Neurosurgery Treatment & Procedures

1.Craniotomy & Craniectomy

The Carniotomy is a surgical operation in which a portion of bone is temporarily removed from the skull to allow access to the brain so that the disease can be tackled surgically. Craniotomies are undertaken for brain tumors, injuries, aneurysm, arteriovenous malformations or other surgically amenable lesions. These operations are often fraught with serious complications but modern neurosurgeons are equipped with skill and resources to circumvent these complications.

The craniotomy is differentiated from Craniectomy in which the removed portion of the skull is not immediately replaced and scalp is sutured without the underlying bone. This procedure provides space to accommodate brain swelling which may otherwise create life-threatening raised pressure inside the skull.

Traumatic Brain Injury (TBI) occurs when the head gets injured in an accident due to a fall or an assault. The timely operation may be required to save the life or to limit disability by surgically removing blood clots or by performing Craniectomy (see above) to allow the injured brain to swell without raising potentially lethal pressure inside the skull.

There are two main types of stroke, ischemic stroke, and hemorrhagic stroke.

An ischemic stroke occurs when a blood clot prevents blood from flowing to the brain and results in death (infarction) of the affected portion of the brain. If treatment is made available within three hours for this type of stroke, it may be possible in some cases to administer a medication to dissolve the clot. In some other cases, procedures are carried out to physically remove the offending clot through tiny blood vessels of the brain. Sometimes the infarcted brain can rapidly swell and cause a dangerous rise in pressure inside the skull. In these cases, a decompressive craniectomy may be required urgently as a lifesaving procedure.

A hemorrhagic stroke occurs as a result of rupture of a blood vessel in the brain and blood collects into the surrounding brain and adjacent spaces. Haemorrhagic strokes can occur in three situations. Firstly very high blood pressure can cause progressive damage to the small blood vessels in the brain and result in bleeding into the brain tissue. Secondly, an aneurysm, which is an abnormal ballooned out portion of a blood vessel, can rupture and bleed. Thirdly an arteriovenous malformation, which is a bunch of abnormally formed blood vessels, can cause bleeding. Hemorrhagic stroke treatments involve supportive treatment to maintain blood pressure and other vital functions, measures to stop further bleeding in the brain and reduce the ill effects associated with brain bleeding. Surgical procedures include surgical clipping or coiling of the ruptured aneurysm. Surgical Excision, embolization or Gamma Knife therapy is carried out for arteriovenous malformations. Some large clots which are located superficially may require surgical evacuation.

There are several spaces in the brain which are filled with Cerebro-spinal Fluid (CSF). This fluid remains in continuous circulation and is essential for the proper functioning of brain cells. Certain conditions can cause blockage in the flow of CSF resulting in an excessive build-up of CSF (hydrocephalus) leading to potentially lethal raised pressure inside the skull.

CSF diversion procedures are needed to treat excessive build-up of CSF or hydrocephalus. It may be a temporary External Ventricular Drainage (EVD), an endoscopically performed Third Ventriculostomy (ETV) or a CSF shunt. The Shunt procedure commonly entails connecting one of the brain cavities with the abdominal cavity (Ventriculoperitoneal Shunt) via a pressure-regulated unidirectional valve & tubing so that the excess CSF is drained from brain cavities and is absorbed by the lining of the abdominal cavity.

Spinal Cord is lodged in the spinal canal in the vertebral column which is formed by individual bony vertebrae and discs between the vertebrae. Intervertebral discs provide flexibility to the vertebral column. Sometimes these discs can rupture and prolapse causing pressure on the spinal cord or the adjacent roots or nerves. The patient feels pain in the affected region and this pain radiates to the limb. Surgical procedure needed to remove offending disc is called Discectomy.

In the neck region, this operation is safely carried out from the front of the neck and is named 'Anterior Cervical Discectomy'. After removal of the offending disc one may leave the gap as it is, or fill the gap with normal bone (Fusion) or with a metallic or PEEK spacer. These days we fill the gap with the artificial metallic disc (Disc Replacement Surgery) to retain normal mobility at the motion segment.

