Treatment of brain cavernoma by partial resection and coiling in University Hospital Erlangen

About the department

The Department of Adult and Pediatric Neurosurgery, Spinal Surgery at the University Hospital Erlangen offers modern diagnostics and effective treatment of the full range of diseases, injuries, inflammatory processes, tumors and malformations of the brain, spinal cord and their meninges, as well as spinal diseases. Spinal surgery is performed in collaboration with doctors from the Department of Adult and Pediatric Traumatology, Orthopedic Surgery. The department admits adults and children with malformations of the nervous system, brain and spinal cord tumors, drug-resistant epilepsy and other diseases. As one of the largest medical facilities of this kind in Germany, the department's doctors annually perform more than 2,500 surgical interventions on the brain and spinal cord, peripheral nerve endings. The department's specialists also perform over 400 spinal surgical procedures annually. To achieve high success rates of the surgical treatment, doctors use the very latest equipment, including neuronavigation systems. Thanks to this, surgeons not only successfully eliminate the pathology, but also guarantee the patient maximum safety. The department has 78 beds, including 14 beds in the Intensive Care Unit. The priority goal of the department's medical team is to provide high-quality treatment focused on the patient's needs.

The Chief Physician of the department is Prof. Dr. med. Michael Buchfelder. The neurosurgeon has an excellent reputation not only in Germany, but also far beyond its borders. He can be deservely proud of over 20 years of clinical experience, as well as thousands of successful surgical procedures, which have brought patients back to a full life without pain and discomfort.

The surgical treatment of diseases of the central and peripheral nervous system is performed in four state-of-the-art operating rooms. In addition to high-tech surgical microscopes, neuronavigation systems and devices for spinal surgery with the possibility of complex 360-degree stabilization, the operating rooms are equipped with a 1,5 Tesla magnetic resonance imaging system for intraoperative imaging.

The department also offers outpatient appointments, including consultations on general pathologies of the central nervous system, diseases of the pituitary gland, spine, cancer, epilepsy, and neurovascular malformations. It also provides preoperative and postoperative care. The department's specialists annually provide outpatient medical care to more than 5,500 patients with various diseases of the central nervous system.

The primary focus of the department's neurosurgeons is on the treatment of benign and malignant tumors of the nervous system. The doctors most often deal with brain tumors. The team of neurosurgeons of the medical facility specializes in the treatment of acoustic neuroma, which is a benign tumor of one of the cranial nerves. As in many other tumors, neuroma symptoms manifest themselves only after the neoplasm reaches a large size, and therefore the tumor is quite often diagnosed by accident, during magnetic resonance imaging (MRI) for other indications. The examination for suspected neuroma involves the use of an audiogram, ultrasound ear scanning, electronystagmography, biopsy and other diagnostic tests. To treat the tumor, the department's surgeons use three main approaches: dynamic monitoring (monitoring of an auditory nerve neuroma when it is detected at the initial stages and does not manifest any symptoms), microsurgical removal of the neoplasm, and radiation therapy. The last method is most often used for contraindications to surgery or localization of a neuroma in a hard-to-reach place.

The department's therapeutic options are not limited to the treatment of benign tumors. The medical facility often admits patients with brain and spinal cord malignancies. Upon confirmation of oncology in the patient, the clinical case is considered at the tumor board with the participation of neurosurgeons, oncologists, radiologists, radiation therapists and other related specialists. The classic treatment regimen includes surgical resection of the tumor, radiation therapy, and chemotherapy. The treatment regimen is accurately thought out taking into account the particular clinical indications of the patient, on an individual basis.

The department's neurosurgeons are proud of their outstanding results in the field of surgical treatment of epilepsy, which is carried out within the specialized center. Today, there are many medications that can fight epilepsy, but in some cases the only effective way to eliminate epileptic seizures is surgery. With all the diagnostic data, neurosurgeons, neurologists, neuropsychologists, neuroradiologists and specialists in nuclear medicine have a board, during which they develop the optimal treatment tactics. If surgery is the most advisable option, doctors decide which exact intervention will be most effective for the patient. The department successfully performs interventions for resection of the epileptic focus and various modifications of hemispheric disconnection. The procedure for stimulating the vagus nerve is also widely used. The Epilepsy Center, which is part of the department, is one of the four best centers in Germany and has a 4th degree accreditation. Therefore, the patients with epilepsy can be confident that they entrust their health to highly qualified and experienced doctors.

