PROF. DR. FEYZA KARAGOZ GUZEY CV
A-Dejeneratif Omurga Hastalıkları:
1-Lomber disk hastalığı-lomber spinal stenoz ve spondilolistezis:
meliyat endikasyonları: Lomber disk hastalığı-lomber spinal stenoz ve spondilolistez ile omurilik veya sinir kökü basısı ve nörolojik bulgulara/şiddetli ağrıya neden olan ve medikal/konservatif tedavi yöntemleri sonrasında semptomları azalmayan olgularda, lomber diskektomi ve/veya lomber Füzyon ve enstrümantasyonlu veya onsuz spinal dekompresyon yapılır.
Olası komplikasyonlar:
-Anesteziye bağlı genel komplikasyonlar (akciğer-kalp veya böbrek yetmezlikleri, kan hipotansiyonuna bağlı beyin enfarktüsü veya kan hipertansiyonuna bağlı kafa içi kanama vb);
-Karın içi büyük damar ve/veya iç organ yaralanması;
-Omurilik ve/veya sinir kökü yaralanmaları ve ilgili geçici veya kalıcı nörolojik bozukluklar;
-Beyin-omurilik zarlarının yaralanması ve beyin-omurilik sıvısı ve/veya menenjit fistülleri;
-Şiddetli kanama nedeniyle şok ve ölüm;
-Ameliyat sonrası operasyon bölgesinden kanama;
-Yüzeysel veya derin yara enfeksiyonları;
-Ameliyattan sonra kalıcı ağrı ve/veya nörolojik bulgular;
-Enstrümantasyonlu durumlarda cihaz kırılması veya yetersizliği;
-Çeşitli komplikasyonlar nedeniyle tekrar ameliyat gerektiren.
Cerrahın Ameliyat Sayısı: 1000'den fazla
Ameliyat öncesi ve sonrası işlemler:
-Anestezi için gerekli tetkikler ve ameliyat öncesi anestezist, gerekirse çocuk doktoru veya dahiliye, kardiyolog veya göğüs hastalıkları uzmanı tarafından değerlendirilmesi;
-Gerekirse ek radyolojik inceleme yapmak;
-Ameliyat sonrası gerekirse hastanın yoğun bakım ünitesinde veya beyin cerrahisi kliniğinde takibinin yapılması;
-Röntgen veya bilgisayarlı tomografi ile enstrümantasyon yapılan olgularda ameliyat sonrası radyolojik inceleme;
- Komplikasyon gelişen olgularda komplikasyonları ile ilgili gerekli incelemeler;
-Komplike olmayan durumlarda ameliyat günü veya ertesi gün hastanın mobilizasyonu;
-Yapılan operasyona göre hastayı operasyondan bir veya birkaç gün sonra taburcu etmek.
2-Cervical disc disease-cervical spinal stenosis:
Indications of surgery: In the cases with cervical disc disease-cervical spinal stenosis causing spinal cord or nerve root compression and neurological findings/severe pain whose symptoms do not diminish after medical/conservative treatment modalities, cervical anterior or posterior discectomy and/or cervical spinal anterior or posterior decompression with or without fusion and/or instrumentation is performed according to the characteristics of the patients.
If there is severe compression on the spinal cord, neuromonitorization may be required during operation for protection of the spinal cord.
Possible complications:
-General complications related to anesthesia (lung-hearth or kidney insufficiencies, brain infarction due to blood hypotension, or intracranial bleeding due to blood hypertension, etc);
-In anterior operations, large vessel, esophageal or tracheal injury;
-Spinal cord and/or nerve root injuries and related transient or permanent neurological deficits;
-Injury of brain-spinal cord membranes, and fistulas of brain-spinal cord fluid and/or meningitis;
-Shock and death due to severe bleeding;
-Bleeding from operation site after operation;
-Superficial or deep wound infections;
-Persistent pain and/or neurological findings after operation;
-Device breakage or insufficiency in the cases with instrumentation;
-Re-operation requiring due to various complications.
Operation numbers of the Surgeon: More than 500
Preoperative and postoperative procedures:
-Necessary investigations for anesthesia, and preoperative evaluation by the anesthetist, and if necessary, by the pediatrician or internist, by the cardiologist, or chest disease specialist;
-If necessary, to perform additional radiological investigation;
-Postoperatively, to follow the patient in the intensive care unit, if necessary, or to follow in the neurosurgery clinic;
-Postoperative radiologic investigation in the cases with instrumentation with X-rays or computerized tomography;
-In the cases with complications, necessary investigations related to their complications;
-In the uncomplicated cases, mobilization of the patient in the operation day or next day;
-To discharge the patient one or a few days after operation according to the performed operation.
