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Brain Tumour · Spinal Surgery · Pituitary · Cerebrovascular

Neurosurgery in Turkey — Brain Tumour Surgery, Awake Craniotomy, Spinal Surgery and Pituitary Surgery at Eyeglow Istanbul

Neurosurgical consultation, second opinion, and treatment coordination in Istanbul — brain tumour resection (gliomas, meningiomas, metastases) with awake craniotomy, intraoperative MRI, neuronavigation, and 5-ALA fluorescence-guided resection; spinal surgery (discectomy, decompression, fusion); endoscopic transsphenoidal pituitary surgery; and cerebral aneurysm clipping. Coordinated through Eyeglow Health's accredited partner neurosurgical network at JCI-aligned hospitals. Honest disclosure: craniotomy carries 1–3% mortality and 5–25% neurological deficit risk depending on location — stated explicitly in every written care plan.

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Neurosurgery at Eyeglow, Istanbul
Awake craniotomy — brain mappingEloquent area preservation
Intraoperative MRI/CTReal-time resection guidance
NeuronavigationGPS-precision tumour localisation
Fluorescence-guided (5-ALA)Glioma margin identification
Hospital stay — craniotomy7–10 days typical

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What it is

Neurosurgery — scope and approach

Neurosurgery encompasses surgical procedures on the brain, spinal cord, vertebral column, peripheral nervous system, and cerebral vasculature. It requires one of the most specialised surgical training pathways in medicine — typically 6–8 years of postgraduate residency followed by subspecialty fellowship. Modern neurosurgery integrates advanced intraoperative technology: neuronavigation (GPS-precision instrument tracking relative to pre-operative MRI), intraoperative MRI or CT (real-time imaging during resection), awake craniotomy for eloquent area mapping, and fluorescence-guided surgery (5-ALA for glioma margin identification).

A second opinion before elective intracranial or spinal surgery is standard at major academic centres internationally — neurosurgery is irreversible, and the right approach, timing, and indication matter as much as technical execution.

How it works

From imaging review to surgical recovery

  1. 01

    Online consultation + imaging review

    You share your MRI brain (with and without gadolinium contrast — full sequences including FLAIR, DWI, perfusion, spectroscopy if available), CT spine, or cerebrovascular imaging (CTA, DSA) as applicable. Clinical history: symptoms and timeline (headache, seizures, focal neurological deficit, visual changes, weakness, speech difficulty), prior neurosurgical procedures, prior radiotherapy to head/spine, current neurological status, performance status. Our neurosurgery coordinator flags completeness of imaging — standard MRI protocol is not always adequate for surgical planning; 3T MRI with thin-slice volumetric MPRAGE is optimal. The partner neurosurgeon receives a full pre-clinic imaging summary before your consultation.

  2. 02

    Neurosurgeon assessment + MDT brain tumour board

    For brain tumours: the partner board-certified neurosurgeon reviews your imaging with neuroradiology. Your case is presented at the multi-disciplinary neuro-oncology tumour board including neurosurgeon, neuro-oncologist, radiation oncologist, neuroradiologist, and neuropathologist. The board determines resection extent (gross total resection vs subtotal resection vs biopsy-only vs watchful waiting), need for intraoperative functional mapping, adjuvant treatment pathway (Stupp protocol for GBM — concurrent temozolomide + radiotherapy, then adjuvant temozolomide), and rehab needs. For spinal surgery: neurosurgeon reviews MRI/CT with neurophysiology, pain clinic, and physiotherapy MDT. For vascular lesions: neurointerventional radiologist and vascular neurosurgeon joint assessment.

  3. 03

    Pre-operative workup and surgical planning

    Brain surgery pre-op: functional MRI (fMRI) for eloquent area mapping if lesion is near motor, language, or visual cortex — determines awake vs asleep craniotomy approach. Diffusion tensor imaging (DTI) / tractography to map white matter tracts (corticospinal tract, arcuate fasciculus, optic radiation). Neuropsychological baseline assessment (important for post-operative comparison and medico-legal documentation). Seizure management review (levetiracetam, dexamethasone preoperatively for oedema). Baseline neurology assessment. Anaesthesiology consultation — awake craniotomy requires specific anaesthetic protocol (asleep-awake-asleep or conscious sedation technique). Spinal surgery pre-op: neurophysiology consultation, pain quantification (VAS, ODI), physiotherapy assessment, anaesthesiology.

