Surgical techniques and resources

Surgery using optical magnification and precise dissection to treat brain lesions while protecting vessels and functional tissue.

• Surgery for low- and high-grade gliomasCombines tumour resection, tissue diagnosis and preservation of relevant neurological functions.
• Glioblastoma surgeryAims to reduce tumour volume and obtain histological and molecular diagnosis to guide subsequent treatment.
• Brain metastasis surgeryRemoves accessible metastatic lesions and enables confirmation of diagnosis through tissue analysis.
• Meningioma surgerySeparates the tumour from the dura, brain and neurovascular structures with which it is in contact.
• Surgery for recurrent or previously operated tumoursRe-enters a field altered by earlier surgery or treatment to address residual or recurrent disease.

Planned surgery for deep lesions or tumours close to regions responsible for language, movement and other neurological functions.

• Surgery for tumours in eloquent brain areasPlans resection around regions involved in language, movement, sensation or vision.
• Insular tumour surgeryApproaches insular lesions while protecting nearby arteries and motor and language pathways.
• Surgery for deep brain lesionsUses planned anatomical trajectories to reach lesions distant from the brain surface.
• Intraventricular tumour surgeryReaches tumours within the ventricles and the pathways of cerebrospinal-fluid circulation.

Microsurgical approaches to tumours beside cranial nerves, vessels and deep structures of the skull base.

• Microsurgical skull-base approachesCreate specific anatomical corridors to reach deep lesions while limiting brain manipulation.
• Vestibular schwannoma surgeryTreats a vestibular-nerve tumour with attention to facial and hearing function and the brainstem.
• Surgery for schwannomas of other cranial nervesRemoves tumours arising from cranial nerves while preserving neural and neighbouring structures.
• Clinoidal meningioma surgeryApproaches meningiomas beside the clinoid process, carotid artery and optic nerve.
• Petroclival meningioma surgeryTreats deep meningiomas beside the brainstem, basilar artery and several cranial nerves.
• Chordoma and chondrosarcoma surgeryCombines resection of skull-base bone tumours with reconstruction of the surgical corridor.

Combines neuronavigation, functional imaging and monitoring to guide surgery around important neurological structures.

• Brain neuronavigationWorks as a positioning system that locates instruments on the patient's MRI or CT images.
• Integration of preoperative imaging into planningCombines MRI, CT and other sequences in one model to define the approach.
• TractographyUses MRI data to estimate the course of major white-matter tracts.
• Functional imagingMaps brain regions associated with functions such as movement or language.
• Intraoperative neurophysiological monitoringRecords electrical responses during surgery and warns of changes in monitored neural pathways.
• Cranial-nerve monitoringTracks the response of specific cranial nerves during procedures performed nearby.

Three-dimensional reconstruction of anatomy to study spatial relationships and prepare the surgical approach.

• Three-dimensional anatomical reconstructionTransforms medical images into a spatial model of the lesion and neighbouring structures.
• 3D surgical planningAllows trajectories to be compared and surgical exposure anticipated on a three-dimensional model.
• Three-dimensional modelsRepresent the lesion, vessels and neighbouring structures within a manipulable spatial scene.
• Virtual reality applied to surgical planningProvides immersive review of anatomy and the planned approach before surgery.

Focal treatment that directs high-precision radiation at an intracranial lesion without open surgery.

• Radiosurgery for brain metastasesConcentrates radiation on one or more defined metastases while limiting dose to surrounding brain.
• Radiosurgery for meningiomasDelivers focal radiation to control meningioma growth without open resection.
• Radiosurgery for vestibular schwannomaDirects high-precision radiation at the schwannoma while limiting exposure of the brainstem and nearby structures.

Microsurgical techniques designed to release compression of the spinal cord or nerve roots.

• Lumbar microdiscectomyUses magnification to remove disc material compressing a lumbar nerve root.
• Nerve-root decompressionEnlarges the space around a specific root by removing structures that narrow its course.
• Cervical decompressionRelieves pressure on the spinal cord or nerve roots in the neck through an approach tailored to each level.
• Lumbar decompressionWidens the lumbar canal and lateral recesses to free the neural structures causing symptoms.
• LaminoplastyEnlarges the cervical canal by reshaping the lamina without removing it completely.