An important area of ​​work of the team of neurosurgeons working in the medical facility is the surgical treatment of spinal diseases, as well as traumatic injuries and degenerative changes in the spine. To provide medical care to patients with spinal pathologies, the department has a highly specialized center. To achieve excellent therapeutic results, neurosurgeons cooperate closely with orthopedists and traumatologists. The specialists most often deal with the treatment of spinal disc herniation, tumors of the spine and spinal cord, spinal stenosis, spinal inflammatory diseases and injuries. Whenever possible, operations are performed using sparing minimally invasive techniques, which contributes to the rapid postoperative recovery of the patient. To ensure the maximum safety of surgical procedures, when performing surgery doctors use modern intraoperative 3D imaging, neuronavigation systems and other computer-assisted technologies.

The department is also distinguished by its rich experience in the treatment of diseases of the central nervous system in infants, young children and adolescents (in cooperation with the Department of Pediatric and Adolescent Medicine, the Department of Neuropediatrics, Pediatric Oncology). The therapeutic spectrum includes the treatment of both common and rare diseases, including cranial malformations, meningomyelocele, spina bifida, brain and spinal cord tumors. The department's pediatric neurosurgeons use all modern surgical techniques for the treatment of young patients with pathologies of any severity.

The department's main clinical focuses include:

• Surgical treatment of acoustic neuroma
  • Follow-up monitoring using MRI after initial diagnosis
  • Radiosurgery or fractionated radiation therapy
  • Neurosurgical operation using a surgical microscope
  • Operations using intraoperative electrophysiological monitoring with registration of acoustic evoked potentials
  • Surgical interventions with intraoperative stimulation of the facial and trigeminal nerve
  • Surgery in sitting position to protect the facial and auditory nerves
• Surgical treatment of malignant brain tumors (special focus on the treatment of gliomas)
• Surgical treatment of pituitary tumors (about 250 operations per year)
  • Microsurgical interventions
  • Endoscopic interventions
  • Surgery using intraoperative MRI
• Surgical treatment of spinal cord malignancies
• Surgical treatment of spinal diseases (more than 400 operations on the spine, including more than 100 stabilization operations, as well as replacement of vertebral bodies in all parts of the spine)
  • Microsurgery
  • Navigation-assisted surgery
  • Open surgical interventions
• Surgical treatment of pathologies of the central nervous system in children of all age groups (in cooperation with specialists from related disciplines)
• Surgical treatment of epilepsy (in cooperation with the Department of Neurology)
  • Microsurgical resection of certain brain areas, up to total removal (usually when the focus is located in the temporal lobe)
  • Resection of particular brain areas, such as hippocampectomy or removal of the amygdala
  • Resection of the brain near functionally important areas (for example, motor center, speech center, memory center, optic tracts)
  • Removal of multiple lobes (multilobectomy)
  • Resection of epileptogenic defects (tumors, scars, malformations)
  • Resection of the cerebral cortex (hemispherotomy) and its connective structures (callosotomy), functionally important brain areas (multiple subpial transactions)
  • Implantation of a system for deep vagus nerve stimulation
• Surgical treatment of cerebral aneurysms
  • Open neurosurgical interventions (clipping, aneurysm wall enhancement)
  • Neuroradiological endovascular procedures (coiling, stent implantation)
• Surgical treatment of hemangiomas (arteriovenous malformations)
  • Classical interventions
  • Neuroradiological endovascular procedures (embolization)
  • Combination therapy (in rare cases)
• Skull base surgery
  • Surgery in sitting position
  • Electrophysiological monitoring
  • CUSA device (ultrasonic aspiration system for the treatment of tumors)
  • Endoscopy
  • Microscopy
  • Intraoperative imaging
  • Neuronavigation
  • Laser surgery
  • Preoperative functional imaging
  • 5-ALK fluorescence diagnostics
  • Highly specialized, postoperative intensive care
• Surgical treatment of neurovascular compression syndromes (for example, trigeminal neuralgia, hemifacial spasm)
• Intraoperative MRI and neuronavigation
  • Recurrent pituitary adenoma
  • Brain tumors with indistinct boundaries (low- and high-grade gliomas)
  • Surgical treatment of epilepsy
  • Invasive diagnostics (implantation of electrodes into the brain) to accurately determine the localization of an epileptogenic focus
  • Biopsy of hard-to-reach brain tumors
• Neurosurgical intensive care (early detection and treatment of dysfunctions of the brain and spinal cord caused by traumatic brain and spinal cord injury, intracranial hemorrhage or inflammation of the central nervous system)
• Other medical services