Department of Adult and Pediatric Neurosurgery, Spinal Surgery - University Hospital of Ludwig Maximilian University of Munich

About the Department of Adult and Pediatric Neurosurgery, Spinal Surgery at University Hospital of Ludwig Maximilian University of Munich

The Department of Adult and Pediatric Neurosurgery, Spinal Surgery at the University Hospital of Ludwig Maximilian University of Munich provides a comprehensive range of surgical procedures for patients with diseases of the central and peripheral nervous systems. The department is certified by the German Cancer Society (DKG) as a Neuro-Oncology Center, which operates as part of the Comprehensive Cancer Center Munich. The department's team of neurosurgeons has extensive experience in the surgical treatment of brain and spinal cord tumors, neurovascular diseases, epilepsy, and pituitary disorders. Brain tumor surgery represents a particular area of clinical expertise for the facility's team. Another specialized area is the treatment of neurosurgical diseases in children and adolescents. Specialists in this field primarily treat brain and spinal tumors, traumatic brain injuries, spinal dysraphism (such as spina bifida), epilepsy, and hydrocephalus. The department's neurosurgeons use state-of-the-art minimally invasive microsurgical techniques, computer-assisted navigation systems, intraoperative imaging and neuromonitoring, and other advanced tools to perform surgery on the brain and spinal cord while minimizing the risk of neurological deficits. The department has 84 beds, including 10 intensive care beds. The neurosurgery team takes a thorough and personalized approach to planning each surgical procedure, carefully considering every aspect of the patient's clinical condition. In addition to providing high-quality neurosurgical care, the department’s doctors place great importance on preserving patients’ quality of life. All diagnostic and treatment procedures are performed in accordance with current clinical protocols and international medical standards.

The department is headed by Prof. Dr. med. Florian Ringel, a renowned German expert in neurosurgical oncology, aneurysm surgery, and spine surgery. Prof. Ringel serves as president of the German Spine Society (DWG) and is an active member of the European Association of Neurosurgical Societies (EANS) and the Neuro-Oncology Working Group (NOA).

As a certified Neuro-Oncology Center of the German Cancer Society (DKG), the department offers advanced treatment options for patients with benign and malignant brain tumors. The most commonly treated tumors here include gliomas, meningiomas, medulloblastomas, hemangioblastomas, and primary brain lymphomas. Neurosurgeons are also highly experienced in treating brain metastases originating from other malignancies, such as lung or breast cancer. The department provides comprehensive, patient-centered care in accordance with the latest national guidelines, supporting optimal treatment outcomes.

If a brain tumor is suspected, the diagnostic work-up routinely includes MRI. In some cases, a positron emission tomography (PET) scan may also be performed. A stereotactic brain biopsy may be performed to obtain tissue for histopathological examination and establish a definitive diagnosis. Treatment decisions are made during regular weekly interdisciplinary tumor board meetings. The most appropriate treatment strategy is selected based on the specific type and location of the brain tumor, its growth rate, the patient’s general condition, and their clinical symptoms. When clinically appropriate, surgical tumor resection is often the preferred treatment option. The department's neurosurgeons are experts in surgically removing complex brain tumors in hard-to-reach locations, as well as tumors that were previously treated with multimodal therapy. The department’s operating rooms are equipped with advanced surgical microscopes, neuronavigation, intraoperative neuromonitoring, and intraoperative fluorescence imaging techniques, including 5-ALA and ICG. The team also has access to intraoperative computed tomography and other technical resources that ensure precise and safe surgical treatment. The department is one of the few in Germany that offers innovative brain tumor treatments such as interstitial brachytherapy and photodynamic therapy. Chemotherapy, radiation therapy, symptomatic treatment, and maintenance therapy are also widely used when treating brain tumors.

The department is part of the Interdisciplinary Epilepsy Center Munich and provides high-quality medical services for children and adults with epilepsy. The department's neurosurgeons are among the leading specialists in epilepsy surgery in Germany. Most cases of epilepsy can be treated effectively with medication, and surgery therefore is not required. Nevertheless, in some clinical situations, surgery may be the only way to provide long-term seizure control and preserve the patient’s quality of life. A crucial step before the surgical procedure is a comprehensive diagnostic evaluation to determine whether surgical treatment is appropriate. A diagnostic work-up may include electroencephalographic monitoring during and between seizures, seizure semiology assessment, invasive EEG monitoring, tractography, and MRI scans, including functional ones, as well as 18F-FDG PET/CT scans and SPECT. Epilepsy surgery is planned using 3D technology based on the diagnostic findings. The goal of the procedure is to remove or isolate the brain region responsible for the abnormal electrical activity. For patients with bilateral or multifocal epilepsy, conventional resective surgery may not be appropriate. In such cases, the department's medical team offers alternative treatment options, including vagus nerve stimulation. Depending on the type of epilepsy, up to 80% of patients become seizure-free after surgery. It is worth noting that the department's neurosurgeons provide thorough assessments and second opinions for individuals who have undergone epilepsy surgery yet still experience seizures. This is because repeat surgery can provide seizure freedom in some cases.

