Range of neurosurgical treatments

Deep brain stimulation (DBS) is a neurosurgical procedure in which electrodes are implanted in certain areas and nuclei. This method is mainly used to treat movement disorders, pain, and mental illness. After the operation, a pacemaker is implanted under the skin activates the electrodes. Various symptoms are improved. The thalamus stimulation reduces or eliminates tremors (tremors in the extremities) that can occur with multiple movement disorders. The subthalamic nucleus stimulation leads to an improvement in all the main symptoms of Parkinson's disease, such as tremors, immobility (akinesia), rigour, and severe over-movements (dyskinesias). The stimulation also reduces medication intake.
For the treatment of dystonia, electrodes are implanted in the internal globus pallidus. Prof. Krauss introduced this therapy method in cervical dystonia (torticollis) at the end of the 90s and is now certified worldwide. The Department of Neurosurgery has the most incredible experience worldwide in the surgical treatment of dystonia.
More extensive studies show that deep brain stimulation in Parkinson's disease, dystonia, and essential tremor improves symptoms of particular movement disorders.
The Department of Neurosurgery performs all stereotactic interventions for Parkinson's disease, dystonia, chronic pain, cluster headache and essential tremor. Another focus is the treatment of chronic nerve pain. Both ablative and stimulation methods are offered here: SCS = spinal cord stimulation (spinal cord stimulation), ganglion stimulation, peripheral nerve stimulation and occipital stimulation, see pain: surgery/therapy).
If you or your attending doctor believe that stereotactic surgery and deep brain stimulation are suitable for your disease, you are welcome to introduce yourself in our specialist consultation hour or private consultation hour.

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The brain is surrounded by nerve water, the so-called liquor, in the skull. It circulates in and around the brain in a particular cycle. It is constantly produced and reabsorbed to be replaced almost three times within 24 hours.
One speaks of hydrocephalus (water head) if there is a disturbance in this cycle or the balance between production and absorption; one speaks of hydrocephalus (water head). Overpressure develops in the head, which presses on the brain. The consequences are headaches, nausea, vomiting, visual disturbance, incontinence, dementia, impaired consciousness, and coma.
Treatment of hydrocephalus is carried out using two methods: During shunt operation, excessive nerve water is guided from the head into the stomach or heart via a small pipelining tube placed under the skin like a pipeline.
Another option is endoscopic surgery, in which the circulatory seal is opened, or a bypass circuit is created.
Hydrocephalus is a curable disease. Both treatment options are available.
Use the general polyclinic or private consultation hour to introduce questions to clarify.

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Central nervous system (CNS) tumours include benign and malignant tumours of the brain and spinal cord. Surgical treatment aims to remove the tumours as altogether and gently as possible. Current computer-assisted operations with intraoperative monitoring procedures allow function-preserving tumour resection even in eloquent brain areas.
The Department for Neurosurgery has the most modern technical aids to increase surgery safety and was the first clinic in Lower Saxony to receive the institute certification for Special Neurosurgical Oncology. In addition to microsurgical brain tumour removal, minimally invasive surgical procedures and neuroendoscopy, stereotaxy, fluorescence-controlled tumour resection and neuronavigated biopsy are available to secure the tumour tissue. Awake surgery can also be performed to monitor speech, movement, and other brain functions during the procedure.
Depending on the type of tumour, surgical treatment can achieve complete healing. For tumours that require follow-up treatment and tumour follow-up in our neurosurgical outpatient clinic, patients are also cared for on an interdisciplinary basis as part of the CNS tumour board. The interdisciplinary tumour board CNS is led by the Department of Neurosurgery.
We offer a particular consultation hour.

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Neurotraumatological symptoms result from accidents that occur unexpectedly and lead to different problems. The term "traumatic brain injury" (SHT) is commonly used. In addition to the bony injuries of the skull, it is primarily about the consequences of injuries to the nerve structures of the brain.

Depending on the type and severity of the acting forces, a distinction is made between a head bruise or a concussion, the commotio, moderate or severe traumatic brain injuries. A point table, the Glasgow Coma Scale, is used for diagnosis, which the emergency doctor already uses at the accident scene. Interdisciplinary treatment is required in the event of injury to multiple organ systems and broken bones.

The difference between a so-called covered and an open craniocerebral injury consists in the intactness of the hard meninges, the dura, in which the brain is embedded as in a water bed, the nerve water, also called liquor. In addition to the frontobasal injury, in which nerve water drips from the nose, open injuries include perforating injury, such as a gunshot wound. In these cases, the primary goal of surgical treatment is a tight seal.

