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Neurology and Neurosurgery

GVM’s Department of Neurology and Neurosurgery deals with the treatment of the diseases of the Central Nervous System (brain, cerebellum, brainstem and spinal cord), of the Peripheral Nervous System.

The specialists who work at the GVM facilities can rely on state-of-the-art instrumentation. Innovative techniques that either minimize or eliminate the common esthetical side-effects of craniotomy have been developed in-house and are employed in our patients since many years. Diagnostic tools include MRIs, CAT scans and PET/CT, besides the most advanced tools for Angiography operated by internationally renown practitioners.

Dedicated neurosurgeons have particular experience in brain tumor and vascular microsurgery integrated by minimally invasive stereotactic neurosurgical procedures and precise targeting by neuronavigation. Spine disorders treated include disc, tumoral, functional and post-traumatic deformities, and also the latest stabilization techniques are implemented at cervical, dorsal and lumbo-sacral segments. Vertebral stabilization is employed also in spinal pain syndromes, while mini-invasive techniques are preferred (osteoporotic fractures) in elderly patients.

Each clinical situation can be addressed by the most appropriate microsurgical and microvascular technique, and selection of each approach is based on the experience of a team of neurosurgeons with 8000 cases treated by ‘non-invasive’ Gamma Knife radiosurgery in the course of more than 20 years.

Following the successful introduction of neuro-microsurgery in the ‘70s, the principle of reduced surgical trauma has progressively led to the wider adoption of Gamma Knife procedures: many years of experience with both invasive and non-invasive approaches in the treatment of neoplastic, vascular and functional disorders of the Central Nervous System have given our team a unique perspective of what is the best approach available in each individual patient.

Surgery is selected whenever the patient may benefit from quick relief from the intracranial pressure of an expanding mass or for surgical distancing of very delicate structures that may not bear deformation.

The targeted administration of the Gamma Knife irradiation (in single session) is on the contrary selected whenever experience supports a proved efficacy in over 80-90% (in some conditions even 100%) of lesions that would be inoperable otherwise, including remnants/recurrences to previous surgery, or when the general condition of the patient contraindicates open surgery under total anesthesia.

The experience gained with this approach has provided guidelines regarding comparative risks even for targets many times larger than the original limit of 3 cm in diameter given by the Swedish pioneers. AVMs (arteriovenous malformations) in all locations and meningiomas in the cranial base (otherwise attacked by very demolitive and incomplete surgical approaches) have been cured even with volumes up to and exceeding 50cm3.

In 2015, the Department performed a total of 4.603 operations. In particular, in 2015, 435 Central Nervous System operations were performed, 2.920 at the vertebro-spinal level, 266 on the Peripheral Nervous System, 447 different cases and 500 cases using the Gamma Knife.
 

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