Neurocentre du Valais

Neurosurgery

NeurosurgeryNeurocentre du Valais

Neurosurgery is the medical speciality involving the surgical treatment of disorders of the nervous system, namely the brain, the spinal cord and the spinal nerves, as well as the skull and spine that envelop them.

Neurosurgery forms part of the clinical neurosciences and therefore collaborates very closely with other specialities. The most important specialities include neurology (diagnosis and non-surgical treatment of diseases of the nervous system), neuro-oncology (treatment of tumours), neuroradiology (specialised imaging of the brain and spine), neurorehabilitation and orthopaedics.

The neurosurgeon performs microsurgical techniques using an operating microscope and a set of extremely fine instruments, which make it possible to work with great precision and limit the size of the resulting scars. Minimally invasive surgery is another modern technique applied at the Valais Hospital.

The technical equipment available to the neurosurgery department in Sion corresponds to that of a university hospital with microscope, neuronavigation system (“GPS” for the brain), the O-arm imaging system that facilitates accurate guidance for the placement of screws in the spine, intraoperative electrophysiology by a neurologist who measures nerve activity during surgery, as well as cerebral and spinal endoscopic systems. This makes it possible to cover the entire spectrum of neurosurgery, with the exception of certain highly specialised areas of medicine such as vascular neurosurgery (aneurysms) and deep brain stimulation for the treatment of Parkinson’s disease.

A large part of neurosurgical activity is carried out on an emergency basis, and this medical speciality calls for extensive technical facilities (imaging, operating microscope, cerebral or spinal endoscopes, navigation, special instruments, neuroanesthesia, etc.). These technical facilities allow the neurosurgeons at the Valais Hospital to perform the majority of neurosurgical operations at the Sion hospital, which is a designated “trauma centre”.

Some rare lesions such as a cerebral aneurysm that require a special infrastructure are not treated, but transferred to a university hospital. This is also the case for radiosurgery and paediatric neurosurgery. These transfers are facilitated by a collaboration agreement between the neurosurgery department of Valais Hospital and that of the Vaud University Hospital (CHUV), with which it maintains regular contact. Regular exchange also takes place with colleagues in Brig, including the neurosurgeon Dr Perrig, who comes to Sion to operate on brain tumours in patients from Upper Valais.

The neurosurgery department of Valais Hospital performs over 600 operations per year.

Examinations

Endoscopy for lumbar disc herniation

The neurosurgery department of the Centre Hospitalier du Valais Romand (CHVR) is the first public hospital department in Switzerland with an entire team trained in endoscopy for lumbar disc herniation. 
This condition, often affecting the lowest lumbar discs, is the result of a tear in the outer ring of the intervertebral disc. 
There are two possible treatment options: unless there is significant muscle weakness, a conservative, non-surgical treatment is first proposed.  This involves the administration of analgesic or anti-inflammatory drugs that relieve pain and inflammation, often combined with physiotherapy or even infiltration of the compressed root under CT. If this conservative treatment fails, or if there is significant muscle weakness, surgery will be proposed. Removing the disc fragment that is compressing the nerve makes it possible to put an end to the pain and restore strength.

Endoscopic surgery: significant benefits for patients

The endoscope, a slender tubular instrument with a diameter of 8 mm, makes it possible to see and work in the spinal canal with the aid of a camera. This minimally invasive surgical solution is considered for all patients choosing surgery,
and offers many advantages for patients:

  • No bleeding, as the muscles are not cut
  • Significant reduction in postoperative pain 
  • Virtually no risk of infection 
  • Minimal scarring not only on the skin, but also more deeply, around the nerve
  • Patients can return to their usual level of activity sooner than the four to six weeks required after traditional surgery

Diseases

Brain tumour

A tumour is an abnormal growth, and one that occurs in the brain prevents the brain from functioning normally. Depending on when it is discovered, a tumour may still be very small or may have already  become huge (the size of a small orange). The tumour must be removed, and this is usually done by opening the skull and using microsurgery technology. In certain cases, radiosurgery – a highly accurate and intense irradiation technique – is used and makes it possible to operate without opening the skull. In other cases, the removal of a small piece of tumour (stereotactic biopsy) is needed to determine the best treatment.

Craniocerebral trauma

This is the result of an accident with an injury to the skull and/or brain. Depending on the case, the neurosurgeon will be required to implant a probe in the brain, operate to remove a blood clot, repair skull fractures, etc. These are severe emergency situations, and require a certain amount of time to be spent in intensive care for neuroresuscitation.

Treatment of spinal fractures

In some of these cases, the neurosurgeon is required to remove what is compressing the spinal cord and join the vertebrae together.

Ruptured aneurysm

This is an abnormality of an artery in the brain that has bled and needs to be repaired. The procedure can be performed surgically (via “clipping” by the neurosurgeon), or by passing a probe through the artery (embolisation by the neuroradiologist). These vascular pathologies are managed at university hospitals.

(Cervical/dorsal/lumbar) spinal fusion

In some cases, two or more vertebrae need to be “fixed”, and this is done using screws, rods and implants to replace the discs. Depending on the case, these procedures require only small incisions (minimally invasive surgery).

Cerebral haemorrhage

Depending on the type of haemorrhage, the neurosurgeon must remove the clot by opening the skull, and two small holes in the skull are occasionally used to drain the blood. In the event of haemorrhage after an accident, the operation must be carried out as a matter of urgency, as this is a life-threatening emergency.

Lumbar spinal stenosis

This is a narrowing, often due to arthrosis, of the spinal canal in which the spinal cord or nerves are located. Various techniques can be used to “recalibrate” the spinal canal (laminectomy, foraminotomy, laminoplasty, etc.). These procedures are performed under a microscope and, since 2022, in some cases also using a minimally invasive endoscopic technique.

Hydrocephalus

This is an abnormal accumulation of water in the brain. In this case, the neurosurgeon implants a small tube with a valve that extends from the brain to the stomach and allows the fluid to drain. Endoscopic surgery can sometimes be used to restore cerebrospinal fluid flow and avoid the need for valve implantation.

Lumbar or cervical disc herniation

This involves the compression of a spinal nerve or spinal cord by a fragment of intervertebral disc. The procedure involves removing the fragment that is crushing the nerve and is performed by microsurgery (microdiscectomy) under a microscope and, at the lumbar level since 2019, endoscopically (8 mm incision).

Kyphoplasty

If a vertebra is crushed in an accident, the vertebra can sometimes be reshaped by injecting cement.

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