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Monday, 23 July 2012




In the field of neurosurgery, almost all of the techniques are invasive surgery performed in other words have to make cuts and the opening of the skull to access into the brain tissue or commonly known as a craniotomy. With the development of information technology, neurosurgery techniques become more advanced. Information technology can help create a mapping in brain function that can prevent the complications of nerve function deficits (neurological deficit) caused by operatif intervention.
Similarly, the development of modern imaging technology is now a very significant contribution to the success of neurosurgical operations. Visualization using a microscope at the time of surgery, increasing the efficacy and safety for the patient postoperatively. More sophisticated, endoscopic tools have helped the neurosurgeon to look at every angle in the human brain to determine the position of aneurism (enlargement of blood vessels) in the brain prior to clipping (clamping of blood vessels that are at risk of rupture occurred / rupture).
In the last decade, neurosurgery action with computer-assisted image-guided (neuronavigation) has been developed to assist neurosurgeons perform safer surgery. Neuronavigation allows the neurosurgeon to know the location of the lesion / tumor more accurately, by determining the size of the lesion / tumor and determine the appropriate surgical technique to approach the lesion / tumor. Currently available navigation system shaped frame-based or frameless techniques based on differences in the position of the lesion / tumor as points points points by means of integrated optical or electromagnetic systems.
Furthermore, all types of imaging systems that support at the time of neurosurgical operation requires imaging data obtained from CT scan (computed tomograph scanning), MRI (magnetic resonance image) and also integrated functional MRI, positron emission tomography, and magnetoencephalography taken before surgery is performed. Thus there is no single system that can detect changes in the brain during surgery on an ongoing basis as a shift in the brain due to leakage of cerebrospinal fluid (fluid in the brain), making the tumor, as well as changes in brain shape due to changes in patient position.
A. Gamma Knife
Gamma Knife is a tool that uses stereotactic radiosurgery. Different from ordinary operations, with this technique the doctor does not need to do surgery. Physicians should only focus on the gamma rays so that the diseased organ such as the procedure applicable surgery.Gamma Knife radiosurgery, despite its name contains the word meaning knife blade, this therapy did not use these tools.
This therapy is very promising for the treatment of brain tumors. Therefore, the location can be hidden 
There was also a kind of non-invasive treatment is not painful and minimal risk.
Although using gamma rays, but the radiation emitted is very small. Because radiation is only performed on the sick with the level of accuracy yangtinggi so it does not have an effect on brain neurons that sehat.Untuk determine the accuracy of target irradiation, prior therapy, patients are required to undergo a series of procedures. First, the wear of a metal tool called stereotactic head frame. With the tools that are glued together using screws physician can determine which parts of the brain that would be treated so as not misplaced.
Another function is keeping the head is not moved during the irradiation takes place. To reduce pain in the head exposed screws, doctors usually give the patient a local anesthetic.
The next step is imaging using magnetic resonance imaging (MRI), Computed Tomography (CT), or angiography. Useful to know denganpasti tumor size and position in the patient's head. After evaluating the results, the doctor will make the planning of therapy. Quite often in this stage involve other specialist physicians to determine what kind of therapy given, in accordance with the relevant patient's medical condition. This process usually takes about two hours. During the waiting patients are welcome to rest first.
If so, then the patients were asked to lie on the bed and the head frame is attached to the helmet. During this procedure the patient remains conscious and able to communicate with doctors and nurses who accompanied the video connection. Patients were then inserted into the dome and immediate therapy, this therapy is not painful. Patients can undergo therapy even while sleeping or listening to music.
Irradiation is also only a short duration, in just minutes. On average it only takes 30 minutes. However, there are up to an hour. Depending on the patient's medical condition.
Unfortunately, not all diseases can be treated using this therapy. Gamma Knife is only effective in treating brain tumors (both benign and malignant), arteriovenous malformations (AVMs), acoustic neuromas, Trigeminal Neuralgia, and tumor pituatari. And that which is below 22 cc or 3.5 cm. Above it is better to use konvension surgery.

