National Institute of Clinical Neurosciences

Országos Klinikai Idegtudományi Intézet (OKITI) - It is not by chance that legends surround the history of our Institute: throughout the past decades, many of our patients have spread the word not only in Hungary but worldwide. The “Amerikai úti” tradition, which goes back several decades, serves as an example to us all: we would like to offer this professional heritage to as many patients as possible, and help to make it even greater as a result of our everyday work. 

The predecessor of our Institute, the National Institute of Neurosurgery (Országos Idegsebészeti Tudományos Intézet) was established in 1953. Since then, our hospital has developed into a unique, broad spectrum, professional centre. Our professional profile has been completed 2007, by including epilepsy and stroke neurology. Our hospital has been called The National Insitute of Neurosciences since then.  

Neurosurgeons, neurologists, neuro-oncologists, epileptologists and stroke experts work together in our Institute as a team. This guarantees the most optimal and effective circumstances for the treatment of patients: in-house examinations are performed quickly, so that there is an immediate chance of consultation and intervention. In many cases, survival and the chance of unaltered quality of life are due to these factors. 

Today, OITI is the third largest neurosurgical centre of Europe. It is a vanguard of neuronavigational methods that require great surgical precision, ablative operations that can in many cases be replaced by neurostimulating interventions in the field of spinal surgery, involving smaller incisions and many other modern neurosurgical procedures.  

Our institute has earned a good reputation as a result of cooperation with the National Institute of Oncology and the Debrecen Rotating Gamma Institute regarding the treatment of; tumours without surgical intervention, the operation of large and difficult tumours, or injuries, and the treatment of epilepsies and pains that cannot be treated with medication. Hungary’s first and only Paediatric Neurosurgery is part of our institute. The professional expertise that has accumulated here through the years is of inestimable value. 

We treat some four thousand in-patients each year, and almost 20 thousand outpatients visit our specialist health care service. Each day, our highly qualified doctors and specialist nurses use their vast knowledge and talent to offer the best to our patients and their families. They treat the patients who have been “placed” in their hands with humaneness and compassion, and use medical instruments of the highest standard.

Epilepsy that can not be controlled with drug therapy, various incurable pains, for example: facial neuralgia ( trigeminal neuralgia), cancer- associated intense pain, post spinal surgery or stroke pain, complex regional pain syndrome (CRFS), shingles residue, known as post-herpetic neuralgia, as well as migraine and tension type headaches. Movement disorders, for example: spastic muscle contractions occurring around the face and neck area (dystonia) tremor associated with Parkinson's Disease and multiple sclerosis or stiffness (e.g. essential tremor spasticity).

In some rare cases, it can occur that neither the medication nor any other conventional therapy is able to help those, who are in constant pain, live with frequent seizure-inducing epilepsy, or are struggling with limb spasms and tremors, and are incapable of a normal life because of movement disorder. Except, the normally negligible statistic rate, in respect of their own lives, means 100% threat and vulnerability for those struggling with these diseases. 

Our Institute’s Functional neurosurgery is able to offer help in even these seemingly hopeless cases. Our specialists can choose from many modern interventions to offer the patient personalised modern therapy, which will most likely terminate persistent excruciating pain, movement disorder or any other serious neurological complaints. Our Functional Neurosurgery Program provide such invaluable achievements in modern medicine for patients turning to us, that are capable of providing good quality of lives for those that were previously thought incurable, even without causing irreversible processes. Nowadays, there is no need for traditional (ablative)neurosurgical surgery to mitigate complaints. In many cases effective treatment can be achieved by implanting a small device (medicine pump, nerve stimulator or electrode). In addition, the function of the implanted device, i.e. the dosing of the medicine or the electric pulse can be modified externally at any time without further surgical intervention. 

The fact that, with regards to neuromodulation interventions, our Institute is one of Europe’s leading centres: the second largest Functional Surgery Center on the continent, is hardly known even among professionals. The state of the art surgeries performed here have already helped hundreds of patients: in the vast majority of cases that were otherwise unmanageable, the problems passed, the pain occurred much less or not at all and the quality of life destroying attacks and seizures stopped. 

We maintain close contact with our Functional Surgery patients post hospital interventions. We welcome our patients back for multiple mandatory post operative follow-up examinations. For those who benefit from neurostimulation medical treatment, there are nursing centres, who are in close contact with our Institute, to help with the devices management and maintenance.

