Neurology and Neurosurgery

The Departments of Neurology and Neurosurgery at ACIBADEM Healthcare Group treat the most complex disorders with a multidisciplinary approach. Both neurology and neurosurgery programs for adults and children work in close collaboration with other pediatric, radiological and oncological disciplines to provide comprehensive care for our patients.

Acıbadem neurosurgeons and neurologists have experience in evaluating and treating the most complex of neurological disorders and providing the most up-to-date treatment present. Acıbadem neurosurgeons utilize the latest technology available in neurosurgery.

All kind of neurosurgical operations can be performed at ACIBADEM Hospitals.

Adults

  • The Brain
    • Brain tumors (benign and malignant)
    • Skull base tumors
    • Vascular Diseases (brain hemorrhage, cerebral aneurysms, arteriovenous malformations, cavernous malformations, and stroke)
    • Hydrocephalus (fluid accumulation in the brain)
    • Trauma
    • Congenital malformations
    • Infections
    • Functional neurosurgery (Movement disorder surgery, pain surgery)
    • Gamma-knife Radiosurgery
  • The Spine
    • Herniated Disc Surgery
      • Cervical
      • Thoracic
      • Lumbar
    • Degenerative and age-related spine disorders
    • Complex spinal surgeries, including instrumentations
    • Spinal cord and spinal bone tumors
    • Vascular malformations (Spinal arteriovenous malformations)
    • Trauma
    • Infections
  • The Peripheral Nervous System
    • Nerve Entrapment Syndromes
    • Nerve Injuries
  • Pediatric
    • Congenital Cerebral Anomalies
    • Hydrocephaly (fluid accumulation in the brain)
    • Craniosynostosis (premature closing of the bones of the skull)
    • Arachnoid Cysts (brain cysts)
    • The craniovertebral junction abnormalities
    • Spinal Dysraphism (Tethered Cord Syndrome, Split Cord Anomalies)

Skull-base Surgery

Skull base lesions constitute a group of tumoral and vascular lesions located at the base of the brain in a delicate and intricate anatomical region. Treatment of these lesions poses great difficulties for the doctors, as it is necessary to provide relief from tumor-associated problems, while simultaneously preserving and protecting normal anatomy and function. Hence, advanced surgical skills, proficiency and high-end techn

ology are required for the operation. At ACIBADEM Healthcare Group hospitals, all skull-base pathologies, -including tumors such as meningiomas, chordomas, schwannomas and skull-base vascular malformations like aneurysms and arteriorvenous and cavernous malformations are regularly performed. Innovative technologies such as the 3T intraoperative MRI and Gamma-knife radiosurgery available at ACIBADEM make these treatments safer than ever. Our neurosurgical department is one of the leading centers of the world, with members and leaderships in international organizations and participation in and organization of international meetings.

The ACIBADEM Healthcare Group Adult and Pediatric Neurosurgery Department, performs all types of surgical interventions available in epilepsy surgery. Although the primary treatment of epilepsy is medical, patients do not respond to medication in about 20-30% of the cases. In such patients, an alternative is surgery. All three methods of epilepsy surgery (resective surgery, disconnection surgery, and vagal nerve stimulation) are performed with success at the ACIBADEM Healthcare Group.

How is epilepsy diagnosed?

1) Epilepsy is an entirely clinical diagnosis. An accurate diagnosis can be made following the hearing of a detailed history of the patient, or following the observation of a fit.

2) The EEG (electroansephalography), a brain MR (magnetic resonance), a PET scan, SPECT, and neuropsychological evaluation are methods that help in the diagnosis of epilepsy.

How is epilepsy diagnosed?

1) Epilepsy is an entirely clinical diagnosis. An accurate diagnosis can be made following the hearing of a detailed history of the patient, or following the observation of a fit.

2) The EEG (electroansephalography), a brain MRI (magnetic resonance), a PET scan, SPECT, and neuropsychological evaluation are methods that help in the diagnosis of epilepsy.

How is epilepsy treated?

1) Treatment with medication

The patient is started on medication immediately after a diagnosis of epilepsy has been made. The decision on the type of medication to be used is made taking into consideration the types of seizures, the category of the epilepsy, and EEG and MRI findings. The most frequently observed side effects are peeling of the skin, an increase in liver functions, and pressure on the spinal cord. Relatives of the patient are informed and cautioned about these side effects. Certain medication necessitates that the liver functions and blood counts of the patient be monitored in certain intervals. Although it varies with each patient, medication must be continued to be used for at least two years. At the end of this term, it may be discontinued under the doctor’s supervision.