With the advancement of medical technology is growing, there is now a new technique for the special operations Neuroendoskopy neurosurgery. Neuroendoskopy is a tool in the form of fiber optic operations. It is helpful to make a small hole that can be inserted into the patient's wound, so that by using a tool that could help doctors to determine the perceived neurological disease patients. Neuro means nerves endoskopy is looking into this. So neuroendoskopy is a tool to look into the neurosurgery disease.
This tool is actually very helpful doctor and usually have the advantage for pasien.Karena in neurosurgery operating very large incision on the patient and the treatment is very long, but by using this neuroendoskopy can minimize injury to the patient, so the recovery process and patient care at the hospital to be faster. For nerve surgery itself can take 5 minutes or more, depending on the illness. As for the cost of operations in Indonesia when compared with other countries about 30 to 50 U $ U $.
Neuroendockopy effective to handle hidrosephalus, colloid cyst removal, arachnoid cyst, neurocysticercosis,

3.Microsurgery and Endoscopic surgery
Microsurgery and Endoscopic surgery is one of the least invasive action. This technique has many advantages are recognized. Such, has a small wound, injury to surrounding tissue is minimal, short period in ward, only one day or even directly home after surgery (ODS), so patients can be directly performed activities. Thus would not require prolonged treatment and reduce the productivity of these patients.
But sometimes, a disorder does not require operative measures, such as abnormalities fail back syndrome, discogenic pain, and lumbar / cervical facet joint syndrome. Wherein, the aberration of the bearing bones, joints of the spine, can be done using radiofrequency therapy or Epidurolysis action. This action does not require anesthesia, the patient even aware of the treatment or therapy. Thus, patients do not require hospital treatment

4.vestibular prosthesis
Balance disorders are characterized by vertigo or dizziness like a floating head is now no longer need medication. For the first time, American scientists successfully embed technology in the permanent antidote to vertigo in the head. Last Friday (22/10/2010), a man from Washington who was not named an operation of planting tool called a vestibular prosthesis on his head. 56 year old man knew it was Meniere's disease patients, a kind of balance disturbances trigger vertigo. Tool-shaped microchip that is embedded in the head was controlled wirelessly with the device mounted mini behind the ear. Can be activated at any time of the attacks of vertigo occur and will affect the center of balance is located in the ear.

"It really just to divert the symptoms. Not to heal, only reduce the vertigo until the actual disease successfully treated," said Dr. James Phillips, one of the doctors from the University of Washington who designed the tool in the last 4 years. To truly heal, a doctor may perform surgery on the ear memberan damaged. This step can be overcome vertigo for ever, but sometimes sacrificing auditory function so that patients become somewhat deaf.

5.Endonasal endoscopic skull base surgery
The doctors in the UK to make new breakthroughs in neurosurgical techniques. They perform tumor surgery in the head with the aid of an endoscope through the nasal passages or referred to as endonasal endoscopic skull base surgery. Procedures conducted by experts at Southampton General Hospital was intended to remove the tumor at the base of the skull. To minimize injuries, doctors rely on sophisticated tools are inserted through the nose. Invasive surgical technique is similar to the digestive organs, the doctor uses an endoscope, a type of small flexible tube equipped light and tiny video camera. The tool is inserted into the body to send pictures to television screens in the operating room. This surgical technique allows them to reach the tumor at the base of the skull and the top of the bone directly.

This technique was first used to remove blockages in the sinus, and a new one applied to overcome the tumor. Previously, the neurologist must divide the face or scalp skull and remove the skull on the forehead to complete the same operation. But with this new technique, the surgical wound to be very minimal.

Minimal access and maximal invasive procedure is a breakthrough in neurosurgery. One of the patients who underwent this technique tumors with skull base erosion. Conventionally, he would have undergone a bifrontal craniotomy pose a risk of epilepsy and stroke. It also makes the patient should be hospitalized for several days and banned from driving afterwards. "By using the endonasal endoscopic procedure, we can reach the tumor with minor disturbance to the surrounding parts of the brain and not have to do surgery on the head, the result should be more patient length of stay in hospital.

