Prof. Dr. Erkan Kaptanoğlu

Open and Closed Surgeries in Neurosurgery

In neurosurgery, surgical technique is commonly referred to as open and closed surgery according to the way the surgeries are performed. Academically, operations performed with a smaller skin incision and less healthy tissue damage are called minimally invasive surgery. Here, the surgical field can be accessed by means of tube retractors and microscope or endoscope cameras and tubes allowing surgery with less tissue damage. Examples include pituitary tumor surgery in the brain through the nose, endoscopic or microscopic cervical, lumbar and dorsal hernia and narrow canal surgeries.

Advantages and Disadvantages

Some diseases are so large and so technically challenging to treat that it may be necessary to operate in the widest way possible, to have a wide field of vision and to control many anatomical areas. In these cases, large, open and wide surgeries are inevitable.
In some approaches, minimally invasive, or “closed surgeries” are possible. The advantage of this is that the surgery is performed through a smaller incision, so tissue healing is faster, less bleeding is expected, hospital stay is shorter and pain is expected to be less. However, the surgeon’s field of vision is usually more limited compared to open surgery.

Open Surgeries

In fact, the type of surgery called “open surgery” describes classical surgical operations. Generally, the surgical area is accessed through skin incisions as needed. Subsequently, all layers and skin are closed after the surgery is performed. In brain surgeries, it is sometimes so difficult to reach the pathology without damaging the brain that many difficult techniques have been described to open the surgery as wide as possible. Fortunately, experienced surgeons who are used to performing these most difficult operations with these techniques use these wide openings.

Open operations on the brain are performed with a procedure called craniotomy. After a skin incision, part of the skull bone is removed. The pathological area in the brain is accessed. The operation is often performed with microsurgical techniques using a microscope. The bone is then replaced and fixed to the main bone during closure. It is closed by suturing layers of tissue and skin over it.

Closed Surgeries

Surgeries known as closed surgery are more commonly known as operations performed through small surgical incisions. These operations are usually performed through a tube, visualized by a camera and the patient is expected to be discharged from the hospital as soon as possible. Closed surgeries in the brain include transsphenoidal or endoscopic pituitary surgery, endoscopic 3rd ventriculostomy surgery, and endovascular treatments for aneurysms.

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