2) Surgical treatment

Treatment through surgery may be possible for patients who do not response to treatment with medicine (epilepsy with endurance). Most of these patients have abnormal MRIs. These patients undergo methods such as focal resection (the excision of the area of concern), corpus callosotomy (the disconnection of the cerebral hemispheres), hemispherectomy (the disconnection of a single hemisphere of the brain with the other, in cases in which only side of the brain is damaged), and batteries (vagus nerve stimulation).

ACIBADEM Hospital Child Epilepsy Center

In this center, patients undergo medical and surgical treatments of epilepsy. Divisions such as pediatric epileptology, pediatric neurology, pediatric brain surgery, pedagogy, neuroradiology, speech therapy, and physiotherapy work in together in collaboration in this center.

Comprehensive Spasticity Treatment

Monthly Spasticity Councils are held during which a multi-disciplinary team of pediatric and functional neurosurgeons, pediatric neurologists, orthopedists, speech therapists, and rehabilitation specialists evaluate and plan treatments for spastic children from throughout the country. Baclofen Pump Implantations, pallidotomies, thalamotomies, Deep Brain Stimulation implantations, and Selective Dorsal Rizotomies are performed on appropriate patients with promising results.

In each and every council, a high rate of guarantee of treatment by highly experienced physicians and superb medical infrastructure lead to the finest results with success rates that exceed international medical averages.

Cerebral Palsy

Cerebral palsy is a disorder of movement and form linked to damage in the brain caused before or after birth, or during delivery.

Types of Cerebral Palsy

Cerebral palsy portrays different characteristics and is divided into categories in accordance with the location of the damage in the brain.

1- The Spastic type

Spasticity is the increased tone of muscle in the arms and legs. This limits movement. It is divided into types based on the location of the spasticity in the body.

  • Diparesis : Spasticity is present in the legs only.
  • Hemiparesis: Spasticity is present in one side of the body.
  • Tetraparesis: Spasticity is present in the arms and legs.

2 – The Dyskinetic types

  • The athetoid type: Children with involuntary and slow twirling of the upper segments of the arms and legs
  • The dystonic type: Children with spasms similar to the twisting of a pipe or twirling. The spasm increases with voluntary movement. It is observed more frequently in the upper portions of the arms and legs.
  • Ataxia: A disorder of coordination. The child has difficulty maintaining balance while walking.
  • Hypotonia: No spasms are present in the body. A completely contrary state of looseness is present.

Treatment alternatives in cerebral palsy

Physiotherapy

  • To enable the prevention of structural disorders that could result from the spasms
  • To decrease spasms through the use of different techniques
  • To increase the functional capacity of the child to enable increased independence in the daily life of the child
  • To select the equipment needed by the child and to teach the child to use of the equipment

Medical Treatment

  • To regulate nutrition
  • To hinder the fits
  • To take general health precautions
  • To decrease spasticity
  • Neurosurgical interventions

Spasticity surgery should be undertaken if rehabilitation fails to yield results, spasms make daily care difficult and cause pain upon the child.

Operation alternatives:

  • Selective dorsal rhizotomy
  • Neurotomy
  • Deep brain simulation
  • Baclofen pump implantation
  • Pallidotomy

Orthopedical Interventions

Shortening of the muscles that prevent the growth of the child, or structural irregularities in the joints require orthopedic intervention.

Special Education

Special education in cerebral palsy begins with the interventions upon the child in proportion with his/her physical insufficiency and training of the child on the usage of the supplementary equipment necessary. After independence in the usage of such equipment has been obtained, education is planned in accordance with the intellectual performance of the individual.

Speech Therapy

The patient is evaluated based upon his/her language development and speech particularities, determining the level and method of communication established. Goals of communication aiming to increase independence in daily life are identified, and therapy is provided. Nutritional therapy, including the support and education of the family is provided, based on an evaluation of chewing and swallowing skills. The selection and usage of alternative systems of communication and other therapy tools to enable or advance communication serve as a guide for the family.