Modern trauma treatment wants to avoid so-called secondary brain damage. Especially bleeding from injured vessels and pronounced swelling of the brain leads to an increase in intracranial pressure. In the case of masses, there is an operative relief when the skull is opened. In some injuries, intracranial pressure measuring probes are implanted in the head, representing the brain's blood flow situation.

After significant accidents, the patient is taken over to the central emergency room, and computed tomography performs holistic imaging. If necessary, the patients are transferred to the intensive care unit and, in severe cases, put in an artificial coma. In addition to imaging methods, various equipment options are available for assessing the course. The progress of the healing is discussed in interdisciplinary conferences.

Upon recovery, the patient is discharged home through the regular ward. Otherwise, a rehabilitation procedure and transfer to a special clinic designed for this purpose are initiated if further treatment is required.

Introduce in the general polyclinic or private consultation hour for further information.

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Pediatric neurosurgery deals with the surgical treatment of special neurosurgical diseases such as brain and spinal cord tumors, cerebral hemorrhage, hydrocephalus, vascular malformations, congenital malformations and developmental disorders of the central and peripheral nervous system. In addition, all neurosurgical diseases that also occur in adults are treated.

In order to enable child-friendly handling, our patients are accommodated in the children's clinic of the MHH. At our neurosurgical children's ward, the children are looked after by our specially trained team of doctors and nurses. In addition, there is an interdisciplinary collaboration with all pediatric departments, in particular with neuropediatrics, pediatric hematology and oncology, pediatric intensive care, neonatology, oral and maxillofacial surgery and pediatric surgery. In addition to the planned surgical interventions, all neuropediatric emergencies are also treated in our clinic. This is where we work closely with colleagues from trauma surgery, anesthesiology and pediatric intensive care to enable optimal care for seriously injured children; To ensure optimal follow-up care for the operated children, we offer a special neurosurgical children's consultation.

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The skull base includes the lower bony part of the brain skull including the transitions to the cervical spine, the nasopharynx and the facial skull. Foci of disease in this area often affect the deep parts of the brain (brain stem) and the 12 cranial nerves. Tumors of the skull base form the largest part of the diseases to be treated.

Foci of disease or lesions in the area of ​​the skull base can be classified according to the cause and the structures affected:

Tumors, outgoing

• the meninges: meningiomas

• from the cranial nerves: neurinomas / schwannomas

• from the base of the skull: chordomas, chondrosarcomas

• from the pituitary gland: pituitary adenomas

Injuries

• Fractures of the base of the skull

Vascular disorders

• Vascular sagging (aneurysms)
• Nerve compression through vascular loops

  • Trigeminal neuralgia

  • Facial spasm

  • Glossopharyngeal neuralgia

The surgical treatment of the above Diseases occur under intraoperative security through the routine use of an operating microscope, neuronavigation, and intraoperative electrophysiological monitoring of cranial nerves. Skull base tumors often cross the border of the skull base and grow extra-cranially. Interdisciplinary surgical treatment is then necessary, which is guaranteed in close cooperation with the Clinic for Ear, Nose and Throat Medicine, Clinic for Oral and Maxillofacial Surgery and Clinic for Ophthalmology. In the interdisciplinary skull base conference, doctors from the above Clinics worked out common and alternative therapy concepts. With larger tumors or tumors in risk areas, it is sometimes not possible or too risky to perform a complete surgical removal. In such cases, specialists from the fields of radiation therapy have a significant share in interdisciplinary therapy decisions and advanced therapies.

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Neurosurgical reconstruction surgery deals with the restoration of congenital or acquired bone defects of the skull.

Bony defects usually arise after surgery. The removed skull bone is no longer available for plastic covering for various reasons. This occurs when the bone is severely splintered as a result of an accident or cannot be re-implanted after operations on bone tumors or inflammatory diseases of the cranial bone.

The aim of the reconstruction is to protect the brain from external mechanical influences, to rebuild normal skull contours to correct cosmetically disturbing defects, and to normalize a disturbed pressure inside the skull. If the bone parts cannot be reinserted, an implant is required. This usually takes place from the 3rd month after the original illness has healed. A later cover is possible. Each implant is computer-aided after three-dimensional planning before the operation. The patient is examined on an outpatient basis by computer tomography for implant preparation. Here, the skull bone is spatially imaged in the area of ​​the defect by means of a high-resolution image sequence.

