常见问题

视肿瘤的类型和位置而定，通常在 2 至 8 小时之间；简单的脑膜瘤切除可在 2 至 3 小时内完成，而深部或清醒胶质瘤手术可能需要 6 至 8 小时。时间较短并不意味着更成功。术后通常需在重症监护室停留 24 至 48 小时，住院共计 3 至 7 天。

不一定。某些肿瘤手术是首选，但小而无症状的脑膜瘤可仅作随访，淋巴瘤用化疗-放疗而非手术刀治疗，某些深部胶质瘤则以活检和伽玛刀为主。正确的途径由组织诊断和团队评估决定。

不会。如今的做法是尽量少剃；多数情况下，沿切口线剃出一条窄带即可。如今很少需要剃光整个头部。

可以。您可以从伊斯坦布尔通过电话或 WhatsApp（+90 533 075 72 94）发送您现有的 MRI 或 CT 影像，获得初步评估。若合适，将邀请您前来检查，必要时安排进一步影像检查。

不会。绝大多数动脉瘤从不破裂且未被察觉；小于 7 毫米的囊袋年破裂概率相当低。风险随大小、位置、家族史和生长速度而变化，并用 PHASES 评分等工具来估算。

两者都是有效方法，文献报告 90-95% 的成功率；‘更好’的是最适合该患者的。Coiling 创伤更小、恢复快，但有重新开放的风险；夹闭提供永久性解决方案，但需要开颅。决定取决于动脉瘤的特点和患者因素。

如果突然出现一生中最剧烈的头痛（‘脑中有东西崩裂’的感觉），并伴有颈项强直、恶心呕吐或意识模糊，请毫不拖延地前往急诊并拨打急救电话。这种情况可能是动脉瘤破裂所致的蛛网膜下腔出血。

大多数动脉瘤并非遗传。但如果您的一级亲属有两个或更多动脉瘤或脑出血史，家族风险会升高；此时可能建议进行 MRA 筛查。您可以从伊斯坦布尔通过电话或 WhatsApp（+90 533 075 72 94）分享您的 MRI/CT 影像，获得初步评估。

分流术通过永久性的导管—阀门装置将多余的脑脊液输送至腹腔，通常会终身留存。而 ETV 通过在脑室底部开孔，使人体自身的液体循环重新运作；它不会留下任何异物。分流术在交通性脑积水和 NPH 中占主导，ETV 则用于合适的梗阻性病例。方法根据脑积水的类型和患者来选择。

在大多数置入分流装置的患者中，由于脑脊液循环不会自行纠正，该系统是永久性的。尽管如此，绝大多数患者都能回归学校、工作和日常生活；游泳、步行和骑自行车都适宜，只是不建议进行高冲击的接触性运动和深潜。在 ETV 成功的病例中，可能无需分流装置。

NPH 是一种可治疗的疾病，采用分流术后，据报告相当一部分患者的步行与认知功能有显著改善；但无法保证每位患者都获得相同程度的成功。为预测成功的可能性，可在术前进行“放液试验”。携带步态视频和近期 MRI 前来就诊有助于评估。

您可以从伊斯坦布尔通过电话或 WhatsApp（+90 533 075 72 94）发送您手中的 MRI 影像（若怀疑 NPH，请另附步态视频）。如认为合适，将邀请您前来检查；必要时会安排脑脊液流动 MRI 等进一步影像检查和放液试验。

通常不需要。小而无症状、生长缓慢的脑膜瘤可通过定期 MRI 随访，尤其在老年患者中。如果肿瘤生长、引起症状或产生压迫，则考虑手术或伽玛刀。决策根据肿瘤的大小、位置及其在随访中的表现个体化作出。

绝大多数病例（约 80-85%）为良性（世界卫生组织 1 级），并非传统意义上的癌症。较小比例表现为非典型（2 级）或恶性（3 级）。肿瘤的真实分级只有通过对手术中获取组织的病理检查才能明确。

在部分患者中可以。对于深部、手术风险高或中小型脑膜瘤，立体定向放射外科（伽玛刀、射波刀）是有效的选择。然而，对于大型、有症状或产生压迫的肿瘤，手术更为优先。何种方法合适由 MRI 和多学科评估决定。

可以。您可以从伊斯坦布尔通过电话或 WhatsApp（+90 533 075 72 94）发送您现有的 MRI 或 CT 影像，获得初步评估。如果合适，将邀请您前来检查，必要时会安排进一步的影像检查。