Other problems observed in children with cerebral palsy

  • Issues of intelligence
  • Seizures
  • Problems of nutrition (absence of swallowing and chewing skills)
  • Speech difficulties
  • Issues of teeth
  • Vision disorders
  • Difficulty in hearing
  • Respiratory disorders
  • Urinary problems (toilet control)

The treatment of cerebral palsy is done by a multidisciplinary team. All members of the team must be present in the center in which the child with cerebral palsy is undergoing treatment. Periodic councils must be organized, in which all members of the team are present for a joint evaluation of the patient. The objective of such councils is for a simultaneous evaluation of the patient by all members of the team, and the formation of a treatment plan.

Participants of the Council

Treatment of cerebral palsy at ACIBADEM Hospitals is done by multidisciplinary councils. Such teams consist of child brain surgeons, orthopedists, child neurology specialists, radiologists, speech therapists, and personnel of the laboratory for the analysis of movement and walkingThe council is free of charge. Patients are reviewed for participation in the council.

Analysis of Walk

What is an analysis of walk? It is the numerical measurement, identification, and evaluation of movements. A physical examination is not always enough in the identification of the joint or muscle from which arises the walking disorder. In an effort to remedy the walking disorder, the brain utilizes mechanisms of compensation, -thereby making more difficult the determination of the main area or muscles of disorder. Thus, walking analysis technology is needed for the numerical interpretation, recording, and re-evaluation of the problem, and for an objective measurement of the effectiveness of the therapy. The analysis of walk defines in clear terms the disorders in movement, with a high rate of accuracy.

It does not inflict pain or fatigue, and as such, is usually easily adapted by the patients.

There are three different types of analysis in the analysis for walking:

  • Analysis of the lower body (applied only upon the pelvis and the legs)
  • Analysis of the upper body (applied only upon the shoulders and the arms)
  • Analysis of the whole body (applied upon the head, trunk, and the legs, and arms)

What are the advantages of an analysis of walk?

  • The clear identification of the illness
  • The identification of compensatory (supportive) mechanisms
  • Assistance in rehabilitation
  • The identification of the surgical intervention to be undergone
  • The following-up of the effectiveness of the treatment

What are the areas of application of the analysis of walk?

  • Cerebral palsy (congenital muscle spasms)
  • Spina bifida (congenital disorders of the spine and the spinal cord)
  • Injury of the spinal cord
  • Hemiplegia (partial stroke)
  • Amputations of the leg (Amputations or absence of the leg)
  • Muscular dystrophy (Diseases of the muscle)
  • Parkinsonism
  • Inflammatory and/or degenerative diseases of the joints
  • Head trauma sequels
  • Multiple sclerosis (MS)
  • Arthroplasty (joint prosthesis)
  • Sports injuries

What should you do for an analysis of walk?

  • Our center works with appointments. You should schedule an appointment prior to analysis.
  • You may obtain information about liaison institutions from the hospital and the call center.
  • For your comfort during the evaluation, you may bring tights or shorts with you.
  • The walking analysis takes approximately one hour, and the evaluation result is presented to you in CD format.

Intraoperative MR, an imaging technology which only used at ACIBADEM Kozyatağı Hospital in Turkey, facilitates the complete removal of the tumor by providing images during brain surgery. It thus eliminates the risk of that a second operation would be required, due to tumor residues.

Advantages of 3-Tesla MR:

  • Generates more robust informationThan low-Tesla systems The 3-Tesla MR device generates faster data with higher resolution during and after the operation, and provides physicians with more reliable information than that obtained from low-Tesla MR systems. The device achieves this thanks to its strong magnetic field. By generating a magnetic field twice as strong as the magnetic field of the 1.5-Tesla MR device, which had been used previously, it receives more signals from tissues.
  • Works more rapidlyThe 3-Tesla MR device works much more rapidly than other devices. This is especially important during brain surgery. The system allows the surgeon to take images during the operation at the required moment without waking the patient and without closing the surgical area. In particular, it addresses surgeons’ concerns that they cannot obtain correct information on the size and direction of the tumor if it is in a place difficult to reach. The chances of the operation’s success improve as images may be evaluated during the operation.
  • Eliminates the risk of a second operationVarious risks may arise in operations in which intraoperative MR is not used. In these operations, residues cannot be identified due to the fact that they are so small that they cannot be seen with a microscope, or they are of the same color as the brain tissue. As such, there is a 30-40% probability of residues being left over in brain tumor operations. The patient is taken into intensive care after the operation. The determination of whether or not residues are present may be taken on the basis of MR images taken 24 hours after the period of intensive care. In the event that any residues are identified in the MR, a second operation will take place. Here, thanks to its intraoperative feature, a second operation is not required as residues may be fully identified and removed during the operation.
  • Zero probability of residuesThanks to the 3-Tesla MR device, there is no chance of residues being left in the brain after the operation. All residues that may be omitted are identified with the images the device takes. Thus, the surgeon has reliable information when it comes to removing these residues as well. One of the worst results of leaving residues is that the tumor may grow again from these residues. The growing tumor may compromise the patient’s quality of life or even threaten the patient’s life again. Another satisfactory result of the complete removal of the tumor is further delays the recurrence of malign brain tumors.
  • Accurate identification of operation area
  • Operation-related side effects are eliminated

