Treating Cerebral Tumors
Neurosurgery is one of the top fields in medicine. This is because doctors successfully operate and treat serious cases, and the complication rate has fallen over the past 15 years from 10-15 percent to about 2 percent. This is possible primarily because of teamwork and then treatment personalization, depending on each case. As a matter of fact, top neurosurgery experts in the world, such as Dr. Ilhan Elmaci of ACIBADEM Maslak Hospital, believe that this domain is no longer a “one man show”, but it translates into tackling each case by complex teams, consisting of at least 10 specialists. The brain is an extremely delicate vital organ, and surgical treatment of many affections requires maximum precision and accuracy: in their absence, any uninspired gesture can have serious consequences. The accuracy of interventions is nowadays better and better due to the technologies that assist doctors’ teams, and the treatment of tumors is inconceivable without a microscope, endoscope or neuromonitoring. Prof. Dr. Ilhan Elmaci further explains how technology and digitization have become the best allies of doctors in the operating theater.
What are the technologies that are currently assisting you in the surgery room and helping you to fully excise the tumors?
Prof. Dr. Ilhan Elmaci: At this time, neurosurgery is a team work, and the preparation of each case before surgery, deals with at least 10 people, depending on complexity. We are talking about the team that assists neurosurgeons, neuromonitoring experts, neuroscientists, the neuro-anesthesia team, and technical department representatives who assist us when we use cutting-edge technology in neurosurgery interventions. We often call for microscopes, advanced endoscopic techniques, or intraoperative imaging techniques (advanced intraoperative tomography, angiography or advanced neuro-imaging) to monitor how intervention works. Advanced imaging techniques help us see real-time how action is advancing because we need to be sure we are doing the right thing. Today, we also have technologies that allow us to do real-time tomography, especially for spinal pathologies. So, we have 10-12 people who are preparing modern interventions in neurosurgery.
What is the contribution of technologies such as Gamma Knife or Cyber Knife to the treatment of malignant tumors?
Prof. Dr. Ilhan Elmaci: We have already had a long experience with Gamma Knife starting right after graduating the college. We are basically the first group of Middle Eastern physicians to work with this technology. So, our expertise allows us to use it in many situations, either on its own or after surgery, if there are any other tumor remains. These can be addressed through Gamma Knife, Cyber Knife or other LINAC technology (Linear Accelerator that uses X-rays or electrons to destroy tumor tissues). To strengthen our experience, we need study groups, and at ACIBADEM Maslak Hospital we are working at this level. We have a study group for skull base tumors, and we work with ENT surgeons. Together, we decide on the best therapeutic approach for each case, discuss with patients what we do and work together in the surgery room from start to finish. We still have a study group dedicated to cerebrovascular treatments, because endovascular treatments are a good opportunity to treat various cases. Teachers’ teams decide together what is best for patients, if surgery is appropriate or if we can treat it endovascularly, for example. We also discuss solutions if complications arise. There is also a third study group dedicated to neurology and neurosurgery issues in which we decide on the neuromonitoring method in more special cases. We also do genetic research on brain tumors to find new treatment methods for patients. We are very active, and we are constantly seeking to provide the best solutions to patients, starting from the neuro-oncology study group.
What is neuromonitoring and how do you apply it to brain tumors?
Prof. Dr. Ilhan Elmaci: It is known that the central nervous system and the brain work based on electrical impulses. Electroencephalography, electromyography, somatosensory generated potential, motor generated potential, give us the ability to monitor the electrical activity of the central nervous system in order not to damage certain vital functions during surgery. Neuromonitoring means, in fact, the continuous assessment of this electrical activity of the brain in the operating room, under anesthesia, neuroanesthesia or with the patient awake. In parallel with these, we also do the neuroradiological examinations, and all these advanced techniques help us precisely locate the eloquent areas responsible for the vital functions in the body and evaluate the brain circuits. Every person has certain peculiarities at the cerebral level, and we need to evaluate and know them well before surgery. And we do it because of ETR-type technologies that use some software. And with their help, neuroradiologists can tell us precisely what areas are responsible for various functions in the body, what are the brain circuits and how they are affected or not by brain tumors. Thus, with all these data, we analyze them in a team before the operation and it is much easier for us to do the surgery, depending on the particularities of each case. We also perform simulations before the intervention and determine the limits we can operate in order not to affect eloquent areas and important brain circuits. Basically, before the intervention, we make a brain map that guides us during the intervention to minimize the risks of interventions.
What are the indications of microsurgery, a method that you apply at ACIBADEM?
Prof. Dr. Ilhan Elmaci: In the neurosurgery sections of ACIBADEM, microsurgery is done routinely in all types of interventions that are made in the sphere of the central nervous system because we need a maximum accuracy visualization of the areas in which we intervene, both in the brain, as well as in the spine and the marrow. For column disorders such as herniated disc, we must perfectly visualize the compressed nerve, but also the disk area that is herniated. In these situations, we do minimally invasive surgery: for example, in the case of lumbar disc herniation, nowadays we make a 1 cm incision. When we did not have the technology, the incision was 10 cm, the surgery was open, and the risks of tissue damage were much higher. But today microsurgery has become the basis of neurosurgery, interventions are unthinkable without it. This means faster recovery, fewer side effects, reduced bleeding and hospitalization.
What are the strengths of ACIBADEM in neurosurgery compared to other clinics in the world?
Prof. Dr. Ilhan Elmaci: Nowadays, neurosurgery is no longer a “one man show”, it is team work, and this is a principle respected in ACIBADEM. We evaluate the patient step by step in a large team. There are situations in other countries or hospitals when the neurosurgeon sends the patient further to an oncologist or radiotherapist, but they have not seen the patient from the beginning and did not follow the case in detail. But we work in a team and we follow the evolution of each case. I am extremely pleased that I can work together with my colleagues in a valuable team, in which we can share the professional experiences, the best expertise to solve the cases and that we have access to very advanced techniques. And all this contributes to maximum chances of success and to a very low rate of morbidity, as we treat very serious cases. Thus, our patients receive the best medical care due to complex teams, without which top neurosurgery would not be possible.
Do you think these team experiences, working in study groups and expertise are the best things you can do for the next generation of doctors?
Prof. Dr. Ilhan Elmaci: Exactly, this is the big win for medicine, for patients and for future generations of doctors.