由于胶质母细胞瘤在显微镜层面浸润周围脑组织，单靠手术并不能提供“治愈”；因此手术后会进行放疗和化疗（Stupp 方案）。治疗的目的是控制疾病并保持生活质量。任何结果都无法保证，预期会被诚实地说明。

由于胶质母细胞瘤生长迅速，治疗通常会迅速安排。一旦诊断明确，手术以及随后的放疗-化疗阶段会毫不拖延地开始。等待多久由肿瘤位置、患者状况和多学科评估决定。

目标是在保留功能的前提下尽可能广泛的安全切除。如果肿瘤靠近言语或运动等关键区域，可能会限制切除范围以降低永久性损伤的风险。无法切除的显微病灶通过放疗和化疗加以处理。

可以。您可以从伊斯坦布尔通过电话或 WhatsApp（+90 533 075 72 94）发送您现有的 MRI 或 CT 影像，获得初步评估。如果合适，将邀请您前来检查，必要时会安排进一步的影像检查和多学科评估。

视情况而定，两者均可能正确。对于单发、大型、有症状的病灶，手术更为优先；对于中小型或少数病灶，则首选伽玛刀（立体定向放射外科）。对于超过五处的广泛转移，则考虑伽玛刀或全脑放疗。决策根据转移灶的数目、大小、位置和原发癌以多学科方式作出。

影像可提供有力线索，但并不总是确定。即使已知有癌症，脑部肿块有时也可能是另一种肿瘤（例如脑膜瘤）。对于单发病灶，手术切除既提供治疗又明确组织诊断；因此病理对于鉴别诊断很重要。

可以。即使是多发转移，也有包括伽玛刀、全脑放疗以及针对原发癌的全身治疗（靶向药物、免疫治疗）等选择。结果随原发癌的类型和分子特征而异；部分患者可实现长期控制。方案由多学科团队个体化制定。

可以。您可以通过 WhatsApp（+90 533 075 72 94）发送现有的 MRI 或 CT 影像，以及（如有）原发癌信息，并获得初步评估。如果合适，将邀请您前来检查，必要时会安排进一步的影像检查和多学科评估。

不是。根据 2021 年世界卫生组织分类，IDH 突变型星形细胞瘤和 IDH 野生型胶质母细胞瘤被视为不同的疾病。IDH 突变型星形细胞瘤的预后明显更好。肿瘤的真实类型和级别通过对手术或活检所获组织的病理和分子检查才能明确。

决策根据肿瘤的级别、IDH 状态、位置和大小作出。虽然某些低级别肿瘤术后可密切监测，但在大多数病例中，尽可能广泛的安全切除是第一步。正确的路径由组织诊断和多学科评估决定。

目标是在保留功能的前提下尽可能广泛地切除。如果肿瘤靠近言语或运动等关键区域，会使用功能定位以及必要时的清醒开颅，并据此设定切除边界以降低永久性损伤的风险。风险会在术前坦诚讨论。

可以。您可以通过 WhatsApp（+90 533 075 72 94）发送现有的 MRI 或 CT 影像，以及（如有）病理-分子结果，并获得初步评估。如果合适，将邀请您前来检查，必要时会安排进一步的影像检查。

确诊需要组织：根据 2021 年世界卫生组织分类，必须同时证明 IDH 突变和 1p/19q 共缺失。该组织通过手术切除或立体定向活检获取。在大多数病例中，尽可能广泛的安全切除既提供治疗又提供准确的分子诊断。

少突胶质细胞瘤在弥漫性胶质瘤中具有最佳预后，并对放疗-化疗敏感，但由于它是弥漫性肿瘤，称其为“良性”并不正确。预后随级别、切除程度和分子特征而异；建议密切随访。任何结果都无法保证。

有可能。由于其皮质位置，少突胶质细胞瘤可能在很长一段时间内仅以癫痫为唯一症状。在 MRI 上看到皮质-皮质下、常伴钙化的病灶会引起怀疑；确诊通过组织和分子检查作出。您可以发送现有的 MRI 供我们评估。

可以。您可以通过 WhatsApp（+90 533 075 72 94）发送现有的 MRI 或 CT 影像，以及（如有）病理-分子结果，并获得初步评估。如果合适，将邀请您前来检查，必要时会安排进一步的影像检查。

Not directly. First the diagnosis of drug-resistant epilepsy must be confirmed and the seizure focus clearly mapped. This requires video-EEG monitoring, epilepsy-protocol MRI and neuropsychological testing. Surgery becomes an option only if all of this data points to a single focus that can be safely removed.

