Neurology and Neurosurgery

Diseases and Conditions

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 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).

PEDIATRIC NEUROSURGERY

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

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.

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.