Clinical Interests

My clinical practice centres on cranial surgery. Four areas overlap in most of my operative work, and the same method runs through all of them: the anatomy is studied first, on the patient’s own images, and the operation is planned from that study.

Skull base surgery

Cerebellopontine angle tumours (vestibular schwannoma, meningioma, epidermoid), skull base meningiomas, craniopharyngiomas and tumours of the petrous and jugular region, by open microsurgical approaches. The approach is chosen by the position of the tumour relative to the cranial nerves and vessels, assessed on a patient-specific three-dimensional model where it helps, and carried out with cranial nerve monitoring where indicated. Where part of a tumour is adherent to a nerve or vessel, leaving it and following with radiosurgery is the safer decision.

Cerebrovascular surgery

Microsurgical clipping of ruptured and unruptured aneurysms, resection of arteriovenous and cavernous malformations, and bypass surgery. I perform and read the diagnostic cerebral angiography of my own patients, so that the surgeon making the decision is the one who produced the image. Microsurgery and endovascular treatment complement each other; where coiling or flow diversion is the better option I say so.

Cranial neuro-oncology

Gliomas, brain metastases and brainstem lesions. The aim is maximum safe resection: awake craniotomy with cortical and subcortical mapping in suitable patients with tumours near language or motor areas, neuromonitoring under anaesthesia where awake surgery is not suitable, and intraoperative ultrasonography for real-time images of the surgical field. Adjuvant treatment is decided with radiation oncology, medical oncology and neuropathology at the tumour board.

Epilepsy surgery

Temporal lobe surgery for drug-resistant epilepsy, lesionectomy, hemispherotomy in selected cases and vagus nerve stimulation. Candidates are evaluated together with neurology on the basis of video-EEG, MRI and neuropsychological testing. For selective amygdalohippocampectomy I also use the paramedian supracerebellar transtentorial approach, on which I have published anatomical work and an operative video.

For referring physicians

A referral is most useful when it includes DICOM copies of the current MRI, CT angiography and, if performed, catheter angiography; the history of haemorrhage or seizures with dates; current antiplatelet, anticoagulant or antiepileptic treatment; and previous operations, radiotherapy and pathology reports. Correspondence: yucel@yuceldogruel.com.