B-Traumatic spinal diseases:
1-Cervical vertebral with or without spinal cord injuries:
Indications of surgery: In the cases with cervical vertebral/spinal cord injuries causing spinal cord or nerve root compression and neurological findings/severe pain or spinal instability, cervical anterior or posterior decompression, fusion and instrumentation is performed according to the characteristics of the patients.
If there is severe compression on the spinal cord, neuromonitorization may be required for protection of the spinal cord during operation.
Possible complications:
-General complications related to anesthesia (lung-hearth or kidney insufficiencies, brain infarction due to blood hypotension, or intracranial bleeding due to blood hypertension, etc);
-In anterior operations, large vessel, esophageal or tracheal injury;
-Spinal cord and/or nerve root injuries and related transient or permanent neurological deficits;
-Injury of brain-spinal cord membranes, and fistulas of brain-spinal cord fluid and/or meningitis;
-Shock and death due to severe bleeding;
-Bleeding from operation site after operation;
-Superficial or deep wound infections;
-Persistent pain and/or neurological findings after operation;
-Device breakage or insufficiency in the cases with instrumentation;
-Re-operation requiring due to various complications.
Operation numbers of the Surgeon: More than 200
Preoperative and postoperative procedures:
-Necessary investigations for anesthesia, and preoperative evaluation by the anesthetist, and if necessary, by the pediatrician or internist, by the cardiologist, or chest disease specialist;
-If necessary, to perform additional radiological investigation;
-Postoperatively, to follow the patient in the intensive care unit if necessary, or to follow in the neurosurgery clinic. The cases with spinal cord injury may be required to be followed in the intensive care unit for a long time, and in some cases, tracheostomy may be required.
-Postoperative radiologic investigation in the cases with instrumentation with X-rays or computerized tomography;
-In the cases with complications, necessary investigations related to their complications;
-In the uncomplicated cases, mobilization of the patient in the operation day or next day;
-To discharge the patient one or a few days after operation according to the performed operation.
The cases with spinal cord injury may be required to be followed in the rehabilitation center.
2-Thoracic/lumbar vertebral with or without spinal cord injuries:
Indications of surgery: In the cases with thoracic/lumbar vertebral/spinal cord injuries causing spinal cord or nerve root compression and neurological findings/severe pain or spinal instability, cervical anterior or posterior decompression, fusion and instrumentation is performed according to the characteristics of the patients.
If there is severe compression on the spinal cord, neuromonitorization may be required for protection of the spinal cord during operation.
Possible complications:
-General complications related to anesthesia (lung-hearth or kidney insufficiencies, brain infarction due to blood hypotension, or intracranial bleeding due to blood hypertension, etc);
-In anterior operations, large vessel and/or internal organ injuries;
-Spinal cord and/or nerve root injuries and related transient or permanent neurological deficits;
-Injury of brain-spinal cord membranes, and fistulas of brain-spinal cord fluid and/or meningitis;
-Shock and death due to severe bleeding;
-Bleeding from operation site after operation;
-Superficial or deep wound infections;
-Persistent pain and/or neurological findings after operation;
-Device breakage or insufficiency in the cases with instrumentation;
-Re-operation requiring due to various complications.
Operation numbers of the Surgeon: More than 500
Preoperative and postoperative procedures:
-Necessary investigations for anesthesia, and preoperative evaluation by the anesthetist, and if necessary, by the pediatrician or internist, by the cardiologist, or chest disease specialist;
-If necessary, to perform additional radiological investigation;
-Postoperatively, to follow the patient in the intensive care unit, if necessary, or to follow in the neurosurgery clinic. The cases with spinal cord injury may be required to be followed in the intensive care unit for a long time, and in some cases, tracheostomy may be required.
-Postoperative radiologic investigation in the cases with instrumentation with X-rays or computerized tomography;
-In the cases with complications, necessary investigations related to their complications;
-In the uncomplicated cases, mobilization of the patient in the operation day or next day;
-To discharge the patient one or a few days after operation according to the performed operation.
The cases with spinal cord injury may be required to be followed in the rehabilitation center.
C-Vertebral and spinal cord tumors:
1-Cervical vertebral/spinal cord tumors:
Indications of surgery: In the cases with cervical vertebral/spinal cord tumors causing spinal cord or nerve root compression, neurological findings/severe pain or spinal instability, and in the tumors without pathological diagnosis, complete or partial tumor removal via cervical anterior or posterior route, with or without fusion and instrumentation is performed according to the characteristics of the patients and the tumors.
