EVANGELOS M. ROKAS, MD
Consaltant of neurosurgical Clinic of “EUROCLINIC“ Athens and Children's Hospital
Paediatric neurosurgical Clinic of “IASO“ Children ́s Hospital
30 Str. Nikolaou Rokka, 19 600 Mandra Attikis
Tel. +30 211 8504544 | Fax +30 211 8504511 | Mob: +30 6944 251692
3-5 Athanasiadou 115 21, Ampelokipoi (4th floor)
Tel. +30 210 6416016
￼Evangelos M. Rokas is a graduate of the Medical School of the National and Kapodistrian University of Athens, hence completed his specialty in Neurosurgery at the General Hospital of “Asklipieio“ Voulas. Onwards, he was trained in and applies in his daily practice minimally invasive and minimally access techniques in brain and spine surgey.
His core interests as far as surgical and scientific fields are concerned, are listed as such:
Minimally invasive spine and brain surgery (minimal invasive & minimal access techniques)
Microneurosurgery, brain vessels ́ surgery and spinal cord tumour surgery
Vascular anastomosis and by pass surgery
Hydrocephalous, pathophysiology and treatment
Brain and spinal cord electrical stimulation
Spasticity and balcofen pump implantation in adults and children
Non-linear analysis of the intracranial pressure in the Traumatic Brain Injury (TBI) and the Normal Pressure of the hy- drocephalous (NPH)
Participation in numerous medical conferences, both in Greece and abroad, with more than 70 public speeches and presen- tations in his credit with respect to spine and brain ailments ́ treatments. He is an active member of the Hellenic Neurosurgery Society (ENXE) as well as the European Association of Neurosurgical Societies (EANS).
MINIMALLY INVASIVE SURGERY OF BRAIN AND SPINE
BLOODLESS SURGERY - PAINLESS RECOVERY - RAPID REHABILITATION
Minimal Invasive and Minimal Access Surgery of the Brain and Spine, allows the Neurosurgeon and Spine Surgeon to perform rather complicated operations, thus succeeding maximum effectiveness whilst minimizing any dangers and operative complications that may arise.
The use of latest technological equipment enables:
The width reduction of a surgical incision;
The lesion minimization to adjacent normal tissues;
Better portrayal of Surgical Pathology. In this way achievement is as such:
Minimum blood loss;
Less postoperative pain;
Better and faster rehabilitation.
MIS ON BRAIN SURGERY:
The neurosurgical endoscope is an excellent instrument for access to brain areas, such as the ventricular system and the base of the skull. Now, ailments as hydrocephalus, traumatic cerebral hematoma, tumors of the ventricular system, of the skull ́s base and the posterior fossa, can be handled by a small hole, without any unnecessary loss of blood and minimal trauma of the sensitive brain tissue.
The neuronavigation procedure allows the neurosurgeon to have a clear 3D imaging of the brain and the area that is interested in, to spot the exact entry point and design the optimal towards a specific area. In that way, operations like biopsies are performed through a very small hole (smaller than 2cm), whereas in other cases the mini- mization of the incision is being achieved as it is designed with millimeter precision over the area of interest.
With the use of percutaneous dilation, a gradual creation of an open- ing is evident through the tissues, without cutting or even injuring them. Thus, allows users the access to areas of the spine, which via the classical method would require a wide range of intersection, wide- spread manufacture of tissue and therefore a greater loss of blood and increased time of rehabilitation. The percutaneous dilation is mainly used in classical lumbar discectomy, lumbar laminectomy, while it can be used for foraminectomy, both in as much lumbar and cervical spine.
Kyphoplasty/Vertebloplasty is a relatively new method of minimal in- vasive technique by which the neurosurgeon or spine surgeon has the potential of repairing and stabilizing a fractured vertebra, while al- lowing aid to BIO cement of the osteoporotic vertebral having over- worked. Finally, it is a procedure of choice in cases where a biopsy of the spine is to be taken, as well can be done percutaneously, while general anesthesia is not necessary.
The advancement of the classical technique of the spinal fusion is the percutaneous fusion. Via this technique the loss of blood, which in classical techniques could overcome the two units of blood (> 600ml) and the transfusion of patients is almost certain, now it can be ac- complished by blood loss approaching 50-100ml, while transfusions seem to be extremely rare. Consequently, the patients recover much faster whilst the tissues experience less injury, whereas the complications are clearly reduced since there is continuous and thorough checking that controls the proper course of the materials. Furthermore, with the use of percutaneous dilation, the necessary decompression of neural elements can be done simultaneously, without making any large incisions on the skin.
The use of the endoscope in spinal surgery, allowed the performance of a discectomy and foraminectomy by skin lesions of length less than 1.5 cm, or even under local anesthesia(!). Although its use is still of limited evidence, it gives however the possibility for relief in pa- tients who may not be able to receive general anesthesia.
Robotic surgery both in the spine and the central nervous system is the sheer future. Robotic systems are already in existence and oper- ation, but they are rather bulky and dysfunctional for the very small incisions that the neurosurgeon performs. Nevertheless, technology is growing at a fast pace and there will be soon systems that will allow better access and visualization of the areas of most interest with incision width of just few millimeters as well as a higher degree of accuracy in manipulations.