6.Atasi addiction to Neurosurgery
Therapy to overcome drug addiction berkembang.Jenisnya increasingly became more diverse, ranging from consulting and support psychological therapy to drug-obatan.Selain, there are other therapies that could be an alternative. Namely, cure drug addiction with neurosurgical operative techniques, an attempt to cure drug addiction with neurosurgical techniques is the development of surgical techniques psychocsurgery types.
Psychosurgery is a neurosurgical operative techniques to treat psychiatric disorders or psychiatric disorders can be overcome psychosurgery.Berbagai with psychosurgery, including schizophrenia and obsessive compulsive disorder (OCD). In the process, psychosurgery and then do well to handle people with drug addiction ..
The technique was performed by heating using radio frequency energy to specific points in the brain. Heating is done to undermine the points in the brain that become part of the process of drug addiction.
Addictive effects arising as a result of the stimulus given drug substances to specific points in otak.Lokasi these points vary depending on the type of drug used. The stimulus provided by the drug substance through a pathway called the reward pathway.
Heating at points that will break the line, before surgery, drug addicts should be checked by means of magnetic resonance imaging (MRI) in advance. Through that examination, it is known, the points which shall be used as a target of the operation. Patients who previously operated lokal.Jadi sedated, during surgery, the patient remains conscious and can communicate.
So far, efforts to cure drug addiction with drugs often have failure. many patients who had recovered but one day it lagi.Hal relapse and addiction often leads to frustration in both patients and families themselves.
Effort to cure drug addiction with a neurosurgical technique could be an alternative solution tersebut.Teknik neurosurgical problems it has the advantage that the success rate reached 80% -90% in curing the patient and eliminates the risk of recurrence.
7.Bedah Nerves Cure Epilepsy
The development of neurosurgery Indonesia has been able to cure diseases or at least reduce the frequency of epileptic attacks against the sufferer.
neurosurgery is one of the alternative treatment of epilepsy after curing disease through medication with drugs not berhasil.Jika patients do not heal, it will cause resistance to drugs.
If the test shows suitable for children and epilepsy surgery, then the doctors may decide to perform the operation. Every operation is different, so the operation must adjust to the problems facing children.
In general, there are three types of surgery may be performed:
• resective surgery or surgical removal of part of the brain source of epileptic seizures.
• Corpus callosotomy, the break between the two parts of the brain tissue.
• vagus nerve stimulation, which include a small tool in the vagus nerve (vagus nerve) in the neck. Tool that is used to deliver electrical stimulation to the vagus nerve.
8.Atasi neurological disorder with neuro simulator
Surgery can cure patients with pain, anxiety, forgetfulness, imsomania, anorexia and other neurological disease cases. The new science in the field of neurosurgery that has a device called a neuro stimulator which can be inserted into the patient's body to cure the illness.
With these tools, the mentally ill could be in operation. Doctors uses neuro stimulator device in the patient's body to block the pain yangmenyebabkan it to the signal being sent to otak.Ibarat computer, this tool will block images or text that are not desirable in order not to appear on the screen komputer.Meskipun neuro stimulator is an advanced tool that effectively treat , not everyone who suffers from neurological diseases directly in the operation of plugging the device into the body.
Surgery with a pair of neuro stimulator to the patient's body is the last option, if a variety of other healing techniques fail.
This treatment technique has been developed in the United States and China.
The workings of the device [neuro stimulator] is lying to the brain by blocking the pain from reaching the brain. If surgery for people with drug, simply made with a technique similar ablative surgery or arson that destroyed part of the brain cells lost to addiction narkobanya.
The development of this condition is surgical technology brings hope for people with mental disorders. Treatment, during which only by taking drugs, is often ineffective because of the possibility of curing patients not taking the medicine in the discipline is enormous. In fact, the behavior of people with mental disorders are generally disturbing the family and the environment. They usually like to attack others or other humiliating acts.
Neurosurgery tool that uses a battery life of 5 years-10 years it could be installed in the brain or spinal cord, depending on the case. Nerve surgery, the need of Rp40 million to Rp80 cost . relatively expensive, it does not preclude interest in the sick to choose a surgical operation to cure the illness condition.

9.Bedah Nerves With Virtual Reality
Neurosurgery is probably one of the surgical expertise that has lots of intrigue and perhatian.Dalam require surgery, neurosurgeons have to find and operate around the critically important part of life that requires knowledge of the body structure manusia.Scan and traditional images provide anatomic structures in two dimensions (2-D), which is required to generate an appreciation of Virtual Reality 3-D structure.
In medicine and in particular virtual reality neurosurgical methods are used for education, surgical planning and simulation of a virtual patient. Neurosurgery Department at the National Neuroscience Institute (NNI) using Dextroscope Virtual Reality Surgery System, developed by the interaction volume, as part of overall patient management.
All images are related such as MRI, CT scan, angiography venografi and entered into the system dekstroskopi to form a 3D computer results.
Virtual workplace produces interactive platform virtual 3-D for the neurosurgeon to plan the merger pembedahan.Peralatan pictures, color coding and transparency, manual and automatic segmentation of structures such as brain tumor, measuring curve, linear, volumentrik also stimulate tissue disposal is available. The use of sophisticated equipment is based on the actual scan images of patients and provide important information about the spatial relationships of surgically relevant individual structures, which can be explored and stimulated with different approaches to help the best surgical planning decisions. The end result is the appropriate surgical planning with the patient.
Virtual Reality Surgery is an important part of the range of existing technology to improve patient care, surgical outcomes and safety in surgical patients saraf.Ditujukan for brain tumors, vascular malformations, tumors of the skull and other complex neurosurgical pathology.