Our Institute encompasses the most advanced techniques to correct surgical disorders of the spine and spinal cord. Spinal surgeons of our Department are treating the entire spectrum of spinal diseases, through conventional and minimally invasive surgical treatment options. Degenerative disorders, trauma, tumors, and vascular diseases are treated through a team approach.

Conventional surgery of spinal disorders bring together an extensive scale of treatment options, that have been used and developed by spinal specialists over the past years. We offer for our patients leading-edge technologies of spinal instrumentation and implantation.

The treatment modalities of spinal disorders are also enhanced by using minimally invasive surgical techniques with special instruments inserted through small incisions. Minimally invasive spinal approaches represent major advantage in treatment preserving static and dynamic stability of the spinal column. It is combined with conventional surgical techniques such as spinal fusion as well.

The spinal surgeons in our Department endeavor in technical innovations and scientific discovery using latest developments to achieve best possible surgical outcome.

With the National Institute of Neuroscience’s Infant and Children’s Neurosurgery department being the only one in the country, they take in and treat premature babies, infants and children suffering from operable brain and spinal diseases, from all over the country. We welcome patients from birth until the age of 18, our department has 13 + 5 intensive care beds. 

Our department is specialised in, brain tumours, spinal tumours, congenital central nervous system malformations, skull, malformations ( craiostenosis) vein development disorders, hydrocephalus, epilepsy and neurosurgical operations for traumatic nervous system injuries. 

Being the country’s only department that specialises in pediatric neurosurgery, we see it both professionally and ethically mandatory that we accept patients on any day of the year, at any hour of the day, from any part of the country, regardless whether they are sent from the pediatric neurology department, or from other institute’s neurosurgery departments. We are also open to accepting patients from other countries. 

- In addition to specialised pediatric neurosurgical care, our rare diseases team also have pediatric neurologists, and so they are able to provide the neurosurgical patients with complex care and tracking. 

- The most common illness with which our department deals with is hydrocephalus, we operate on 160-180 premature babies, infants and children suffering from this a year. Hydrocephalus occurs most often in preterm babies, due to ventricular haemorrhage, we have great experience in diagnosing the illness, and in it’s temporary or permanent treatment. The number of patients we treat because of Hydrocephalus is above 1200. 

- Children’s brain tumour operations in Hungary have been done in our department for over 50 years, since the institute was established, we operate on and provide long-term care for an average of 70-90 brain- and spinal tumour patients a year. 

- Surgeries for epileptic patients that can not be drug-treated, take place in our institute, after an appropriate presurgery examination. Our well prepared team perform operations on epileptic patients, with care and under suitable material conditions, our department specialises in postoperative care. 

- We can treat brain and spinal malformations, i.e.: brain and spinal herniation, in the newborn period. An average of 60 patients a year need surgical care due to infant skull malformations ( craniostenosis, scaphocephalia). 

- We care for newborns, infants and children with vein development malformations jointly with the neurointervention team working in our institute. 

In summary, our Institute’s highly experienced, disease appropriate team carry out the children’s neurosurgical care, the departments doctors and nurses cherish and take care of our little patients with great expertise, years of experience and dedication. Our pediatric neurologists are in close relations with European and overseas pediatric neurologists, they participate in the international neurosurgery training program (EANS ) as speakers and further education organisers alike. Our pediatric neurosurgeons and neurologists are in continuous working relationship with the country’s other pediatric neurologists and pediatricians, they participate in the pediatric and child neurology training programs and conferences as speakers. There is ongoing research into everolimus therapy in tuberous sclerosis and the treatment of therapy resistant epilepsy.

Monitoring of patients who have undergone brain- and extensive spinal surgery that require the opening up of the skull, as well as the neuro-intensive treatment of patients needing priority care after having received invasive stroke care. In addition to these, in all other cases when a patient’s condition requires intensive care.  

In our Intensive Therapy Programme our doctors specialising in intensive therapy regard it as their task to monitor and provide support as soon as possible to stabilise the condition of patients in the post-operative period directly after neurosurgical intervention.  

Stroke patients whose condition or planned intervention requires hospitalisation in an intensive care unit are also treated in our programme.  