An approach through the front of the neck to treat discs, neural compression and cervical instability.

• Anterior cervical discectomy and fusion (ACDF)Removes a cervical disc through an anterior approach and stabilises the segment with fusion.
• Cervical disc replacementReplaces a cervical disc with an implant designed to preserve motion between vertebrae.
• Cervical corpectomyRemoves part of a cervical vertebral body to decompress the spinal cord and reconstruct the spine.

Integrates tumour resection, neurological protection and spinal reconstruction according to lesion location.

• Vertebral tumour surgeryResects tumour from a vertebra and prepares the reconstruction required to preserve spinal support.
• Surgery for vertebral metastasesCombines tumour control, neurological decompression and stabilisation according to disease extent.
• Microsurgery of spinal meningiomasDissects a dural tumour within the spinal canal away from the spinal cord and its vessels.
• Schwannoma microsurgerySeparates a schwannoma from its nerve root of origin and the surrounding spinal-canal structures.
• Intramedullary tumour microsurgeryApproaches a lesion within the spinal cord through microsurgical planes with neurophysiological control.

Combines smaller approaches with three-dimensional guidance for spinal decompression or instrumentation.

• Minimally invasive decompressionUses a limited muscle corridor to enlarge the canal or foramen at the affected level.
• Percutaneous instrumentationIntroduces screws and rods through small incisions to stabilise the spinal segment.
• Intraoperative CTAcquires images during surgery to update anatomy and verify instrumentation.
• Navigated placement of implants and instrumentationChecks the entry point and trajectory of each implant in three dimensions during insertion.
• Robot-assisted spinal surgeryTransfers pre-calculated instrumentation trajectories to surgery through a robotic platform.

Reoperations to correct compression, instability, implant problems or adjacent segment disease.

• Cervical and lumbar reoperationsRe-enters anatomy changed by previous surgery to address new compression or instability.
• Instrumentation revisionAssesses existing implants and replaces or repositions components that require correction.
• Spinal reconstruction and stabilisationRestores support and alignment after resection, deformity or failure of previous surgery.

Microsurgery that separates a blood vessel from a compressed cranial nerve and maintains that separation.

• Microvascular decompression of the trigeminal nerveMoves the vessel responsible for neurovascular contact away from the trigeminal root associated with facial pain.
• Microvascular decompression of the facial nerveMoves the vessel irritating the facial nerve at its origin to treat hemifacial spasm.
• Facial-function monitoring during decompressionTracks facial-nerve and muscle responses while the vascular contact is released.

Brings together percutaneous options and radiosurgery directed at specific facial-pain pathways.

• Percutaneous procedures targeting the Gasserian ganglionReach the trigeminal ganglion through the cheek with a needle to modify selected pain fibres.
• Radiofrequency thermocoagulationApplies controlled heat to trigeminal fibres to reduce pain transmission.
• Balloon compressionUses a temporary small balloon to compress the Gasserian ganglion in a controlled manner.
• Stereotactic radiosurgery targeting the trigeminal nerveFocuses radiation on a precise segment of the nerve without an incision.

Implantation of brain electrodes connected to a generator that modulates movement-related circuits.

• Deep brain stimulationSends electrical pulses to a brain target through implanted electrodes.
• Stereotactic implantation of brain electrodesPlaces each electrode along a calculated trajectory from the skull to the deep brain target.
• Anatomical and functional planningCombines MRI, stereotactic coordinates and the clinical profile to design electrode implantation.
• Selection and planning of the brain targetChooses the brain nucleus and electrode path according to the movement disorder and its predominant symptoms.
• Treatment of Parkinson's disease, essential tremor and dystoniaModulates specific motor circuits to reduce selected symptoms of these movement disorders.

Covers trial stimulation, implantation and programming of systems designed to modulate neuropathic pain.

• Spinal cord stimulation trialTemporarily assesses the effect of stimulation before permanent system implantation.
• Epidural electrode implantationPlaces stimulation contacts in the epidural space beside the spinal cord.
• Neurostimulation generator implantationPlaces the battery powering the stimulation system under the skin.
• Programming and follow-up of neurostimulationAdjusts electrical settings and monitors the response to the implanted system.