Neurosurgery in Iran
Best Neurologist Surgeon

Neurosurgery in Iran | Best Neurologist Surgeon

Neuro Brain Surgery

In addition, a differentiated approach is being introduced, especially for spinal surgery. The understanding came that it is impossible to treat all patients even with a common disease in the same way – it is necessary to individually select neurosurgical treatment.

A lot of new things appear in neurooncology: the treatment of brain tumors, including metastatic ones, is being improved. For example, techniques such as gamma knife and cyberknife are used – methods of focused radiation therapy that can slow or stop tumor growth without damaging neighboring tissues.

Functional surgery is also developing and exists in Iran – I have been doing such operations for about ten years.

costs a neurostimulator

In addition to having skilled and competent doctors and surgeons, Iran is very affordable and cheap in terms of the cost of treating various diseases, including in the field of neurosurgery, due to the low value of Iran’s currency compared to other countries.

How are neurosurgical operations performed so as not to harm the patient?

Brain surgery. There are various methods associated with Awake Surgery, this is surgery when the patient is conscious during the operation. In fact, a person is awakened, disconnected from endotracheal anesthesia and then operated on. This is done, for example, when removing tumors of functionally significant areas of the brain.

Awake Brain Surgery

A person follows the commands of a neurologist or neuropsychologist, and the surgeon thus receives information about whether he touches an important area during the operation.

Spinal surgery. Here there is a method of neurophysiological monitoring. During the operation, the roots of the spinal cord are affected – this is how the surgeon understands when he begins to harm more than help.

Intraoperative neurophysiological monitoring — Medscape

It looks like this: a special apparatus sends signals from the cerebral cortex to the arms and legs, the neurophysiologist monitors the parameters and tells the surgeon what is happening from a functional point of view.

This method is also used in the surgical treatment of spinal deformity – by assessing the functions of the roots of the spinal cord, their injury during surgery is avoided.

Is surgical treatment of brain tumors safer now?

The success of the operation depends on the type of tumor, while at present, neurosurgery has everything to remove the neoplasm as safely as possible.

Brain Tumor Surgery 

There are special surgical techniques, for example, the use of a microscope, also using intraoperative fluorescent navigation. The patient shortly before the operation takes a small amount of a special substance. It tints the tumor tissue in a different color with fluorescent radiation. Without this, they would be indistinguishable from brain tissue, and this is how the surgeon sees them during the operation.

Fluorescent imaging in oncological surgery – article in The Lancet

In addition, endoscopic accesses are used. Now it is possible to do a radical operation through a small endoscopic puncture. Among other things, this completely changed the surgery of pituitary tumors – earlier, a craniotomy was needed to remove them, there was a big risk of blindness and other risks. Now surgeons operate through the nose, without opening the skull – and the intervention has become much safer.

Is it necessary to remove benign tumors of the brain or spinal cord if there are no symptoms?

Some small brain tumors, most notably meningiomas, can sometimes not be operated on—either observed or treated with radiation therapy.

With spinal tumors – benign gliomas or meningiomas, but in the spinal cord – the situation is more complicated, because they grow in a closed, narrow space of the spinal canal. Even a small tumor can cause neurological damage. Therefore, most spinal tumors are removed even if there are no symptoms.

Spinal Cord Tumors

There are situations when an asymptomatic tumor is in such a place that its removal can lead to complications, such as paralysis. In this case, the choice is always up to the patient – no one has the right to make a categorical decision for him: take a risk or wait.

How often do you need surgery for herniated discs?

If surgery is recommended for all people with a herniated disc, especially when the diagnosis was made only on the basis of an MRI, almost everyone over 55 years old and many over 20 years old will have to be operated on.

Herniated Disc

A herniated disc needs to be removed when it is compressing a nerve root in the spinal cord. Because of this, the so-called radicular symptoms appear – pain, numbness, weakness in the leg, if it is the lower back, or the arm, if it is the neck.

Herniated discs in the cervical and thoracic spine can compress the spinal cord itself. This can lead to myelopathy – in populist terms, spinal stroke, a focus of circulatory disorders. Such hernias almost always need to be removed: often this is the only thing that saves from severe neurological deficits.

9 important questions for neurologist Pavel Brand

Lumbar disc herniations are less likely to require surgery. In addition to root compression, the operation is indicated for severe narrowing of the spinal canal or displacement of the vertebrae relative to each other, which prevents a person from standing and walking normally.