Using the CT data, a virtual model of the patient's skull is designed, after which a skull implant is made.

Both one-sided and multi-sided defects of any size can be treated. We use the refobacin-Palacos ® bone cement that has been tried and tested for years. It is extremely compatible with the body (biocompatible) and shows a similar hardness to the bone itself.

You can introduce yourself in the general polyclinic or private consultation hour.

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Pain treatment has an important place. A variety of treatment options are offered as needed. We primarily treat painful conditions of the musculoskeletal system - such as back and neck pain, but also nerve pain, headache and facial pain, as well as pain with circulatory disorders. Surgical treatment is particularly suitable for chronic pain that can no longer be treated satisfactorily with tablets or pain plasters.

As with drug pain therapy, pain cannot be completely eliminated by surgery, but should be reduced so that the quality of life is improved.

Various interventional procedures are available for the treatment of acute and chronic pain.

• Injections and infiltrations

• Nerve root blockages

• Facet joint blockages and facet denervation

• Thermocoagulation (heat probe)

• Stimulation methods such as nerve stimulation, spinal cord stimulation

• Deep brain stimulation of the thalamus Cortex stimulation

• Trigeminal Neuralgia (Janetta)

• Decompression surgery Pain and medication pump

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Herniated discs

If severe pain persists after unsuccessful, conservative therapy or if there are pronounced paralysis, surgery is necessary if imaging evidence is present. This removes the parts of the intervertebral discs that compress the nerves.

Lumbar spine herniations (lumbar spine): This is opened for herniated discs in the spinal canal. In the case of so-called lateral incidents, the operative access is from the back to the side of the spine. In the case of bladder and / or rectum emptying disorders, there is an urgent need for surgery.

Disc herniations of the cervical spine (cervical spine): Access is from the front to protect the spinal cord behind the vertebral bodies. Interponates are used so that the vertebral bodies do not collapse after the intervertebral discs have been removed.

Bony degenerative processes

If there have been signs of wear for some time, bony attachments can result, which in turn can lead to compression.

Spinal canal stenosis is increasing in the lumbar region. The clinical picture is called Claudicatio spinalis. The bony and connective tissue-like structures are opened during the operation so that the nerve tissue has room again.

In the area of ​​the cervical spine, especially posterior bone attachments in the spinal canal, which press on the spinal cord and can cause damage (cervical myelopathy), are eliminated. Several segments are often affected here.

In all areas, instabilities of wear and tear arise, which are also favored by congenital developmental disorders (spondylolisthesis). The disease is treated by stiffening, which is also recommended for very painful osteochondrosis.

Mass of the spinal canal

A mass in the spinal canal narrows the canal and damages the nerves. Surgery relieves the nerves.

Tumors are differentiated according to their location. The tumors outside the meninges (dura) sit in the surrounding bone. If the bone is badly affected, additional stabilization of the spine may be necessary. Tumors that lie within the dura often originate from nerve tissue. The risk of surgery is determined by where the tumor is located in the spinal canal. The accumulation of fluid also narrows the spinal canal. These are mainly bleeding or inflammatory material.

If neurological functions are impaired, relief is recommended. With degenerative changes in wear on the spine, there can also be several causes at the same time, which intensify the symptoms. Changes after operations can also be the cause. Treatment is inpatient.

Patients are first examined on an outpatient basis and given advice on the imaging diagnostics they have brought with them. If the imaging does not allow a diagnosis, a contrast agent display of the spinal cord canal (myelography) is performed.

The surgery is performed under general anesthesia using microsurgical technology. The patient is discharged home as soon as the state of recovery allows. If necessary, inpatient follow-up treatment or, in the case of tumors, special follow-up treatment in specialized departments is organized with the help of the social service.

Other departments are represented on the MHH campus and provide advice on advice. Special problems are solved interdisciplinarily with the departments for anesthesiology, neuroradiology, neurology and neurophysiology, trauma surgery, oncology, radiation medicine, cardiology and hematology, urology as well as plastic and reconstructive surgery.

Another focus of the clinic is the treatment of chronic nerve pain. Both ablative and stimulation methods are offered here (SCS: spinal cord stimulation (spinal cord stimulation, ganglion stimulation, peripheral nerve stimulation and occipital stimulation (see pain).

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