Spinal surgery is also one of the department's main areas of clinical expertise. The specialists in this field primarily treat degenerative nerve root and spinal cord compression syndromes caused by herniated discs, spinal stenosis, or segmental instability, as well as chronic back pain, spinal fractures, spinal and spinal cord tumors, and spinal dysraphism. The range of therapeutic options in spinal surgery includes tissue-sparing microsurgical and minimally invasive decompression procedures, spinal stabilization surgery, intervertebral disc replacement, spinal tumor resections, as well as CT-guided nerve blocks and cryotherapy for facet joint lesions. The department's surgical team uses advanced neuronavigation and intraoperative neuromonitoring systems during spinal procedures to ensure precise and safe treatment. The surgical treatment options are complemented by effective conservative and rehabilitative therapies.

The department dedicates a significant part of its clinical practice to the treatment of children with brain and spinal cord tumors, skull-base malformations, spina bifida, epilepsy, hydrocephalus, traumatic brain and spinal injuries, arachnoid cysts, vascular malformations, spasticity, and other pathologies. When performing surgery on children, the department's neurosurgeons also employ state-of-the-art technologies, including surgical microscopes, neuronavigation systems, intraoperative neuromonitoring, and endoscopic equipment.

The department's range of medical services includes:

• Surgical treatment of tumors of the brain, spinal cord, meninges, and peripheral nerves in adults and children
  • Brain and spinal cord tumors, including all types of gliomas, glioblastomas, and pilocytic astrocytomas
  • Brain and spinal cord metastases originating from various types of cancer
  • Peripheral nerve tumors, including neurinomas (schwannomas)
  • Tumors of the meninges, including meningiomas
    • Microsurgical tumor resection using 5-aminolevulinic acid (5-ALA) fluorescence guidance
    • Tumor resection using intraoperative neuronavigation and advanced imaging techniques
    • Stereotactic brachytherapy with implantation of radioactive iodine-125 seeds for gliomas and metastases
    • Photodynamic therapy for recurrent malignant gliomas
    • Stereotactic treatment of brain tumors in children
    • Stereotactic cyst puncture, particularly for cystic craniopharyngiomas, with implantation of internal shunts 
    • Stereotactic ventriculocisternostomy for tumor-related hydrocephalus
• Skull base surgery
  • Vestibular schwannomas (neurinomas)
  • Meningiomas
  • Chordomas
  • Epidermoid cysts
    • Minimally invasive surgery
    • Conventional open surgery
• Surgical treatment of neurovascular diseases
  • Aneurysms
  • Dural arteriovenous fistulas
  • Arteriovenous malformations
  • Cavernomas
  • Intracranial hemorrhage
  • Stroke
    • Endovascular procedures
    • Surgical treatment
    • Radiosurgical techniques
• Spinal surgery
  • Degenerative compression syndromes of the nerve roots and spinal cord caused by disc herniation, spinal stenosis, and segmental instability, including spondylolisthesis
  • Chronic neck and back pain, including facet joint syndrome
  • Traumatic spinal injuries, including spinal fractures
  • Tumors of the spine and spinal cord

Spinal dysraphism and other spinal malformations

• Minimally invasive microsurgical decompression procedures, including interlaminar fenestration, foraminotomy, and unilateral laminotomy for bilateral decompression
• Spinal stabilization procedures at all levels using neuronavigation and intraoperative computed tomography
• CT-guided facet joint blocks and facet joint cryotherapy
• Resection of tumors of the vertebral bodies, spinal canal, and spinal cord using intraoperative electrophysiological monitoring
• Intervertebral disc replacement surgery

• Surgical treatment of spinal cord tumors
  • Neurinomas (schwannomas)
  • Meningiomas
  • Ependymomas
  • Astrocytomas
    • Hemilaminectomy for lateral tumors
    • Laminectomy for midline tumors
• Functional neurosurgery
  • Refractory pain syndromes
  • Movement disorders
  • Spasticity
    • Ablative procedures
    • Intrathecal administration of drugs using a catheter or a programmable pump
    • Therapeutic electrical stimulation of the central nervous system
    • Microvascular decompression for trigeminal neuralgia
    • Deep brain stimulation for tremor, dystonia, and Parkinson's disease
• Surgical treatment of epilepsy
  • Anterior temporal lobectomy
  • Electrical stimulation of the cerebral cortex 
  • Vagus nerve stimulation 
  • Deep brain stimulation of the anterior thalamic nucleus
• Surgical treatment of neurological disorders in children
  • Brain and spinal cord tumors
  • Spina bifida and skull-base malformations
  • Epilepsy
  • Hydrocephalus
  • Cerebrovascular malformations
  • Craniosynostosis
  • Spasticity and movement disorders, including dystonia
  • Traumatic brain injuries and spinal fractures
  • Arachnoid cysts
  • Chiari malformation
    • Microsurgical procedures
    • Minimally invasive surgery, including neuronavigation- and neuromonitoring-assisted procedures
    • Endoscopic surgery
• Surgical treatment of pituitary tumors
  • Pituitary adenomas
  • Craniopharyngiomas
  • Rare pituitary tumors
    • Microsurgical procedures
    • Endoscopic procedures
    • Stereotactic irradiation using the CyberKnife system in selected cases
• Surgical treatment of peripheral nerve disorders
  • Carpal tunnel syndrome
  • Cubital tunnel syndrome
  • Radial tunnel syndrome
  • Meralgia paresthetica
  • Tarsal tunnel syndrome
    • Microsurgical procedures
• Surgical treatment of other disorders of the central and peripheral nervous systems