  4. 04

    Surgical procedure

    Craniotomy (brain tumour): bony flap removal to expose underlying brain, dural opening, tumour identification with neuronavigation (GPS-based tracking of surgical instruments relative to pre-operative MRI), intraoperative MRI/CT (available at partner hospital — allows real-time imaging to confirm resection extent before closing), fluorescence guidance with 5-ALA (aminolevulinic acid) where indicated (glioma resection — 5-ALA causes malignant glioma cells to fluoresce pink under violet light, improving margin identification). Awake craniotomy: patient is woken during the resection phase for real-time cortical mapping — neuropsychologist or speech therapist conducts tasks (name objects, move hand, count) while neurosurgeon monitors for function disruption; correlates directly with reduced post-operative neurological deficit rate in eloquent-area tumours. Spinal surgery: discectomy (single-level minimally invasive via tubular retractor or microscope-assisted), laminectomy/laminoplasty for decompression, spinal fusion (TLIF, PLIF, ALIF — choice depends on segment and pathology), neuromonitoring (MEP/SSEP intraoperative).

  5. 05

    Post-operative care and neurological monitoring

    Post-craniotomy: neurocritical care unit (NCU) or high-dependency unit for 24–48 hours minimum. Neurological monitoring: GCS, focal deficit assessment, pupillary response every 1–2 hours. CT head within 24 hours of surgery to rule out haematoma or hydrocephalus. Dexamethasone wean (oedema reduction). Seizure prophylaxis review. Early physiotherapy and speech therapy assessment from day 1. Neuropathology result typically available within 5–7 working days — determines adjuvant oncology pathway. MRI brain (post-operative, with contrast) at 24–72 hours post-surgery for early resection extent confirmation. Discharge planning includes neurological rehabilitation facility if needed, and local neurology/neuro-oncology follow-up arrangement.

  6. 06

    Follow-up and adjuvant treatment coordination

    Post-operative MRI at 3 months, 6 months, then annually (GBM: every 3 months per Stupp protocol surveillance). For glioblastoma (GBM): coordination of concurrent chemoradiotherapy (Stupp protocol — 60 Gy radiotherapy + temozolomide 75 mg/m²/day for 6 weeks, followed by 6 cycles adjuvant temozolomide) through partner neuro-oncology team. MGMT promoter methylation status from neuropathology determines response to temozolomide. For meningioma: post-operative WHO grade determines observation vs radiosurgery. For pituitary adenoma: endocrinology coordination for hormonal axis assessment post-surgery. For spinal surgery: structured physiotherapy programme from week 2, return-to-work timeline, long-term activity guidance.

Surgical approaches

Awake craniotomy vs Asleep craniotomy vs Endoscopic pituitary vs Radiosurgery

The choice of neurosurgical approach is determined by lesion type, location relative to eloquent cortex, and patient factors. Here is how the four main pathways compare:

Aspect Awake craniotomy Asleep craniotomy (GA) Endoscopic transsphenoidal (pituitary) Stereotactic radiosurgery (Gamma Knife)
Primary indication Eloquent cortex tumours — near motor strip, speech (Broca/Wernicke), visual cortex — where real-time function testing reduces neurological deficit risk Non-eloquent area tumours, deep-seated lesions not requiring cortical mapping, patients unable to cooperate with awake protocol (anxiety, young children, cognitive impairment) Pituitary adenoma (non-functioning, GH-secreting, prolactinoma refractory to medical therapy, ACTH-secreting Cushing's) — transnasal approach, no visible scar, shorter recovery Radiosurgery (Gamma Knife) — small (<3 cm) benign/metastatic brain tumours, arteriovenous malformations (AVM), acoustic neuromas, essential tremor (thalamic); no open surgery; coordinated through Eyeglow partner radiation oncology team
Neurological deficit risk reduction Demonstrated reduction in post-operative permanent deficit (motor, speech) in eloquent area tumours — randomised data (De Witt Hamer 2012, Lancet Oncology) Standard anaesthesia; neuromonitoring (MEP/SSEP) provides indirect monitoring of motor tracts but not real-time cortical language mapping Not applicable for cortical mapping; endoscopic approach reduces need for nasal packing, reduces CSF leak vs microscopic transsphenoidal in meta-analyses No surgical deficit risk; radiation-specific risks (radiation necrosis 5–10%, hair loss at entry point, oedema)
Tumour resection extent Higher gross total resection rate in eloquent area tumours — associated with improved survival in glioma (EORTC data) Neuronavigation + intraoperative MRI — resection extent similar for non-eloquent tumours Pituitary: comparable or superior remission rates vs microscopic for most adenoma subtypes in high-volume centres Not a resection — radiosurgery targets abnormal tissue without removal; tumour control rate for meningiomas 90–95% at 5 years
Duration + hospital stay 3–6 hours surgery; NCU 24–48h; total stay 7–10 days 2–5 hours; NCU 24–48h; total stay 7–10 days 2–3 hours; standard ward 3–5 days; lumbar drain if CSF leak risk Single outpatient session (Gamma Knife, 1–6 hours frame or mask); home day of treatment
Recovery 4–6 weeks to functional recovery; neuropsychological monitoring at 3 months 4–6 weeks; similar to awake for non-eloquent lesions Nasal congestion 2–4 weeks; return to work 2–3 weeks typical; endocrine follow-up 6 weeks 24–48h mild headache; no recovery period in most cases; response assessed at 3–6 months imaging
Pricing

Personalised pricing

Every treatment plan is priced individually after your consultation. Request a written, all-inclusive quote — clear, itemised, and with no obligation.

Request a written quote
Package transparency

What's included in your neurosurgery coordination

Included in coordination

  • Neurosurgical second opinion consultation with board-certified neurosurgeon (partner network)
  • Imaging review (MRI, CT, CTA, DSA) by partner neuroradiology
  • Multi-disciplinary neuro-oncology tumour board presentation (brain tumours)
  • Written care plan: diagnosis, surgical approach, intraoperative techniques, expected resection extent, post-operative pathway, adjuvant treatment coordination
  • Explicit neurological deficit risk and mortality disclosure by procedure type
  • Surgical procedure at JCI-aligned partner hospital — neurosurgeon, neurophysiologist, neuroanaesthesiologist, neurointensive care team
  • Intraoperative neuromonitoring (MEP/SSEP) as standard for spinal and eloquent area cases
  • Neuronavigation as standard for intracranial procedures
  • Neurocritical care unit (NCU) post-operative monitoring
  • Neuropathology (if tissue resection — WHO 2021 CNS tumour classification including molecular markers)
  • Post-operative MRI at 24–72 hours for resection extent confirmation
  • Physiotherapy, speech therapy, and neuropsychological assessment coordination from post-operative day 1
  • Multilingual care coordinator — from first imaging review to discharge and follow-up plan
  • Complication insurance policy (Türkiye Ministry of Health certified, covers surgical complications including infection, retreatment, and emergency intervention up to package value)

Quoted separately

  • Adjuvant radiotherapy (radiation oncology — coordinated through partner radiation oncology team if indicated by tumour board)
  • Adjuvant chemotherapy (temozolomide for GBM — coordinated through partner neuro-oncology team)
  • Spinal implants cost (pedicle screws, cages, plates — quoted separately based on level and implant type)
  • Intraoperative imaging (iMRI) supplementary cost where applicable to case complexity
  • Neuropsychological rehabilitation programme beyond acute hospital stay
  • Hotel and accommodation (quoted separately — typical stay 10–14 days for craniotomy)
  • Flights to/from Istanbul
  • Travel insurance (recommended — covers flight cancellation, baggage, non-surgical medical emergencies abroad; we coordinate referral if needed)
Candidacy

Is neurosurgery coordination at Eyeglow Health appropriate for you?

You may benefit from coordination if

  • You have a brain tumour (glioma, meningioma, metastasis, acoustic neuroma, pituitary adenoma) confirmed on MRI and are seeking a surgical second opinion or treatment.
  • You have intractable back or neck pain or radiculopathy after failed conservative management (minimum 6–8 weeks physiotherapy + appropriate analgesia) with correlating imaging pathology (disc herniation, stenosis, spondylolisthesis).
  • You have a cerebrovascular anomaly (unruptured aneurysm, AVM) and are seeking specialist assessment of treatment options (surgical clipping, endovascular coiling, radiosurgery, or observation).
  • You are seeking a second opinion on the recommended neurosurgical approach, timing of surgery, or need for surgery at all (many spinal and some brain cases have non-surgical alternatives that should be explored first).
  • You have been recommended craniotomy near eloquent cortex and want access to awake craniotomy with cortical mapping at a centre experienced in this technique.

