Prof. Dr. Mehmet Şenoğlu — Brain, Nerve and Spine Surgery
Every day in my clinic, I meet patients who need spine or nerve surgery. I see the same expression on almost all of their faces: apprehension. Most of them are more concerned about what comes after the surgery than about the operation itself; some have endured pain for years and have stepped back the moment they heard the word “surgery.” I understand this anxiety very well. That is precisely why I wanted to share with you, in plain language, how spine and nerve surgery has changed in recent years, why the method we call “microsurgery” fundamentally makes things easier, and what my patients most often tell me about this process.
I must say at the outset: what I am about to describe is general information. Every patient, every diagnosis, and every spine is different from one another; only the doctor who examines you can determine the right approach for you.
What Is Microsurgery?
Microsurgery is a surgical technique applied with special operating microscopes and micro-instruments, developed to allow intervention on vessel, nerve, and tissue structures that are very difficult to distinguish with the naked eye. In addition to brain, spine, and nerve surgery, it is used in many fields such as urology, plastic surgery, and orthopedics.
At the heart of this method lies the operating microscope. This microscope both magnifies the area I am working on many times over and illuminates it with its own powerful light source. In other words, microsurgery is not so much “a smaller operation” as “an operation performed while seeing much more clearly.” Being able to see nerve fibers and fine vessels smaller than a millimeter clearly is, for me, not merely a convenience; it is also the foundation of the patient’s safety.
I often explain this to my patients as follows: imagine trying to do a delicate task with gloves on in a dark room. Then imagine turning on the lights and looking through a lens that magnifies everything you are working on… That, roughly, is the difference microsurgery adds to open surgery.
What Does the Operating Microscope Bring to Surgery?
The magnification and illumination provided by the operating microscope do not merely make the surgeon’s job easier; they change the entire logic of the operation. When I work with a clear and magnified image:
- I can keep the incision much smaller.
- I can open the fascia covering the muscles through a small opening and have to strip less muscle from the bone.
- I can focus only on the problem, without removing more healthy tissue, bone, and ligament than necessary.
- I can work right next to the nerve root and the spinal cord without harming them.
- When necessary, I can even suture a very thin dural tear with micro-instruments.
When all of these come together, the resulting picture is this: less tissue damage, less bleeding, and a much more comfortable recovery period for the patient.
In Which Conditions Do I Use Microsurgery?
Microsurgery has a wide range of applications in brain and spine surgery. In spinal conditions, I most often prefer it in the following situations:
- Lumbar disc herniation — the herniation of the disc between the lumbar vertebrae putting pressure on a nerve.
- Cervical disc herniation — the herniation of the disc between the cervical (neck) vertebrae.
- Thoracic disc herniation — the rarely seen disc herniation in the upper/mid-back (thoracic) region.
- Spinal canal stenosis — the narrowing of the canal through which the nerves pass, creating pressure.
Apart from these, brain tumors, brain vascular diseases (such as aneurysms), and various nerve surgery procedures are performed with the same microsurgical principles. In other words, microsurgery is not the name of a single operation; it is a form of surgical approach that we apply to many different conditions.
How Does a Microsurgery Operation Take Place?
My patients often wonder how the surgery goes. Let me briefly describe the process using a lumbar disc herniation operation (microdiscectomy) as an example.
The surgery is generally performed under general anesthesia; that is, the patient is put to sleep and feels nothing. After the patient is positioned face down, I make a small incision, often only 1.5–2 centimeters, directly over the affected disc. Through this small opening I reach the spine, clearly see the nerve root with the operating microscope, and relieve the pressure the herniation is placing on that nerve. The main goal here is not so much to remove the herniation as to relieve the pressure on the nerve and thereby resolve the patient’s pain and numbness.
This type of operation generally takes one to two hours. However, there is a point that patients and their relatives often confuse: the time during which I am actually operating is not the same as the total time the patient spends in the operating room. Steps such as administering anesthesia, positioning the patient, and waking them up after the surgery are also added to the total time. For this reason, the time relatives wait outside is often longer — and this is entirely normal.