Not immediately. Medications continue for a period after surgery; only after a seizure-free observation period can a gradual reduction be planned, and only under your neurologist’s supervision. Some patients continue low-dose treatment. This decision is entirely individual.

This risk depends on the location of the focus, which is exactly why pre-operative neuropsychological tests and functional mapping are performed. For foci adjacent to speech or movement areas, awake surgery is used when needed. Possible effects are explained to you openly and individually before surgery in every case.

Yes. You can send the MRI, EEG reports and your medication history you have from Istanbul via phone or WhatsApp (+90 533 075 72 94) and receive a preliminary assessment. If appropriate, you will be invited for detailed monitoring and testing.

No. Treatment almost always begins with medication; nerve-pain drugs such as carbamazepine provide marked relief in many patients. Surgery comes to the fore when medication is inadequate, when side effects become intolerable, or when the patient does not want to remain dependent on medication.

This choice depends on your age, general health, MRI findings and expectations. Microvascular decompression addresses the cause and can give the most lasting result in suitable patients; Gamma Knife and percutaneous procedures are less invasive and come to the fore with older age or other illnesses but may leave facial numbness. The right choice is individual.

This depends on the method chosen. With microvascular decompression the risk of facial numbness is generally low; with percutaneous procedures and radiosurgery, facial numbness can be more common. Possible effects are explained to you openly and individually before the procedure.

Yes. You can send your thin-slice MRI and pain history from Istanbul via phone or WhatsApp (+90 533 075 72 94) and receive a preliminary assessment. If appropriate, you will be invited for an examination, and additional imaging to clarify the vessel–nerve relationship will be planned if needed.

No. Acoustic neuroma (vestibular schwannoma) is almost always a benign, slow-growing tumor that does not spread to other organs. Even so, because of its location it can affect hearing, balance and the facial nerve, so it requires follow-up and, where appropriate, treatment.

No. For small, asymptomatic tumors — especially in older patients — observation (wait-and-see) with regular MRI is often the right option, because some of these tumors do not grow significantly for years. Surgery or radiosurgery comes to the fore when growth or increasing symptoms occur.

This depends on the tumor’s size, location and your pre-operative hearing level. Continuous nerve monitoring is used during surgery to protect the facial nerve. Hearing can be preserved in some cases and not in others; these possibilities are explained to you openly and individually before surgery.

Yes. You can send your hearing test (audiometry) and thin-slice MRI results from Istanbul via phone or WhatsApp (+90 533 075 72 94) and receive a preliminary assessment. If appropriate, you will be invited for an examination, and additional imaging will be planned if needed.

No. A prolactinoma is most often treated with medication (dopamine agonists) and can shrink; small, non-secreting and asymptomatic adenomas can be followed with regular MRI. Surgery comes to the fore especially in large tumors threatening vision and in growth-hormone or ACTH-secreting tumors. The decision is made according to the tumor type.

In most cases the operation is done through the nose (endoscopic transsphenoidal); the skull is not opened, the brain is not retracted, and no incision scar is left on the face or head. This method is far less invasive than open surgery. Only in selected, very large or differently located tumors may another approach be needed.

Not always; this depends on the tumor’s type, size and how much the pituitary is affected. In some patients hormone levels return to normal, while others may need hormone support under an endocrinologist’s supervision for permanent deficiencies. This becomes clear with post-operative testing.

Yes. You can send your hormone blood tests, pituitary MRI and any visual-field results from Istanbul via phone or WhatsApp (+90 533 075 72 94) and receive a preliminary assessment. If appropriate, you will be invited for an examination; the process is planned together with endocrinology where needed.

Most often, no. For cavernomas that are asymptomatic, have not bled before and are located in a deep/critical region, the most common decision is observation with regular MRI, because the annual bleeding risk is generally low. Surgery comes to the fore in situations such as recurrent bleeding, resistant seizures or progressive symptoms.

No. A cavernoma is a low-pressure, slow-flow structure; its bleeding is usually not sudden and devastating as in an aneurysm but more limited and slow. For this reason most cavernomas are not an emergency, though they still need to be assessed according to their location.

It can, but only in very carefully selected situations. The brainstem is a critical region; the decision to operate there is made by carefully weighing the expected benefit against the possible risk, when there is a strong justification such as recurrent bleeding or progressive symptoms. In some cases observation may be safer.

Yes. You can send your MRI images (preferably ones including gradient echo / SWI sequences) and your symptom history from Istanbul via phone or WhatsApp (+90 533 075 72 94) and receive a preliminary assessment. If appropriate, you will be invited for an examination, and additional imaging will be planned if needed.