Coordination may not be appropriate if

  • You require emergency neurosurgery (ruptured aneurysm, acute subdural haematoma, acute spinal cord compression with rapidly progressive deficit) — arrange emergency transfer to your nearest neurosurgical centre; elective evaluation timelines do not apply to emergency presentations.
  • You have been offered standard-of-care spinal or cranial surgery at a well-resourced local centre without significant wait-time delay — if your local option is appropriate and accessible, we will tell you this.
  • You expect surgery to provide complete pain relief or function restoration as a certainty — neurological outcomes after surgery are probabilistic, not guaranteed; we state realistic outcome ranges explicitly.
  • You have systemic disease (active cancer with short prognosis, severe cardiac or respiratory comorbidity) that makes elective surgery higher risk than the natural history of the lesion — an honest risk-benefit discussion may result in a recommendation against surgery.

Disclaimer. Information on this page is consistent with WFNS (World Federation of Neurosurgical Societies) guidelines, Congress of Neurological Surgeons (CNS) practice guidelines, and NICE clinical guidelines for neurosurgery. Complication statistics are derived from peer-reviewed published registry data and randomised trial publications. Individual outcomes depend on lesion characteristics, patient factors, and surgical team expertise. Treatment decisions require assessment by a board-certified neurosurgeon with access to your full imaging and medical records.

Honest disclosure

What every neurosurgery patient must understand before consenting

Neurosurgery carries mortality and permanent neurological deficit risk that is unique in magnitude among elective specialties. We state this plainly — the same way our partner neurosurgeon does before every consent discussion:

Craniotomy mortality — 1–3% procedure-dependent

Craniotomy (brain surgery) carries a reported all-cause 30-day mortality of approximately 1–3% in elective cases at high-volume neurosurgical centres — higher for malignant glioma, posterior fossa tumours, and vascular procedures. Per WFNS and CNS published neurosurgical outcome data: craniotomy for meningioma 0.5–1%; craniotomy for glioblastoma 1–2%; posterior fossa surgery 2–3%; aneurysm clipping (unruptured) 1–2%; ruptured aneurysm 3–5+%. These figures are procedure-type- and centre-volume-dependent. We state the applicable mortality range for your specific procedure in the written care plan before you consent to surgery.

Neurological deficit — permanent new deficit in 5–25% depending on tumour location and technique

Any intracranial procedure carries risk of new permanent neurological deficit: motor weakness, language impairment (dysphasia), visual field defect (hemianopia), memory change, or personality change — depending on lesion location. Eloquent cortex proximity is the primary risk factor. Published data for glioma surgery in eloquent areas: permanent new deficit 10–20% without cortical mapping; 5–10% with awake craniotomy and functional mapping. Neuronavigation reduces risk by improving resection precision. Intraoperative MRI reduces risk by avoiding inadvertent violation of adjacent eloquent structures. We use all available risk-reduction techniques at our partner hospital — but we also state frankly that these techniques reduce risk, not eliminate it.

Spinal surgery — complication rate 0.3–5% by procedure, with re-operation risk

Spinal surgery complication rates per published registry data (Scoliosis Research Society, National Inpatient Sample): single-level lumbar discectomy — infection 0.3–0.5%, neurological complication 0.1–1%, re-herniation 5–10% at 10 years; lumbar fusion — infection 1–3%, hardware failure requiring reoperation 3–5%, adjacent segment disease at 5–10 years (15–30% radiographic, 5–10% symptomatic requiring surgery); cervical surgery — dysphagia 10–30% (mostly transient), vocal cord injury (recurrent laryngeal nerve) 0.5–1%, C5 nerve palsy 2–4% after laminoplasty. Realistic outcome expectations for spinal surgery: radicular leg/arm pain — typically good improvement (70–90% with disc herniation); back/neck pain — less predictable (40–60% meaningful improvement; fusion does not reliably cure axial pain).

