The neurosurgeon generally suggests an intervention whenever there is an alteration of one or more neurological functions (weakness or paralysis of the limbs, difficulty walking, speaking, seeing, cognitive disturbances ...), or in the case of an existing risk of future alteration, or even a risk for life.
Generally, intracranial lesions, whether benign or malignant, are removed by an operation of craniotomy with microsurgical procedure (through the use of an operating microscope).
When it comes to the excision of a pituitary adenoma, a minimally invasive technique di transnasal endoscopy (accessed inside the skull with a camera through the nose). Diseases of the cerebrospinal fluid (obstructive hydrocephalus, colloid or arachnoid cysts ...) can also be treated with a endoscopic intervention inside the ventricular cavities.
Apart from the rare cases of instability or compression acute neurological structures (traumatology, tumors, voluminous disc herniation ...) the neurosurgeon evaluates, together with the patient, a possible surgical solution. In fact, in the vast majority of cases, if symptomatic, spinal disorders lead to pain in the back and / or limbs.
Surgery can be helpful in case of major impaired quality of life, due to pains or to one paralysis. In the absence of paralysis, it is important to try a first medical treatment pain, possibly associated with a physiotherapy rehabilitation.
Since 80% of pain due to pathologies such as herniated disc (cervical or lumbar) can resolve spontaneously or with the help of suitable therapy, often the neurosurgeon considers it useful to wait 1 or 2 months after the onset of symptoms to propose an intervention. Obviously this timing (based on statistics in scientific publications) has to be adapted individually. In case of paralysis, unbearable pain despite pain relief or severe compression of the spinal cord (spinal cord compression) or all the nerves of the lumbar canal (cauda equina syndrome), the surgical solution may become urgent.
Treatments range from microdiscectomy (excision of disc herniation) e laminectomies (enlargement of the spinal canal) to procedures of arthrodesis (fixation and stabilization of vertebrae) e cementoplasty (injection of cement into a vertebra).
The types of surgical approach to the skull are generally performed in microsurgery. Minimally invasive techniques use the endoscope for transnasal surgery of the pituitary gland or for endoventricular surgery.