10. Computerised image-guidance operating systems / IGS
Tumorotak is a complicated issue, so that managers can handle requires a team consisting of several experts, usually led by a neurosurgeon, and will involve a neurologist, radiologist, anesthesiologist-neurological, oncology and radiotherapy.
Although no exact cause of the underlying disease of the brain tumor, but it is suspected there is some risk factors, including:
A. More developed brain tumors in men.
2. There is a history of cancer in the family.
3. The existence of exposure to radiation, chemicals such as formaldehyde, vinyl chloride and acrylonitrile.
4. Possible effect of mobile phone use.
Until now, the certainty of diagnosis of cancer may take several years, fortunately this time the disease can be overcome with more sophisticated techniques and powerful than sebelumnya.langkah main and most important for brain tumor treatment is neurosurgery.
Pembedahaan goal is to remove as much tumor cells as possible and ensure the healthy tissue surrounding the brain remains intact. There are many technologies offered by the surgeons, which makes the surgery more safely, accurately and with fewer complications than ever before. For example, now the International Neuro Associates, Novena Medical Centre, Singapore, using a system of computerized image-guidance operation (computerized image-guidance operating systems / IGS), which work similar to the GPS system.
This tool allows to point exactly at the point of tumor location, and make a small hole for the lock to pembedahan.Terkadang, neuro-endoscopy may be an option with direct vision into the brain and throw tumor.Pascapembedahan, will in the analysis of tumor tissue and tumor types determined. Radiation therapy and chemotherapy is sometimes necessary, especially if the tumor is malignant properties. Additional therapy and medication will be given to reduce symptoms, such as creating a channel for the flow of cerebrospinal fluid disposal, and drugs to reduce seizures and brain swelling.
In some cases, surgery is followed by the disposal of the relevant parts of the brain, so post operatif, patients have difficulty moving, speaking or makan.Berbagai forms of therapy can help restore or repair activities were disrupted by the condition. For example, a physiotherapist can restore limited movement and the power level of the patient, and the speech therapist will help improve the quality of speech and eating.
It is also important to note that diagnosis and therapy of brain tumors should be performed as early as possible, thus providing . now results, with the development of medical science, the increasing capabilities and sophistication of surgical operating room technology, have created a brain tumor as the disease is curable and treatable.

11.Tehnik awake craniotomi
Brain tumor surgery requires a very high accuracy to avoid healthy brain tissue was interrupted when the tumor involved was taken. A variety of surgical tools were developed to tools like microscopes were included to increase the accuracy so that postoperative complications can be reduced. In addition to the tools and techniques of surgery, the patient's condition is stable during neurosurgical operations (which typically lasts a long time) is obtained with the technique and appropriate anesthetic drugs also served to increase the success of the operation and press complications. Recent breakthroughs in the techniques of anesthesia for neurosurgical operations are technically awake neurosurgical craniotomi or when the condition of the patient is awake. Craniotomydigunakan awake technique to determine the boundary between normal brain tissue by the tumor by giving electrical stimulation on the network. If such effects are expected, meaning that normal brain tissue needs to be maintained, while if they do not react mean tumor tissue should be removed. When this examination the patient was asked to move the hands / feet, speak or perform other movements according to the function of brain areas surrounding the tumor. When checking the patient can perform movements on command (unconscious), while the patient still had no pain or other things that cause discomfort

12.Sphenoidektomi endoscopic
Medical technology has advanced enough Indonesia. For the treatment of pituitary tumor, the patient did not need to bother to neighboring countries. With just do kuretasi sphenoidektomi endoscopic piecemeal without touching the brain tissue at all. The difference with the conventional technique, a relatively new technique does not have to open the skull to take some tissue located behind the basal forebrain. Therefore, the old technique at greater risk than endoscopic sphenoidektomi. In the old technique there is the possibility of brain tissue and result in uncomplicated patients impaired brain function. Technical advantages compared to conventional surgical transfenoid not only that. Long operation, for example, is quite short, about four hours. In fact, brain tumor surgery usually takes 8 to 10 hours. In terms of length of hospitalization, surgery is only a week alias takes one week faster than the normal way. It cost even less, at $ 1 million (care on the ward) of up to Rp 6 million (first class treatment). The success rate depends on the size of the tumor transfenoid operation. In the tumor is still small, less than ten millimeters, one hundred percent success rate.

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