What Are the Advantages of Microsurgery?
For me, the greatest advantage of microsurgery is that it makes treatment possible without directly harming the spinal cord and nerve tissue. The main benefits that touching the tissues less brings to the patient are:
- A smaller incision and less tissue damage: The muscles and surrounding tissues are affected to a minimal degree.
- Less pain after surgery: Thanks to the small incision and the preserved tissues, pain is mostly lighter than expected.
- A shorter hospital stay: Patients generally get on their feet quickly and are discharged early.
- Faster recovery and return to work: It becomes possible to return to daily life and work earlier.
- A lower risk of complications: A clear and magnified image provides a more controlled and safer surgery.
How Do I Explain the Difference Between Microsurgery and Open Surgery to My Patients?
My patients often ask, “Doctor, is this a closed operation?” I summarize the difference as follows: the basic logic of microsurgery and traditional open surgery is actually the same; in both, the goal is to reach the problem and eliminate it. The difference lies in how this goal is reached.
Open surgery requires a wide incision and more tissue intervention; this was why spine operations used to be associated with “a large incision, a long hospital stay, painful rehabilitation.” In microsurgery, on the other hand, work is done through a small incision and under microscopic magnification. This means less bleeding, less pain, and a faster recovery. Microsurgery is often known colloquially as a “closed operation”; that said, in suitable patients even more advanced options, such as full endoscopic (fully closed) methods, may also come into consideration. Which method is appropriate for you can only be decided after a detailed evaluation.
“Should Every Herniation Be Operated On?” — The Importance of Correct Patient Selection
I want to emphasize this question in particular, because it is one of the most frequently misunderstood subjects. No matter how advanced microsurgery may be, not every lumbar or cervical herniation requires surgery. On the contrary, the vast majority of herniations resolve with non-surgical methods such as rest, medication, and physical therapy; indeed, a significant portion of herniated discs are shrunk by the body over time.
When I refer a patient for surgery, I do not look only at the MRI image. The mere appearance of a herniation on an MRI is not by itself a reason for surgery; because the herniation seen on the image may not always be the source of the pain. What is decisive for me is the examination findings and the imaging confirming each other. I generally recommend surgery in cases of severe pain that does not go away despite an adequate period of non-surgical treatment, in progressive muscle weakness, or in emergency situations such as the disruption of bladder and bowel control. In other words, microsurgery is a method that gains value when applied to the right patient, at the right time.
The Recovery Process After Surgery
My patients notice the positive effect of microsurgery most in the post-operative period. Thanks to the small incision and the limited muscle damage, pain is generally low, and the hospital stay and return-to-work times are shortened. Even so, I must remind you that recovery does not progress at the same pace in every patient; this process varies according to the scope of the procedure performed and the patient’s general condition.
During this period, I always tell my patients the same thing: half of the recovery is in the operating room, and half is in your hands. Adherence to the medication and physical therapy program I recommend, along with correct posture and movement habits, are the cornerstones of a successful result. Especially in more extensive procedures such as brain surgery, recovery can take longer; here, patience and regular check-ups are very important.
Comments from My Patients Who Have Undergone Microsurgery
The patients I have operated on with the microsurgical method often touch on very similar points when sharing their experiences. I would like to share with you the common thoughts and feelings I have encountered most frequently over the years.
The great majority of my patients tell me they experienced significant apprehension before the decision to have surgery. The most wondered-about and feared subjects are almost always the same: “Will I be paralyzed?”, “Will I ever be able to be the way I was again?”, “Can I return to my normal life after an operation on my spine?” Frightening stories heard from those around them and memories of the large-incision operations of earlier eras often increase this anxiety even more. What my patients commonly tell me after surgery, however, is that these worries turned out to be largely unfounded.
