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Neurosurgery in India

Increasing survival rates for children, and adults experiencing an injury or illness in the nervous system, has resulted in more people with permanently dysfunctional nervous systems. In response, numerous treatments have been developed.
Neurology provides care to patients with diseases of the brain, spinal cord, peripheral nerves, or muscles. Specialists offer diagnostic evaluation, consultation, and management of neurobehavioral and memory disorders, neuromuscular diseases, cerebrovascular disease, movement disorders, seizure disorders, sleep disorders, brain tumors and headache. Research interests of the departments neurologists include Alzheimers disease, Parkinsons disease, multiple sclerosis, molecular immunology, neuronal cell biology, biochemistry and neuropathology.

Gamma-knife radio surgery - Neurosurgery without a scalpel:

Gamma Knife radiosurgery is a type of radiation therapy used to treat tumors and other abnormalities in the brain. In Gamma Knife radiosurgery, specialized equipment focuses close to 200 tiny beams of radiation on a tumor or other target. Although each beam has very little effect on the brain tissue it passes through, a strong dose of radiation is delivered to the site where all the beams meet.
The precision of Gamma Knife radiosurgery results in minimal damage to healthy tissues surrounding the target. In some cases, Gamma Knife radiosurgery may have a lower risk of side effects compared with other types of radiation therapy. Also, Gamma Knife radiosurgery is often a safer option than is traditional brain surgery.
The following conditions can be treated with Gamma-knife:
Parkinsons
Epilepsy
Trigeminal neuralgia
Arterioveous malformation
Essential tremors
Benign tumors
Malignant tumors

Treatments and Surgery Procedures


Gamma-knife radio surgery - Neurosurgery without a scalpel:

Gamma Knife radiosurgery is a type of radiation therapy used to treat tumors and other abnormalities in the brain. In Gamma Knife radiosurgery, specialized equipment focuses close to 200 tiny beams of radiation on a tumor or other target. Although each beam has very little effect on the brain tissue it passes through, a strong dose of radiation is delivered to the site where all the beams meet.

The precision of Gamma Knife radiosurgery results in minimal damage to healthy tissues surrounding the target. In some cases, Gamma Knife radiosurgery may have a lower risk of side effects compared with other types of radiation therapy. Also, Gamma Knife radiosurgery is often a safer option than is traditional brain surgery.

The following conditions can be treated with Gamma-knife:

  • Parkinson's
  • Epilepsy
  • Trigeminal neuralgia
  • Arterioveous malformation
  • Essential tremors
  • Benign tumors
  • Malignant tumors

Brain Tumor Surgery

All type of brain tumors are removed microscopically. Doctors group brain tumors by grade. The grade of a tumor refers to the way the cells look under a microscope:

Grade I: The tissue is benign. The cells look nearly like normal brain cells, and they grow slowly.

Grade II: The tissue is malignant. The cells look less like normal cells than do the cells in a Grade I tumor.

Grade III: The malignant tissue has cells that look very different from normal cells. The abnormal cells are actively growing (anaplastic).

Grade IV: The malignant tissue has cells that look most abnormal and tend to grow quickly. Cells from low-grade tumors (grades I and II) look more normal and generally grow more slowly than cells from high-grade tumors (grades III and IV). Over time, a low-grade tumor may become a high-grade tumor.

Examples of brain tumors operated are

  • Meningiomas
  • Pituitary tumors
  • Glioma
  • Hemangioblastomaependymoma
  • Acoustic tumors
  • Trigeminal neuromas
  • Base of skull tumors
  • Skull tumors
  • Orbital tumors
  • Intra ventricular tumors

Vascular Surgery

Vascular surgery treats the diseases of the vascular system, or arteries and veins and are managed by medical therapy, minimally-invasive catheter procedures, and surgical reconstruction. It is a specialty evolved from general and cardiac surgery as well as minimally invasive techniques pioneered by interventional radiology. The vascular surgeon is trained in the diagnosis and management of diseases affecting all parts of the vascular system except that of the heart and brain.

