Brain surgery is becoming more and more a safe surgery, greatly due to technological and technical developments and very challenging teaching programs.

Microsurgery allows safe dissection of deep brain structures, cranial nerves and vessels.

Neuronavigation and image-guided surgery allow access to tumors deeply seated with little exposure of normal brain, and thus accelerates post-operative recovery, while reducing the morbidity and the rate of complications.

Neuroendoscopy is used mainly to treat intra-ventricular tumors (ventricules are fluid-filled cavities within the brain). The typical tumor teated with Neuroendoscopy is Colloid Cyst of third ventricule, a benign tumor seated deep in the brain. Neuroendoscopy is also used to make Ventriculocysternostomy, an operation done to derive cerebrospinal fluid which fills the ventricules away from an internal obstacle.

Aneurism Surgery
is feasible nowadays with a low rate of complications. The goal of the surgery is to exclude definitely and secure the aneurism, thus eliminating the risk of rebleed. Surgery, moreover, allows to evacuate hematomas and decompress the brain structures.
Below, left: angioscan showing a right middle cerebral artery trifurcation aneurism, responsible of a huge hematoma.
Below, right: post-operative angiogram showing complete exclusion of the aneurism at its neck. Note the focal stenosis of the proximal segment of the middle cerebral artery.




Brain Tumors
are classified grossly as malignant and benign.
Malignant Tumors in general are best treated with microsurgical resection, followed by radiotherapy and chemotherapy (many protocols are in use, namely the Stuup protocol, associating concommitant radiotherapy and chemotherapy, followed by chemotherapy alone).
Below, left: Axial MRI image showing a right temporo-insular glioblastoma, a highly malignant tumor.
Below, right: Post-operative axial MRI image showing  resection of t he tumor.  



Benign Tumors
 (for example meningiomas, see below) are cured by total excision, without any further need for adjuvant therapy. 
Below, left: Sagittal gado T1-weighted MRI showing a huge anterior cranial fossa meningioma.
Below, right: Sagittal gado T1-weighted MRI showing complete excision of the meningioma.



Colloid Cyst:
benign tumor, classically occurs in the anterior third ventricule, blocking foramina of Monro, and causing hydrocephalus. Though benign, there is a risk of sudden death due to acute major intracranial hypertension.
Treatment of colloid cyst  aims at reestablishing the normal drainage of cerebrospinal fluid. The most popular and less invasive technique is cyst resection by Neuroendoscopy, under neuronavigation (see images below; left: pre-operative MRI showing a colloid cyst responisble of acute hydrocephalus; right: post-operative MRI showing complete removal). Other approaches include mainly the transcallosal approach and the transcortical approach, used when Neuroendoscopy is not feasible or rendered unsafe due to anatomy and localization of the cyst and its relations with the adjacent structures, or when Neuroendoscopy fails.