Second opinion recommendation — we recommend against surgery in a proportion of cases

Neurosurgery is irreversible. For many lesions where patients present expecting surgery, our partner tumour board recommends against immediate surgical intervention: small asymptomatic meningiomas — radiological surveillance rather than surgery (NICE CG guidance); incidental pituitary microadenomas with normal hormones — observation; lumbar disc herniation — non-surgical management with time (80% resolve without surgery over 6–12 weeks); small unruptured aneurysms in elderly patients — observation risk-benefit favours non-surgery. We will tell you if surgery is not in your interest, even when you have sought us for surgery. That conversation is part of our clinical duty.

FAQ

Frequently asked questions about neurosurgery in Turkey

What conditions can be treated with neurosurgery in Turkey?
Neurosurgery encompasses a broad range of conditions affecting the brain, spine, and peripheral nervous system. At our partner JCI-aligned hospital, the core capabilities include: intracranial tumours (low- and high-grade gliomas, meningiomas, brain metastases, pituitary adenomas, acoustic neuromas, craniopharyngiomas), degenerative spinal disease (cervical and lumbar disc herniation, spinal stenosis, spondylolisthesis, myelopathy — treated with discectomy, decompression, or fusion), cerebrovascular surgery (unruptured intracranial aneurysm clipping, surgical management of AVMs — arteriovenous malformations), and functional neurosurgery (deep brain stimulation for movement disorders — coordinated through a separate dedicated pathway at Eyeglow Health). For conditions requiring highly specialised sub-specialist infrastructure (paediatric neurosurgery, complex skull base reconstruction, spinal deformity correction with >3 level fusion) we will assess candidacy and direct you to the most appropriate partner.

What is awake craniotomy and who needs it?
Awake craniotomy is a surgical technique in which the patient is woken during the tumour resection phase of brain surgery to allow real-time cortical and subcortical mapping. While the patient is awake and communicating (naming objects, moving the hand, counting), the neurosurgeon stimulates the cortex with a low-current probe — if stimulation disrupts the patient's function, the surgeon stops resecting at that margin, preserving the eloquent area. The technique requires specific training from the neurosurgeon, specific asleep-awake-asleep anaesthetic management (or conscious sedation), and pre-operative neuropsychological preparation of the patient. It is indicated for tumours adjacent to the motor cortex (controlling movement), speech-dominant hemisphere language areas (Broca's area — word production; Wernicke's area — comprehension), or visual cortex. Published evidence (Lancet Oncology 2012, multiple systematic reviews) demonstrates that awake craniotomy with cortical mapping significantly reduces permanent neurological deficit rate compared to asleep craniotomy for eloquent-area tumours. Our partner neurosurgeon holds documented awake craniotomy volume.

What is the risk of neurological deficit after brain surgery?
New permanent neurological deficit is the most clinically significant risk of intracranial surgery. The probability depends critically on lesion location relative to eloquent cortex and the surgical technique used. General published ranges: meningioma (convexity, non-eloquent) — permanent deficit <2–5%; meningioma (parasagittal, skull base, cavernous sinus) — 5–15% depending on involvement of eloquent structures; glioma (non-eloquent area) — 3–8%; glioma (eloquent cortex, with awake craniotomy + mapping) — 5–10% permanent; glioma (eloquent cortex, without mapping) — 15–25% permanent. Visual field deficits after temporal lobe surgery are common (15–30%) and often permanent (optic radiation involvement). Memory impairment risk after dominant mesial temporal surgery. We disclose the applicable risk range for your specific tumour location and surgical technique before you consent — this is a non-negotiable part of our informed consent process.

Why is a second neurosurgical opinion important?
Neurosurgery is irreversible — unlike many other medical decisions, an operation cannot be undone. A second opinion before elective intracranial or spinal surgery is standard practice at major academic neurosurgical centres internationally. Specific situations where second opinion commonly changes the recommendation: small asymptomatic tumours where surveillance rather than surgery is appropriate; spinal surgery where conservative management has not been fully trialled; selection of surgical approach (awake vs asleep craniotomy, open vs endoscopic, anterior vs posterior spinal approach) where the choice has significant outcome implications; pituitary adenomas where medical management (dopamine agonists for prolactinoma, somatostatin analogues for acromegaly) may be appropriate before surgery. Our partner neurosurgeon provides a written second opinion including the tumour board recommendation, recommended approach if surgery is confirmed, expected resection extent, and the explicitly stated argument against surgery where applicable.