The special elements of the complex therapy – if necessitated by the patient’s condition – are measuring intracranial pressure, cerebrospinal fluid drainage, inducing artificial coma, continuous 24-hour EEG monitoring, complemented by the invasive monitoring of the circulatory system and permanent mechanical ventilation, for the safe administration of which the most modern equipment is available at our institute.  

At present we have 17 beds for the intensive treatment of our patients, who we keep under 24-hour observation. An anaesthetics-intensive care specialist is continuously available. The work of our experienced doctors is supported by a highly trained healthcare staff.  

In the framework of our Intensive Therapy Programme we place great emphasis on early mobilisation, which - mainly in the case of patients who have already had a stroke – can result in a radical decrease in the occurrence of complications.  

In cases without complications the duration of intensive therapy care is an average of two days, after which patients are generally transferred back to the general neurosurgical wards. Those patients who require longer observation and priority care are treated here as long as they need these types of special care and they are only transferred to an open ward when their condition has been stabilised.

Neurovascular diseases, certain spinal diseases (vertebral collapse caused by osteoporosis), hemorrhagic strokes, ischemic strokes, cerebral- and spinal cord aneurysm, vascular development disorders (angioma, fistula), cerebral and intracranial stenosis, acute vascular occlusion leading to stroke, highly vascularised intracranial tumours, cerebral glomerulus. 

Neurointerventional therapy apllies minimally invazive techniques to treat various vascular disorders of the brain and spinal cord, that may result in stroke, as well as some degenerative or traumatic disorders of the spine. These include subarachnoid haemorrhage, aneurysms, developmenatal malformations of the cerebral and spinal vessels and those in the head and neck area, (such as arteriovenous malformations and fistulae), atherosclerotic narrowing of the arteries supplying the brain, acute occlusion of arteries inside the brain resulting in stroke. Vascular tumors of the spine and head and neck area, painful degeneration of the joints in the spinal column and compression fractures of the vertebrae are also treated with such techiques. Using neuointerventional methods, the above lesions are accessed via natural channels, such as through veins or arteries, making direct opening of the skull or spine unecessary. Our Institute has been one of the pioneers in developing such techniques. The members of our neurointerventional team perform an average of 800 neurointerventional procedures annually and belong to the most experienced specialists all over Europe.  

The majority of our patients are admitted to the Hospital either because they suffered a stroke, or because they have a condition that may result in stroke. Some cases of stroke are associated with bleeding in the cranium, many of those are caused by rupture of a small dilatation of an artery, called an aneurysm. Those aneurysms can be identified by imaging technology and than occluded using neurointerventional techniques. These include accessing the lesion through the arteries of the body using small tubes (called microcatheters) under X-ray control and than occluding the lumen of the dilatation by either packing it with fine metallic coils or covering its orifice by a fine metallic mesh tube from within the artery. Occlusion or narrowing of an artery supplying the brain may block or significantly reduce blood flow towards the supplied territory. The lack of proper oxygen supply will result in cell death and subsequent loss of various neurological functions, such as muscle strenghts, speech capability, vision, etc. If a significant narrowing is found by ultrasound, computer tomography or magnetic resonance imaging, the narrow section of the blood vessel can be dilated by inflating a small balloon inside the narrow section followed by placing a small metallic mesh tube within the reconstructed lumen to keep it properly dilated in the future, thus preventing from occlusion and subsequent stroke. If an artery inside the skull gets blocked, it causes a very serious condition called acute stroke, This necessitates immediate reopening of the occluded vessel, that can be achieved using aspiration or clot removal through the arteries using again small microcathter technology under X-ray control. In such cases, the success mostly depends on time: millions of brain celss die in every minute until blood flow is restored. Subsequently, in acute stroke, it is crucial, that the patient is transferred to an appropriately equipped and staffed stroke institution, such as ours. 

In degenerative spinal disorders, neurointerventional therapy is as effective in improving quality of life as it is in saving lifes in cerebro vascular disorders. Compression fracture of the vertebrae occurs due to traumatic injury or tumor growth within the bone. It is very common in osteoporotic patients, the resulting pain greatly limiting qualitiy of life. By vertebroplasty, the compressed vertebral body is filled with a liquid acrylic material (bone cement) trough a needle. This procedure greatly and quickly reduces the associated pain and allows most patient to get back to an independetnt life within a few days.