In the dorsal spine (upper back) the Discectomy procedure can be carried out through the chest (Thoracotomy and Anterior Discectomy) or through the back. In lumbar region (lower back) discectomy is carried out from the back.

Disc surgery is carried out with the aid of Microscope or Endoscopically or by Minimal Invasive Techniques.

The term Prolapsed Intervertebral Disc is generally used as another name for a herniated disc, which is a spinal condition that involves the centre of a spinal disc pushing out through the disc’s outer layer. This condition can produce symptoms such as local neck or back pain, as well as pain, tingling, numbness and muscle weakness in the extremities. If you are dealing with severe neck or back pain, or have been diagnosed with a Prolapsed Intervertebral Disc you should immediately consult the doctor for proper management.

Spinal Stenosis is a narrowing of the spaces within your spine, which can put pressure on the nerves that travel through the spine. Spinal Stenosis occurs most often in the lower back and the neck. Some people with spinal stenosis may not have symptoms. One type of traditional open back surgery for spinal stenosis is called a Laminectomy and Fusion Procedure. This procedure is designed to relieve the pressure on your pinched nerve root and widen the space in your spinal canal while adding stability in the spinal column.

A Brain Aneurysm occurs when a weak spot in your brain’s arterial wall bulges and fills with blood. It may also be called an Intracranial Aneurysm or a Cerebral Aneurysm. A Brain Aneurysm is a potentially life-threatening condition that can affect a person at any age. If a brain aneurysm bursts, it’s an emergency situation that can result in a stroke, brain haemorrhage and even death, if not treated immediately. The patient may require urgent intervention in the form of Clipping/Coiling of the aneurysm. Some people with Brain Arteriovenous Malformations (AVMs) experience signs and symptoms, such as a headache or seizures. AVMs are commonly found after a brain scan for another health issue or after the blood vessels ruptures and cause bleeding in the brain (haemorrhage).

Tumours can start in the brain or elsewhere in the body and subsequently can spread to the brain. Symptoms include new or increasingly strong headaches, blurred vision, loss of balance, confusion and seizures. In some cases, there may be no symptoms. Spine tumours may arise from any of the structures of the spine or the spinal column. They may arise in the cervical (neck), thoracic (mid-back) or lumbosacral (low back) regions. Neck or back pain are common presenting symptoms of spinal cord tumours. Cervical (neck) tumours may cause weakness or numbness in the arms or legs. Thoracic (mid-back) and lumbosacral (low-back) tumours may cause weakness or numbness in the chest area or legs. Difficulty walking is sometimes a complaint. Brain and Spinal tumours invariably need to be removed surgically.

Trigeminal Neuralgia is sudden, severe facial pain. It's often described as a sharp shooting pain or like having an electric shock in the jaw, teeth or gums. It usually occurs in short, unpredictable attacks that can last from a few seconds to about two minutes. The attacks stop as suddenly as they start. In most cases, Trigeminal Neuralgia affects part or all of one side of the face, with the pain usually felt in the lower part of the face. Very occasionally it can affect both sides of the face, although not usually at the same time.

It is the treatment of diseases of the nervous system in which structurally normal appearing nerves behave abnormally. Examples of diseases treated with functional neurosurgery include Parkinson disease and other movement disorders, seizure disorders and some type of chronic nerve pains.

Carpal Tunnel Syndrome (CTS) is a medical condition due to compression of the nerve as it travels through the wrist. The main symptoms are the pain, numbness, and tingling, in the thumb, index finger, middle finger, and the thumb side of the ring fingers. Symptoms typically start gradually and during the night. Weak grip strength may occur.

Spinal Dysraphism is an umbrella term that describes a number of conditions present at birth that affect the spine, spinal cord, or nerve roots. Made up of individual vertebrae (bones), the spine protects the spinal cord. Types include.

Myelomeningocele (also known as Spina Bifida Aperta or Open Spina Bifida), Spina Bifida Occulta, Split Cord Malformation (Diastematomyelia), Spinal Cord Lipoma (Lipomyelomeningocele), Dermal Sinus Tract, Tight Filum Terminale, and Tethered Spinal Cord.