What is endoscopic transsphenoidal pituitary surgery?
Endoscopic transsphenoidal pituitary surgery is the standard modern approach for surgical removal of pituitary adenomas — benign tumours of the pituitary gland that cause visual loss (compression of optic chiasm in macroadenomas), hormonal excess (Cushing's disease from ACTH-secreting adenoma, acromegaly from GH-secreting adenoma), or hormonal deficiency (compression of normal pituitary). The endoscopic technique: the neurosurgeon (working with an ENT surgeon for the nasal approach) passes a 4mm rigid endoscope through one nostril, behind the nasal cavity, through the sphenoid sinus, and into the sella turcica (the bony recess containing the pituitary). No visible scar, no craniotomy, minimal nasal morbidity compared to older microscopic approaches. Published remission rates: Cushing's disease (ACTH adenoma) 65–85% (depends on whether adenoma is visible on MRI); acromegaly (GH adenoma) 70–85% at experienced centres; prolactinoma surgery (for refractory or intolerant of medical therapy) 70–80%. Risks: CSF leak (0.5–3%, managed with lumbar drain or fat graft repair), meningitis (<1%), injury to carotid artery (rare — <0.3%), panhypopituitarism, diabetes insipidus (transient 10–15%, permanent 2–5%).

Will spinal surgery eliminate my back pain?
Not necessarily — and we state this explicitly because unrealistic expectations are a significant driver of patient dissatisfaction after spinal surgery. Outcomes differ substantially by symptom type. Radicular pain (leg pain/sciatica in lumbar, arm pain/cervicobrachialgia in cervical) from nerve root compression caused by disc herniation or foraminal stenosis: typically responds well to surgical decompression — 70–90% meaningful improvement in most published series. Neurogenic claudication (bilateral leg pain with walking, relieved by sitting) from lumbar spinal stenosis: surgery reliably improves walking tolerance — 70–80% meaningful improvement. Axial back or neck pain (pain in the back or neck itself, without radicular component): less predictable response to surgery — spinal fusion for axial pain alone (without structural instability) achieves meaningful improvement in approximately 40–60% of patients; 10–20% have no improvement or worsening. We do not recommend spinal fusion for isolated axial pain without clear structural indication. Your partner neurosurgeon's pre-operative assessment includes explicit outcome probability for your specific symptom pattern.

What is the difference between aneurysm clipping and coiling?
Cerebral aneurysms (bulges on brain blood vessels) can be treated surgically (clipping) or by endovascular approach (coiling, flow diversion). Clipping: the neurosurgeon performs a craniotomy to expose the aneurysm and places a titanium clip across the neck, excluding it from circulation — durable (95%+ occlusion rate at 10 years), definitive, but carries surgical approach risk. Coiling (endovascular): a neurointerventional radiologist threads a microcatheter through femoral artery to the aneurysm and fills it with platinum coils — no craniotomy, lower initial procedural risk, but higher recurrence rate (15–20% incomplete occlusion requiring repeat treatment vs 5–8% for clipping). The ISAT randomised trial (Lancet 2002, updated 2009) showed coiling superior for ruptured aneurysms amenable to both (better survival and functional outcome at 1 year). For unruptured aneurysms, the decision depends on aneurysm morphology (neck width — wide-neck favours clipping), location (some locations technically prefer one approach), patient age and comorbidity, and neurosurgeon/neurointerventionalist expertise. Our partner hospital has both capabilities; the joint assessment recommends the approach most appropriate for your specific aneurysm.

How long is the recovery after brain surgery?
Recovery after craniotomy for brain tumour depends on lesion location, extent of resection, and patient age and baseline neurological status. Typical timeline for an adult with good performance status: post-operative NCU 24–48 hours, general neurosurgical ward 5–8 days, discharge home 7–10 days from surgery. Driving restriction: typically 3–6 months minimum (seizure risk — most patients receive prophylactic anticonvulsants post-operatively regardless of whether they had pre-operative seizures). Return to office work: 4–8 weeks for non-physically demanding jobs. Return to physical work: 3–6 months. Physiotherapy for motor deficit: commenced from post-operative day 1 if motor recovery is part of the treatment plan. Neuropsychological assessment at 3 months post-operatively (important for cognitive outcome documentation, insurance purposes, and return-to-work planning). For pituitary surgery: nasal congestion for 2–4 weeks; return to desk work 2–3 weeks; endocrinology follow-up at 6 weeks for hormonal axis assessment.

