Neurosurgery

Ospedale San Raffaele

key figures 

CLINICAL SERVICES:

  • Outpatient Services
  • Inpatient Services
  • Open Surgery
  • Gamma Knife Radiosurgery Treatments
  • Endovascular Treatments

PROCEDURES PERFORMED PER YEAR/ANNUAL ACTIVITY:

  • 1.200 brain tumours (Gliomas, Skull Base tumours, cavernomas, metastases)
  • 400 cases of meningioma
  • 350 cases of pituitary tumours, craniopharyngioma and other sellar region tumours
  • 130 cases of aneurysms and vascular malformation


The neurosurgery Unit provides comprehensive services for the diagnosis, treatment and surgical management of the main conditions affecting the brain, spinal cord and peripheral nerves. The department is an internationally-recognized centre for brain tumour treatments. It is a national reference centre in the treatment of pituitary and of the cranial base tumours (meningiomas, chordomas, craniopharyngiomas, etc.).

Microsurgery and stereotaxic radiosurgery with Gamma Knife are frequently integrated.  Patients are followed by a multidisciplinary group of neurosurgeons, endocrinologists, neuro-radiologists, neuro-ophthalmologists, ENT surgeons, and radiotherapists to offer optimal treatment. Malformations and tumours of the brain and spinal cord are also treated in children and adolescents.

 

treatmentS

Brain Tumours

Over the years numerous classifications have been proposed with the aim of having an ever-greater correlation between the nature of the tumour, the therapeutic indication and the prognosis.

Currently a review of the classification proposed by the World Health Organization in 2016 is used, which divides tumours according to the type of cells from which they originate.
Nervous system tumours in most cases do not give metastases or invade other organs. However, they may have local malignity due to the location and the relationships with the nervous structures.

Moreover, while in the case of malignancy in other organs the surgical resection can be done with a wide margin in the healthy tissue, in the brain and in the spinal cord this cannot happen due to the high risk of neurological impairment.

Main Pathologies Treated:

  • Astrocytoma and glioblastomas
  • Gliomas
  • Oligodendroglioma
  • Ependymoma
  • Meningiomas
  • Acoustic neurinoma
  • Craniopharyngioma
  • Lymphomas of the central nervous system
  • Primitive neuroectodermal tumours (PNET)
  • Tumours of the pineal region
  • Brain metastases

Top Procedures:

The Unit provides all the main surgeries for brain tumour’s removal.

Pituitary Tumours

These are generally histologically benign neoformations. The first therapeutic option for pituitary adenomas, except prolactinomas, is surgical removal. Sometimes in selected cases it may be necessary to use further drugs and radiation therapies. Among these is the Gamma Knife radiosurgery, a form of stereotaxic radiotherapy that allows extremely high dose doses of gamma rays to be delivered on a small target, preserving the surrounding neural structures. Gamma Knife, compared to conventional radiotherapy, minimizes the risk of decreasing the pituitary function and cognitive deficits.

Main Pathologies Treated:

  • Pituitary adenomas including GH secreting adenomas
  • Non-functioning pituitary adenomas
  • Cushing disease (ACTH secreting adenomas)
  • Prolactinoma and TSH secreting adenomas
  • Craniopharyngioma

Top Procedures:

The Unit provides more than 240 different surgeries on pituitary tumours and 80 Gamma Knife surgical procedure.

Spinal Cord Tumours and diseases

The Unit offers treatments for degenerative spinal diseases such as lumbar and cervical disc herniation, lumbar instability, lumbar stenosis.

Cervical disc herniation- between one vertebra and another there is a bearing, called disc, which allows the movements between the two vertebrae. It consists of a more resistant external component and a more gelatinous interior that absorbs deformations. The external part of the disc can break causing leaking of the gelatinous material known as hernia. When this occurs towards the spinal cord, the hernia can compress the nerve structures in the spinal canal and cause pain and other neurological symptoms.

Spondylosis also known as stenosis of the spinal canal, is decrease of the dimensions of the spinal canal or of the foramen from which the nerve roots emerge. Spondylosis can be cervical or lumbar.

In both cases the optimal treatment for each individual case can be accomplished adopting the most conservative a minimally invasive techniques.

Main Pathologies Treated:

  • Spinal cord tumour
  • Disk herniation
  • Degenerative diseases

Top Procedures:

The Unit provides all surgical and non-surgical procedures for degenerative spine diseases and tumours.

Vascular Malformations

These are mainly malformation diseases whose main risk is to cause a brain haemorrhage with potentially fatal consequences. They can in most cases be cured in a definitive way adopting endovascular non-invasive techniques during a cerebral angiography. The latter consists of introducing a thin catheter into an artery, generally the femoral artery, and pushing it through the blood vessels up to the artery with the malformation. A contrast medium is then injected through the catheter and X-ray images of the malformation and a map of the intracranial arterial arteries are obtained.

Main Pathologies Treated:

  • Cerebral aneurysms
  • Arteriovenous malformations (AVM)
  • Dural arteriovenous fistulas

Top Procedures:

  • Surgical treatment
  • Endovascular treatment
  • Gamma Knife radiosurgery

Gamma Knife Radiosurgery Technique

The Unit performs microsurgery as well as Gamma Knife stereotactic radiosurgery. The multidisciplinary team, composed of neurosurgeons, endocrinologists, neuroradiologists, endovascular neurosurgeon, neuro-ophthalmologists, ENT surgeons and radiotherapists, ensure the best and up-to-date approach to all intracranial tumours and other lesions. This ensures an early and accurate diagnosis an effective treatment and post-treatment follow-up care.

The Gamma Knife Radiosurgery section, part of the neurosurgery department, is dedicated to non-invasive radiosurgery treatments through this dedicated technology. The Gamma Knife allows the minimally-invasive treatment of tumours, vascular malformations and trigeminal neuralgia thanks to the high dose of radiations focused on the targeted areas, while sparing the surrounding tissues.  This advanced radio-surgical system allows high precision performances with highly efficient treatments and, in selected cases, can be offered as additional or complementary option to open-microsurgery. Patients treatment depends on the specific condition and can be planned only after a visit done by a specialist.

Main Pathologies Treated:

  • Brain tumours
  • Arteriovenous malformations
  • Trigeminal neuralgia

 

NOTABLE ADVANCED TECHNOLOGICAL EQUIPMENT

  • 1 Gamma Knife radiosurgery equipment
  • O.T. Bi-dimensional and Tri-dimensional endoscopy
  • Intraoperative brain mapping  
  • Intraoperative ultrasound       
  • Intraoperative neurophysiology   
  • Neuronavigation and stereotaxis