischemic attack because all of them pass within 24 hours.

How is stroke treated?

Various specialists work together to remove or minimize the sequelae left in the person after a stroke. However, it is extremely important to diagnose it as early as possible during stroke and to start treatment as early as possible, in terms of treatment success and prevention of permanent sequelae. If the diagnosis of stroke is made in the early period, neurosurgeons have various treatment options. These include repairing an aneurysm bleeding inside the head, clearing blood clots that cause obstruction in the brain, or cleaning plaques that can break through the carotid vessels in the neck and cause obstruction in the brain.

ARTERİOVENÖZ MALFORMATION

Arteriovenous malformation is called abnormal connections between the artery and vein. It is a local disorder in the structure of the blood circulation system, which can occur mostly when the baby completes development in the womb or after birth. Although this disease is mostly encountered in the central nervous system, it can occur all over the body.

CAVERNOMA

Cavernoma or cavernous malformation is a vascular anomaly of the central nervous system. This disease includes a group of abnormal, bulging vessels. Its images are similar to blackberry and their size is usually less than 3 centimeters. This condition is more common in some people than in others. Cavernomas occur in men and women and all races with the same frequency. The incidence is higher in those with a family history of cavernoma. Rarely, a person may have multiple cavernoma. Cavernomas can occur anywhere in the brain. Its incidence in the community is around 5 per thousand. While most of the cavernomas do not show any signs and symptoms, some may develop symptoms such as referral, progressive neurological findings, cavernosma bleeding and headache. The symptom that initiates the diagnosis process may be to investigate headaches in many patients. Sometimes patients can also apply with double vision, sensory impairments and loss of strength or paralysis on one side of the body.

The findings are closely related to where the cavernoma is located in the brain. Some patients may apply to the emergency department with the complaint of remittance and the underlying cavernoma may occur when the cause of the transfer is investigated. In approximately 35% of patients with cavernoma, referral can be seen as the reason for the application. In about 25% of patients, cavernomas occur after bleeding. This is the most serious result of cavernomas. If cavernoma bleeds, this usually begins with a headache. Headaches start suddenly, nausea followed by vomiting, and neurological problems begin to appear as consciousness gradually closes. In some cases, if the bleeding is too small, it may not produce any signs and symptoms. Diagnosis of cavernomas can be made by CT or MRI. Both radiological diagnostic tests can reveal where and how large cavernomas are in the brain. Cavernomas cannot be seen by brain angiography. Treatment options come to the fore when cavernomas give the following symptoms: emergence of neurological dysfunctions, bleeding, emergence of unbearable symptoms and uncontrollable transfers. Treatment in cavernoma is surgery.

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