Is fluorescence-guided surgery (5-ALA) available?
5-ALA (5-aminolevulinic acid, brand name Gliolan in Europe) fluorescence-guided surgery is available at our partner hospital for eligible glioma resections. The technique: the patient takes an oral 5-ALA solution 3–4 hours before surgery. The drug is selectively metabolised in malignant glioma cells (and some other high-grade tumours) into protoporphyrin IX (PPIX), which fluoresces pink-red under violet-blue (375–440 nm) light. When the neurosurgeon switches to the violet light on the operating microscope, tumour tissue glows distinctly versus surrounding normal brain (which appears blue-grey). This allows real-time identification of tumour margins, significantly increasing the probability of gross total resection of contrast-enhancing tumour. The STUMP randomised trial (Stummer 2006, Lancet Oncology) demonstrated that 5-ALA-guided resection achieved gross total resection in 65% versus 36% with conventional white-light surgery — with no increase in neurological deficit rate. EMA approval: Gliolan is approved in Europe for malignant glioma surgery. Applicability: primarily for high-grade glioma (GBM, WHO grade 3); not indicated for meningioma, metastases, or low-grade glioma (insufficient PPIX accumulation). Our partner neurosurgeon will indicate whether 5-ALA is appropriate for your specific tumour type.

What if the tumour board recommends against surgery?
We present the tumour board recommendation as written — including when the recommendation is against immediate surgical intervention. Neurosurgery is not always the correct initial management, and we do not recommend operations where the natural history of the disease (observation) or non-surgical treatment (radiosurgery, medical management, physiotherapy) offers a better risk-benefit ratio for the patient. Specific scenarios where our tumour board frequently recommends against surgery: incidental small meningioma (<3 cm, asymptomatic) — NICE clinical guidelines support observation with 6-monthly MRI; lumbar disc herniation with radiculopathy of less than 6 weeks — conservative management with time and physiotherapy resolves 80% without surgery; pituitary prolactinoma — dopamine agonist (cabergoline) is the preferred first-line treatment for most prolactinomas, surgery reserved for medical intolerance, resistance, or compression emergencies; small unruptured aneurysm in elderly patients with comorbidity — rupture risk may be lower than procedural risk. We write the recommendation honestly and explain the reasoning, rather than defaulting to surgical recommendation to meet patient expectations.

Why choose Eyeglow Health for neurosurgery coordination?
Eyeglow Health's primary clinical specialty is ophthalmology. We coordinate neurosurgery through our accredited partner specialist network because we have established infrastructure that patients travelling to Turkey need — a care coordinator, complication insurance, written care plan, and a framework of responsibility. The neurosurgery is performed by our vetted board-certified partner neurosurgeon at a JCI-aligned partner hospital. We will tell you honestly when a case exceeds our partner network's capabilities and refer accordingly. We will tell you when surgery is not indicated. We will not recommend an operation to generate a booking — honest case selection is the only practice model we operate under.

Can I return home shortly after neurosurgery?
The minimum safe post-operative stay in Istanbul varies by procedure. Craniotomy for brain tumour: minimum 10–14 days in Istanbul after surgery (7–10 days hospital + 3–5 days local recovery before long-haul flight); air travel after craniotomy requires neurosurgical clearance — typically 4–6 weeks minimum post-operatively for international flights, due to altitude/pressure change risk with cerebral oedema, and seizure risk requiring local emergency access. Spinal discectomy (minimally invasive): discharge 2–5 days, minimum 7–10 days in Istanbul total. Spinal fusion: hospital 5–7 days, minimum 14 days in Istanbul total. Pituitary surgery: hospital 3–5 days, minimum 7–10 days in Istanbul total. Your care coordinator provides a travel clearance document from the neurosurgeon, and arranges local follow-up coordination with your home-country neurologist or neurosurgeon.
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