Gamma Knife Icon is the latest version of Gamma Knife, the device that has been used in treatment of brain tumors and AVMs (arteriovenous malformations) through radiosurgery. The new device makes it possible for radiosurgery to be performed more flexibly and conveniently. Gamma Knife is used for treatment of benign and malign brain tumors, cerebrovascular disorders and intraocular tumors.

Advantages: The device makes use of a technology which is very reliable in protection of brain and nerve tissues through its features of high precision and safe monitoring via use of computed tomography and infrared tracking during the course of surgery. It can be used flexibly. In the ICON version, the limitations of the previous systems, such as treatment difficulty of large lesions, inability to apply treatments in fractions and impossibility of applying treatment to patients with large cranial defects, have all been eliminated. Gamma Knife ICON makes it possible for treatments to be adjusted flexibly and in accordance with the present requirements, such as use of a frame or mask, or application in one or more fractions.

Facilities Equipped with the Technology: ACIBADEM Altunizade Hospital

The Departments of Neurology and Neurosurgery at ACIBADEM Healthcare Group treat the most complex disorders with a multidisciplinary approach. Both neurology and neurosurgery programs for adults and children work in close collaboration with other pediatric, radiological and oncological disciplines to provide comprehensive care for our patients.

Acıbadem neurosurgeons and neurologists have experience in evaluating and treating the most complex of neurological disorders and providing the most up-to-date treatment present. Acıbadem neurosurgeons utilize the latest technology available in neurosurgery.

Gamma Knife is not really a knife. It is a treatment technique that uses state-of-the-art technology instead of a scalpel, directing gamma rays with great precision to the target area inside the skull in a single session. Gamma rays have a safe and powerful effect on the diseased area without the problems associated with surgery, such as bleeding, infection and recovery in intensive care. Gamma Knife makes it possible to direct very precise beams of gamma rays to small areas within the skull due to advanced imaging and planning techniques. 192 radioactive beams from a gamma ray source are focused on the diseased area, thus ensuring that the healthy brain tissue around the targeted area receives a negligible dose of radiation while the diseased tissue is exposed to a high dose of radiation. The entire procedure is completed in a couple of hours and the patient can return home on the same day.

Gamma Knife is a treatment technique especially recommended for patients at a high risk for adverse effects associated with surgery either because of their age or because they have these types of problems. Gamma Knife is a significant advantage with patients for whom general anesthesia is risky.

They may feel some mild pain in their head while the stereotactic frame is being fitted. Local anesthetics are used to minimize this discomfort. The feeling of pressure associated with the fitting of the frame subsides within a couple of minutes. Patients do not feel any pain during treatment. Patients cannot see or feel the gamma rays.

Yes, they are awake, but patients who experience anxiety can take a sedative. The doctor can speak with patients during the treatment through speakers and a microphone and is constantly watching them via a monitor.

No, there is no need to shave the head for this procedure.

Gamma Knife is a brain surgery technique that does not require the skull to be opened and targets diseased tissue very precisely with gamma rays. Gamma Knife treatment prevents the complications that can occur in surgical procedures such as bleeding and infection and does not require hospital admission, so it avoids the associated problems. The probability of a reaction developing in the surrounding healthy tissue due to the radioactive energy used is 1-2% and most of these are temporary.

The results of Gamma Knife radiosurgery can be seen anywhere from a few months to a few years later. The time needed for it to have an effect differs with each disease. In patient monitoring, examinations are performed with tests such as MRI and angiography as frequently as recommended by the doctor.

The goal in Gamma Knife radiosurgery is controlling tumor growth, which means that the tumor does not increase in size or that the tumor shrinks over time.