Right after the operation, the sentence I hear most often relates to the pain being much lighter than expected. Many patients say, “I never thought I would be this comfortable with such a small incision.” Especially for patients who suffered for months before surgery from nerve pain radiating into their leg or arm, the most striking moment is this pain easing markedly from the very first day. I have heard countless times the words, “What really wore me down was the pain shooting into my leg; feeling that it was gone when I woke up was incredible.”
Another common observation is the speed of recovery. My patients generally express the relief they feel at being able to get up and walk in a short time and at not having to stay in the hospital for a long period. “I walked on the evening of the day I had surgery,” “I was surprised at how small the incision was and that the scar is almost invisible,” or “I was able to return to work much earlier than I had anticipated” are among the sentences I hear frequently.
Perhaps the most often repeated feeling is a relief mixed with a kind of regret: “I wish I had come sooner, without enduring the pain for so long.” Every time I hear this sentence, I think once again about how important it is for patients to reach accurate information in good time. Because, as my patients also come to realize over time, the most critical part of this process is actually not the surgery itself, but correct diagnosis and correct planning. Microsurgery does not give the same results in every patient; it is a precise approach planned according to the person, the diagnosis, and the severity of the complaints. This is also where the common advice my patients give to new patients comes from: do not make the decision in haste, get a detailed evaluation from an experienced doctor, and proceed through every stage of the process by talking it over with your doctor.
Frequently Asked Questions
Below, I have gathered the questions my patients most frequently ask about microsurgery, along with brief answers. These answers are for general information; the information that applies to your specific situation is the one given by the doctor who examines you.
What is microsurgery?
Microsurgery is a surgical technique in which nerves, vessels, and tissues that are difficult to see with the naked eye are operated on with special operating microscopes and micro-instruments. In many fields, above all brain, spine, and nerve surgery, it offers the possibility of treatment while causing less damage to the tissues.
What is the difference between microsurgery and open surgery?
The basic goal is the same in both; the difference lies in the method. While open surgery is performed through a wide incision, microsurgery is carried out through a small incision and under microscopic magnification. This provides less tissue damage, less pain, and faster recovery.
Is microsurgery a “closed operation”?
Microsurgery is often referred to colloquially as a “closed operation,” because it is performed through a much smaller incision than open surgery. That said, fully closed (full endoscopic) methods are a separate technique and are evaluated separately in suitable patients.
Does every lumbar or cervical herniation require surgery?
No. The vast majority of herniations resolve with non-surgical methods. Surgery comes into consideration when there is severe pain that does not go away despite adequate treatment, progressive loss of strength, or emergency situations.
Is microsurgery risky?
Every surgical procedure has its own particular risks. However, because work is done in a more controlled manner in microsurgery thanks to the clear and magnified image, tissue damage and the related risk of complications are generally lower. Only the doctor who examines you can carry out a risk assessment specific to you.
How long does microsurgery take?
Although it varies according to the type of procedure, a lumbar disc microsurgery, for example, is generally completed within one to two hours. In more extensive procedures such as brain surgery, the duration may be longer.
How long does recovery after microsurgery take, and when can one return to work?
Because the incision is small and the tissue damage is limited, recovery is often rapid and the return-to-work time is shortened. The exact duration varies according to the procedure performed, the type of condition, and the patient’s general state.
Do patients who undergo microsurgery recover fully?
Microsurgery is a method with a high success rate in suitable patients. However, no surgical outcome can be presented as an absolute guarantee; recovery varies according to the person, the diagnosis, and the severity of the complaints. For this reason, it is important to get a detailed evaluation from an experienced doctor.
Disclaimer (Legal Notice)
The information contained in this article has been prepared for general informational purposes only and in no way replaces a medical examination, diagnosis, or treatment. The applicability, course, and results of microsurgery vary from person to person according to the type of condition, the patient’s general state of health, and the severity of the complaints, and can only be determined by a doctor who evaluates you. Before any decision regarding treatment, always consult a specialist physician.