It is important to understand that almost any operation implies that a person changes something in his life. Spinal diseases are often a consequence of our problems: we sit a lot and move little. Without the participation of the patient in the postoperative period, when he needs to lose weight, exercise, strengthen the muscles of the back and the press, nothing will work. Surgery removes the neurological problem, and then it’s up to the patient himself.

Is there a problem in neurosurgery of over-scheduling operations when they are not needed?

Such a problem, unfortunately, exists when it comes to spinal surgery. It is not only in Iran . For example, in the United States, microsurgical removal of a herniated disc is often performed, while patient satisfaction with this operation decreases every year.

Surgical treatment of subacute and chronic low back pain – Uptodate

You can’t approach the problem like this: “You have a darkened disc, it needs to be removed, otherwise a hernia will form” or “Your back hurts, why do rehabilitation, it’s better we remove everything right away.” Such an approach will eventually turn against the surgeon, and not just against patients. Performing operations for everyone in a row, without thinking about who needs them, the surgeon will choke on complications and unsuccessful results in six months or a year.

In the center where I work, patients are treated by physical rehabilitation specialists and neurologists after surgery. The operation is only one of the links in restoring the normal mobility of the spine.

In addition, spinal pathology is very common, so there is an entire industry around it, where everyone offers their own. This industry is full of methods with unproven effectiveness or proven inefficiency such as chondroprotectors, leeches, “author’s” methods of hernia resorption. Such techniques are in fact quackery, based on the fact that in a certain percentage of people the hernia naturally decreases or disappears.

9 important questions about alternative medicine to doctor Alexei Vodovozov

To avoid ineffective treatment, the patient should receive several opinions about his condition. Also, people with back pain should see a neurosurgeon – not out of those considerations that an operation is needed, but to get an opinion from this specialist too.

I am a supporter of this approach: there is no need to operate if the problem can be solved through physical education, massage, gymnastics or near-surgical manipulations.

When is it worth doing an MRI of the brain and spine, and when not?

MRI is a method that has its indications, although it is generally safe and contraindicated in only a small number of people. For example, those who have a pacemaker.

An MRI should be ordered by a specialist, not by the patient himself. In Iran, this study is available – in Moscow it can be done for 4000-5000 R. For comparison, in the USA, the commercial cost of an MRI is usually not less than 700 $⁣ (41,927 R).

6 tests that healthy people don’t need

Because of this, people in our country sometimes do an MRI as the first examination method, and its result is misinterpreted – this is called “MRI catastrophe”.

For example, some vascular foci are found in the head, which most people have and often do not indicate anything bad. Or protrusions and hernias are found in the spine, which are not really significant and do not cause symptoms. However, a person is frightened by what he reads on the Internet, he turns to doctors, uses meaningless methods of treatment, including surgical ones.

Headache Assessment in Adults – article in the Uptodate Physician’s Handbook

Of course, there are reverse situations, especially in the regions. For example, a patient is being treated without an MRI, his motor deficit is growing, he is given an X-ray, they say that it is a hernia and happens to everyone. In fact, hernias are practically invisible on x-rays: they are made of soft tissues, not bones. And the MRI will show that the hernia has squeezed the spinal cord and an operation is required, which must be done as soon as possible.

For back pain, there are red flags that are familiar to neurologists – they will be an indication for an MRI. Here is some of them:

unusually severe pain;

pain radiating to the leg;

pain associated with weight loss

pain in a cancer patient;

pain that increases over time.

Similarly with headaches – not every case requires an MRI. Most often, headaches are benign in nature, such as migraine or tension headache. Only a neurologist after an examination can correctly identify those people who should have an MRI to rule out tumors or something else.

In the commercial sphere, spinal surgery is well developed. Among operations on the spinal cord and spine, there are those that have an affordable cost and low risks. Private clinics are visited by patients who do not want to get involved with the quota system, referrals from polyclinics and other bureaucracy.

If we talk about brain surgery and neurooncology, then this is a treatment that can be very expensive. For example, due to the fact that the patient may end up in intensive care for a long time, he may need complex rehabilitation, chemotherapy, radiation therapy – this is not always predictable. The treatment of such patients can cost millions and even tens of millions of rubles – few people can afford it.

In my opinion, there is also a problem with voluntary health insurance: few companies can afford to cover neurosurgical care due to the fact that it is quite expensive.