Neurosurgery: Paediatrics to geriatrics

The department has made huge strides in treating difficult cases

Having specialised at Roosevelt Hospital in New York, and with over 20 years of experience at leading hospitals in Israel, Dr Nevo Margalit performs various complex surgeries including the removal of difficult skull-base tumors involving the base of the brain, pituitary adenomas and suprasellar tumors, microvascular decompression, such as to relieve abnormal compression of a cranial nerve causing trigeminal neuralgia, as well as endoscopic and traditional skull-base surgery.

The department of neurosurgery is relatively new, a core branch of the Helmsley Neurological Institute, which was established in 2016. The institute was founded in coordination with Israel's Ministry of Health. The neurology teams are all highly experienced professionals, trained in some of the world's leading institutions and with a wealth of expertise treating patients using the most advanced technologies. The department is also active in paediatric neurosurgery, performing procedures such as the removal of brain and spinal tumours, VP shunting to drain cerebrospinal fluid in patients with hydrocephalus, as well as responding to traumatic injuries of the brain and spinal cord.

Dr Margalit and his team often perform procedures on older patients who might not always have benefited from interventional surgical care. "There was a time when we wouldn't consider brain surgery on an older person," shares Dr Margalit. "But we realised that there were patients in very good physical shape who would be able to withstand the surgery, and who stood to benefit from more years of high-quality life," he said. The team has since treated dozens of such cases, including a recent procedure on an 87-year-old woman who is still going strong.

Dr Margalit notes that neurosurgery has made great strides in the last 10-15 years, with more positive outcomes than ever before. He attributes that success in part to medical advancements, such as imaging technologies, which can indicate "exactly where the tumor is and where it is not"; and electrophysiological monitoring performed during brain or spinal cord surgery. Another surgical technique is brain surgery when the patient is awake; vital information can be obtained to ensure the patient's function and long-term well-being.

In what proved to be a trailblazing event, Dr Margalit performed the very first auditory brainstem implant (ABI) in Israel and the entire Middle East. The patient was a young child with no functioning auditory nerve.

ABI bypasses the inner ear and the auditory nerve, placing an electrode directly on the brainstem to stimulate hearing pathways. As a result of the surgery, performed in collaboration with an otologist surgeon, the child went from being completely deaf to achieving a satisfactory level of hearing. Dr Margalit and the Shaare Zedek team are considered the national experts on ABI.

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