Immediately after treatment. Any restrictions the patient followed prior to treatment will still apply after treatment. There is no need for special restrictions due to Gamma Knife treatment.

ARTERIOVENOUS MALFORMATIONS (Abnormal Tangle of Blood Vessels)Arteriovenous malformations (AVM) are abnormal congenital tangles of blood vessels in the brain. AVM may manifest as brain hemorrhages or epileptic seizures. Any brain hemorrhage that may develop can lead to serious health problems. Furthermore, seizures have a negative effect on the patient’s quality of life. AVMs are treated with techniques such as surgical removal, obstructing them with a technique known as embolization or obliterating them with radiosurgery. Sometimes these techniques can be used to complement each other. Ninety-two percent of AVMs treated with Gamma Knife close up within 3 years. Angiographic images of a patient with AVM prior to treatment and 3 years after treatment

METASTASES

Brain metastasis occurs when a cancer that developed in another part of the body moves to the brain through the circulatory system. An increasing number of patients are developing brain metastasis due to the success achieved in primary cancer treatment methods and the fact that patients are living longer. There is brain metastasis in approximately 20-40% of cancer patients. Surgical, radiotherapy and radiosurgery techniques are used to treat these. Today, Gamma Knife radiosurgery is used extensively to treat metastases with a very high success rate. It can be employed as needed with metastatic patients. The general systemic status of most cancer patients is impaired so surgical treatment can create problems. Therefore, Gamma Knife provides a significant advantage because it makes treatment of metastasis possible in a single session. Gamma Knife can halt the growth of these tumors or shrink them with a success rate of 90 percent. In recent years, metastatic patients have become the largest patient group in most Gamma Knife centers.

MRI images of a patient with liver cancer metastasized to the brain prior to treatment and four months after treatment.

VESTIBULAR SCHWANNOMA (Tumor on Hearing – Balance Nerve)

The tumor known as vestibular schwannoma causes dysfunction in the hearing-balance nerve. Symptoms include ringing ears, advanced hearing loss and imbalance. One of the techniques used to treat it is a surgical procedure. However, problems such as increased hearing loss and facial paralysis can occur following surgery. Another technique is the Gamma Knife treatment, which results in these problems occurring much less frequently than they do with surgery. With Gamma Knife treatment the probability of stopping tumor growth and achieving long-term shrinkage is 98%.

MRI images of a patient with vestibular schwannoma prior to treatment and at 1 and 3 years after treatment

HYPOPHYSEAL ADENOMA (Tumor of the Pituitary Gland)

Hypophyseal adenomas are the most frequently observed tumors in the pituitary gland, which is the hormonal center of the body. These tumors are indicated by hormonal imbalances or loss of vision.

Medication, surgical procedures and Gamma Knife are all used for treatment.

Gamma Knife radiosurgery can be performed in addition to drugs and surgical treatment or on its own. The growth of pituitary tumors can be controlled in 95-98% of cases with Gamma Knife radiosurgery.

MR images of a patient with hypophyseal adenoma prior to treatment and 3 years after treatment

1- Choose a team that has treated a large number of patients. A team that has used Gamma Knife

on a large number of patients for a variety of diseases will understand what you need and be able to safely perform the necessary treatment protocol. The ACIBADEM Gamma Knife team possesses significant scientific know-how not just in Turkey but around the world because it has treated almost 6000 patients to date.

2- Choose a team that has conducted research and published scientific articles.

You will benefit from choosing a team that conducts research and has published scientific articles regarding Gamma Knife. Patients will benefit tremendously from being treated by a group that conducts research, publishes articles, stays abreast of developments in the field and has an excellent command of recent developments.

The ACIBADEM Gamma Knife team follows scientific developments closely through books and congress presentations and the numerous scientific articles published in the field both in Turkey and abroad. Training is provided in this field for physicians from Turkey and abroad through courses and meetings.

3- Choose a center that works with advanced technology and an excellent selection of equipment.

An exemplary Gamma Knife center uses the latest computer programs and equipment. Leading Gamma Knife centers use MRI devices with a high magnetic field strength and digital angiography. All of these ensure that patients are treated with the utmost safety and efficacy.

ACIBADEM Gamma Knife Center possesses “Perfexion”, the most advanced model in Turkey. 3-Tesla MR and digital angiography is used for treatment planning in our center.