The 1st Neurosurgery Clinic and the Spine Disorder Endoscopic Treatment Department of the 1st Neurosurgery Clinic cover the full range of classical neurosurgical pathology. The most advanced methods for diagnosis and treatment are applied to patients. By emphasizing new imaging techniques and minimally invasive surgical approaches, and utilizing state-of-the-art technology infrastructure, the clinic offers the opportunity for true personalization of patient treatment, as various surgical techniques can be provided, specially tailored to each individual patient.

BRAIN

1. Brain Tumors: These can be:
   - primary: Malignant (such as glioma) or benign (such as meningioma or acoustic neuroma)
   - secondary (metastases)
   Treatment depends on the type and location of the tumor and includes surgical removal combined with radiation therapy and/or chemotherapy.
2. Hydrocephalus:
   It is a pathological condition in which cerebrospinal fluid (the fluid within the brain) either cannot flow properly (obstructive hydrocephalus) or cannot be absorbed in the required amount, causing it to build up and exert pressure on the brain, from the inside out.
   Surgical treatment is the most common one, involving the placement of a special cerebrospinal fluid drainage system at various parts of the body (most commonly in the peritoneal cavity).
3. Developmental Disorders
   The most common one is Chiari malformation, in which a part of the cerebellum pushes into the foramen magnum (the area where the head meets the neck), resulting in pressure effects in the area and a disturbance of cerebrospinal fluid circulation. Treatment is entirely individualized, ranging from simple monitoring to surgery, depending on the patient's symptoms.
4. Hemorrhagic Strokes:
   These usually occur when high blood pressure coexists, resulting in the rupture (breakage) of a blood vessel within the brain. When there is a large amount of blood and significant pressure effects occur, surgery is required to evacuate the hematoma.
5. Traumatic Injuries:
   The most common traumatic injuries resulting from a head injury include subdural hematoma (hematoma between the meninges and the brain), epidural hematoma (hematoma between the skull and the dura mater), and cerebral contusion (injury to the brain itself). Depending on the severity of the injury, treatment may range from simple medication treatment and monitoring to emergency surgery.

DISC HERNIATION

Disc herniation, or intervertebral disc herniation, occurs when a part of an intervertebral disc protrudes into the spinal canal, causing pressure on the neural structures within it.
This condition’s most common symptoms include pain, numbness, or even muscle weakness. Modern treatment options for intervertebral disc herniation include microdiscectomy and endoscopic discectomy.

SPINAL STENOSIS

Spinal stenosis is characterized by a reduction in the diameter of the spinal canal. It is most commonly located in the lumbar spine and less frequently in the cervical or thoracic spine. The primary symptom occurring is intermittent neurogenic claudication. Specifically, the patient, when standing or walking, gradually experiences pain, numbness, and weakness in the lower limbs and needs to sit for a few minutes to continue. The surgical procedure of choice for spinal stenosis is spinal decompression surgery, which can now be safely performed using microsurgical techniques, with the use of a microscope or endoscope and specialized instruments.

SPONDYLOLISTHESIS

Spondylolisthesis is a pathological condition in which one vertebra slips out of place with respect to another, and is most often caused by anatomical instability in the area. The most common clinical manifestations are persistent lower back pain that worsens when standing, bending, or doing certain movements. The treatment approach involves stabilization techniques for the area (spinal fusion), which can be performed in various ways. The most modern techniques include percutaneous spinal fusion with screws and rods, as well as endoscopic interbody fusion using expandable cages.

SPINAL FRACTURES

Fractures in the spinal region can be related to high-energy injuries (such as a car accident or a fall from height), but they can also occur from minor injuries in cases of osteoporosis. More rarely, they may be associated with pathological conditions such as tumors or inflammatory conditions. Treatment approaches may include simple pain management and vertebral body reshaping (kyphoplasty/vertebroplasty) when there is no instability, or spinal fusion when the fracture involves dislocation that could potentially harm neural structures.

CERVICAL MYELOPATHY

Cervical myelopathy is a serious condition characterized by compression of the spinal cord in the cervical spine, having as a result the occurrence of symptoms that may initially be limited to pain, nuchal rigidity, and numbness, but if not treated promptly, it can lead to movement disorders, pathologic reflexes, and, in severe cases, tetraparesis or tetraplegia. Early treatment is crucial and typically includes anterior cervical discectomy with stabilization, and less commonly, posterior decompression with spinal canal enlargement.

SCOLIOSIS

Scoliosis is characterized by the deformity of the spine. Symptoms largely depend on the severity of the deformity and can range from cosmetic changes, such as the appearance of a hump, to more severe issues including significant pain or functional difficulties in vital organs, especially in cases of severe deformities that compress important organs. The procedure of choice in such cases is the correction of the deformity through osteotomies, followed by stabilization with spinal fusion.

SPINAL TUMORS

Spinal tumors, also known as spinal neoplasms, are abnormal cell accumulations that may occur at any part of the spine. These tumors are classified based on histological characteristics, location, and behavior. The clinical presentation of spinal tumors varies depending on their location, size, and relation to critical neural structures. As a result, some patients may not present any symptoms, and the tumors are discovered incidentally, while others may experience pain or significant neurologic deficits, even leading to paralysis. The treatment of spinal tumors requires a multidisciplinary approach. The treatment approach depends on factors such as the type of tumor, its location, the overall health of the patient, and their functional status. Surgical removal by a spine surgeon is the cornerstone of treatment for many spinal tumors, especially when the tumor compresses neural structures or causes instability. The aim of surgery is not only the tumor removal but also the decompression of nerves, and if necessary, the provision of support to the spine.