According to the characteristics of the tumor, neuromonitorization, neuronavigation and/or ultrasonography may be required during operation for protection of the spinal cord.
Possible complications:
-General complications related to anesthesia (lung-hearth or kidney insufficiencies, brain infarction due to blood hypotension, or intracranial bleeding due to blood hypertension, etc);
-In anterior operations, large vessel, esophageal or tracheal injury;
-Spinal cord and/or nerve root injuries and related transient or permanent neurological deficits;
-Injury of brain-spinal cord membranes, and fistulas of brain-spinal cord fluid and/or meningitis;
-Shock and death due to severe bleeding;
-Bleeding from operation site after operation;
-Superficial or deep wound infections;
-Persistent pain and/or neurological findings after operation;
-Device breakage or insufficiency in the cases with instrumentation;
-Re-operation requiring due to various complications.
Operation numbers of the Surgeon: More than 50
Preoperative and postoperative procedures:
-Necessary investigations for anesthesia, and preoperative evaluation by the anesthetist, and if necessary, by the pediatrician or internist, by the cardiologist, or chest disease specialist;
-If necessary, to perform additional radiological investigation;
-Postoperatively, to follow the patient in the intensive care unit, if necessary, or to follow in the neurosurgery clinic. The cases with spinal cord injury may be required to be followed in the intensive care unit for a long time, and in some cases, tracheostomy may be required.
-Postoperative radiologic investigation in the cases with instrumentation with X-rays or computerized tomography;
-In the cases with complications, necessary investigations related to their complications;
-In the uncomplicated cases, mobilization of the patient in the operation day or next day;
-To discharge the patient one or a few days after operation according to the performed operation.
-The cases with spinal cord findings may be required to be followed in the rehabilitation center.
-The cases with malignant tumors may be required radiotherapy or chemotherapy according the tumor type.
2-Thoracic/lumbar vertebral/spinal cord tumors:
Indications of surgery: In the cases with thoracic/lumbar vertebral/spinal cord tumors causing spinal cord or nerve root compression, neurological findings/severe pain or spinal instability, and in the tumors without pathological diagnosis, complete or partial tumor removal via thoracic/lumbar anterior, lateral or posterior route, and/or fusion and instrumentation is performed according to the characteristics of the patients and the tumors.
According to the characteristics of the tumor, neuromonitorization, neuronavigation and/or ultrasonography may be required during operation for protection of the spinal cord.
Possible complications:
-General complications related to anesthesia (lung-hearth or kidney insufficiencies, brain infarction due to blood hypotension, or intracranial bleeding due to blood hypertension, etc);
-In anterior or lateral operations, large vessel and/or internal organ injury;
-Spinal cord and/or nerve root injuries and related transient or permanent neurological deficits;
-Injury of brain-spinal cord membranes, and fistulas of brain-spinal cord fluid and/or meningitis;
-Shock and death due to severe bleeding;
-Bleeding from operation site after operation;
-Superficial or deep wound infections;
-Persistent pain and/or neurological findings after operation;
-Device breakage or insufficiency in the cases with instrumentation;
-Re-operation requiring due to various complications.
Operation numbers of the Surgeon: More than 100
Preoperative and postoperative procedures:
-Necessary investigations for anesthesia, and preoperative evaluation by the anesthetist, and if necessary, by the pediatrician or internist, by the cardiologist, or chest disease specialist;
-If necessary, to perform additional radiological investigation;
-Postoperatively, to follow the patient in the intensive care unit, if necessary, or to follow in the neurosurgery clinic. The cases with spinal cord injury may be required to be followed in the intensive care unit for a long time, and in some cases, tracheostomy may be required.
-Postoperative radiologic investigation in the cases with instrumentation with X-rays or computerized tomography;
-In the cases with complications, necessary investigations related to their complications;
-In the uncomplicated cases, mobilization of the patient in the operation day or next day;
-To discharge the patient one or a few days after operation according to the performed operation.
-The cases with spinal cord findings may be required to be followed in the rehabilitation center.
-The cases with malignant tumors may be required radiotherapy or chemotherapy according the tumor type.
D-Congenital spinal diseases:
1-Open or closed spina bifida:
Surgical indications:
In the cases whose skin and other soft and bony tissues are open over the spinal cord at birth, in the cases with a sac over the spinal cord, or in the cases whose spinal cord is adherent to the spinal canal and/or is tight, and in the cases with progressive neurological findings due to these pathologies, the openness of the soft tissues and skin is closed, the sac is resected, and the tightness and adherence of the spinal cord is released according to the characteristics of the patients. If the skin openness is very large, skin closure may be performed with the aids of Plastic and Reconstructive Surgeons. If there is concomitant spinal deformities, operations may be performed with the aids of Orthopedic Surgeons, and spinal instrumentation may be required.
According to the characteristics of the cases, neuromonitorization, and/or ultrasonography may be required during operation for protection of the spinal cord.
Possible complications:
-General complications related to anesthesia (lung-hearth or kidney insufficiencies, brain infarction due to blood hypotension, or intracranial bleeding due to blood hypertension, etc);
-Spinal cord and/or nerve root injuries and related transient or permanent neurological deficits;
-Injury of brain-spinal cord membranes, and fistulas of brain-spinal cord fluid and/or meningitis;
-Shock and death due to severe bleeding;
-Bleeding from operation site after operation;
-Superficial or deep wound infections;
-Persistent pain and/or neurological findings after operation;
-Device breakage or insufficiency in the cases with instrumentation;
-Re-operation requiring due to various complications.
Operation numbers of the Surgeon: More than 500
Preoperative and postoperative procedures:
-Necessary investigations for anesthesia, and preoperative evaluation by the anesthetist, and if necessary, by the pediatrician or internist, by the cardiologist, or chest disease specialist;
-If necessary, to perform additional radiological investigation;
-Postoperatively, to follow the patient in the intensive care unit, if necessary, or to follow in the neurosurgery clinic. The cases with spinal cord injury may be required to be followed in the intensive care unit for a long time, and in some cases, tracheostomy may be required.
-Postoperative radiologic investigation in the cases with instrumentation with X-rays or computerized tomography;
-In the cases with complications, necessary investigations related to their complications;
-In the uncomplicated cases, mobilization of the patient in the operation day or next day;
-To discharge the patient one or a few days after operation according to the performed operation. In the cases treated with skin flap, long-term wound follow-up may be required in the hospital.
-The cases with spinal cord injury may be required to be followed in the rehabilitation center.
-These diseases are required to follow the patients for a very long time.
2-Chiari malformations and syringomyelia:
Surgical indications: In the cases with Chiari malformations with or without syringomyelia causing spinal cord/brain stem compression and neurological findings/severe pain, posterior foramen magnum decompression, dural engrafting and enlargement, and releasing of the intradural adherence, if necessary, is performed. If there is upper cervical and craniovertebral instability, posterior instrumentation and fusion may be required. In the cases with basilar invagination, an open or endoscopic operation from inside of the mouth may be performed.
In the cases with syringomyelia without Chiari malformations, or in the cases with Chiari-syringomyelia who do not benefit from foramen magnum decompression, a shunt system may be performed in the syringomyelia cavity. In these cases, the other end of the shunt tube may be inserted to the spinal or cranial subarachnoid space, plevral space or peritoneal space.
According to the characteristics of the cases, neuromonitorization, and/or ultrasonography may be required during operation for protection of the spinal cord/brain stem.
Possible complications:
-General complications related to anesthesia (lung-hearth or kidney insufficiencies, brain infarction due to blood hypotension, or intracranial bleeding due to blood hypertension, etc);
-In the anterior operations, large vessel and/or pharynx injuries;
-Spinal cord and/or nerve root injuries and related transient or permanent neurological deficits;
-Injury of brain-spinal cord membranes, and fistulas of brain-spinal cord fluid and/or meningitis;
-Shock and death due to severe bleeding;
-Bleeding from operation site after operation;
-Superficial or deep wound infections;
-Persistent pain and/or neurological findings after operation;
-Device breakage or insufficiency in the cases with instrumentation;
In the cases with syringomyelia shunts, shunt breakage or shunt infection;
-Re-operation requiring due to various complications.
Operation numbers of the Surgeon: More than 100
Preoperative and postoperative procedures:
-Necessary investigations for anesthesia, and preoperative evaluation by the anesthetist, and if necessary, by the pediatrician or internist, by the cardiologist, or chest disease specialist;
-If necessary, to perform additional radiological investigation;
-Postoperatively, to follow the patient in the intensive care unit, if necessary, or to follow in the neurosurgery clinic. The cases with spinal cord injury may be required to be followed in the intensive care unit for a long time, and in some cases, tracheostomy may be required.
-Postoperative radiologic investigation in the cases with instrumentation with X-rays or computerized tomography;
-In the cases with complications, necessary investigations related to their complications;
-In the uncomplicated cases, mobilization of the patient in the operation day or next day;
-To discharge the patient one or a few days after operation according to the performed operation. In the cases treated with skin flap, long-term wound follow-up may be required in the hospital.
-The cases with spinal cord injury may be required to be followed in the rehabilitation center.
-These diseases are required to follow the patients for a very long time.