Surgeries include:

  • Clipping of all type of aneurysms of both anterior and posterior circulation
  • Small to giant aneurysms
  • Surgery of arterio-venous malformations
  • Carotid endarterectomy
  • Arterial bypass surgery

Spinal Surgery

In a spinal surgery, a bone is taken from the pelvic bone or from a bone bank. The bone is used to make a bridge between vertebrae that are next to each other. Spine surgery is typically recommended only when a period of nonsurgical treatment — such as medications and physical therapy — has not relieved the painful symptoms caused by your back problem. In addition, surgery is only considered if your doctor can pinpoint the exact source of your pain, such as a herniated disk or spinal stenosis.

Surgeries include:

  • Spinal tumors vise. bony, extra dural tumors, intra dural tumors, intarmedullary tumor and spinal fixation
  • Microsurgery for cervical and lumbar disc surgery
  • Endoscopic lumbar disc surgery

Pediatric Neurosurgery

Pediatric Neurosurgery provides nurturing care for infants, children and adolescents. It specializes in the evaluation and treatment of children with a range of neurosurgical disorders, such as brain tumors, spasticity, movement disorders, intractable epilepsy, hydrocephalus, craniosynostosis, head injuries, and spina bifida, as well as other cranial malformations and spinal deformities.

Surgeries include:

  • All type of congenital, neoplastic, traumatic, vascular problems
  • Hydrocephalus
  • Craniostenosis
  • Spinal dysraphism
  • Chiari malformations

Types of pediatric brain tumors:

  • Craniopharyngioma
  • Gliomas
  • Ependymoma
  • Medulloblastoma

Endoscopic Brain Surgery

The Endoscopic Brain Surgery is a surgical technique used to remove brain tumors and lesions—some as large as softballs—all through the nose. This minimally invasive approach uses the nose and sinuses as natural corridors to access tumors and lesions in critical areas at the base of the skull or top of the spine. The Endoscopic Approach allows surgeons to treat many hard-to-reach tumors, even those once considered "inoperable", without disturbing the face or skull.

  • Endoscopic transnasal surgery for Pituitary tumors
  • Endoscopic third ventriculostomy for hydrocephalus
  • Intra ventricular tumors - colloid cyst, cysticercus

Endoscopic Disc Surgery

Endoscopic Disc Surgery is a minimally invasive spine surgery technique that utilizes an endoscope to treat herniated, protruded, extruded, or degenerative discs that are a contributing factor to leg and back pain. The endoscope allows the surgeon to use a “keyhole” incision to access the herniated disc. Muscle and tissue are dilated rather than being cut when accessing the disc. This leads to less tissue destruction, less postoperative pain, quicker recovery times, earlier rehabilitation, and avoidance of general anesthesia. The excellent visualization via the endoscope permits the surgeon to selectively remove a portion of the herniated nucleus pulpous that is contributing to the patients’ leg and back pain.

  • Lumbar disc surgery (Band-Aid surgery)

Stereo tactic and Functional Neurosurgery

A stereotactic surgery is a minimally invasive form of surgical intervention which makes use of a three-dimensional coordinate system to locate small targets inside the body and to perform some action on them such as ablation, biopsy, lesion, injection, stimulation, implantation, radiosurgery (SRS), etc.

Functional neurosurgery is concerned with the treatment of conditions where the central nervous system physiology is altered but the anatomy that it may/may not be normal. Examples of conditions treated by functional neurosurgery are chronic pain (including cancer pain and failed back surgery syndrome), spasticity, movement disorders (Parkinson's disease, dystonia, tremor etc.), psychiatric conditions and epilepsy etc.

  • Stereotaxy
  • Deep brain stimulation
  • Pallidotomy and thalamotomy
  • Epilepsy surgery-vagal nerve stimulation

Peripheral Nerve Surgery

The peripheral nerves are outside the brain and spinal cord. Like static on a telephone line, peripheral nerve disorders tend to distort or interrupt the messages between the brain and the rest of the body. They can affect one nerve or many nerves. Some are the result of other diseases, like diabetic nerve problems. Symptoms often start gradually, and then get worse. They include:

  • Numbness
  • Pain
  • Burning or tingling
  • Muscle weakness
  • Sensitivity to touch

Treatment aims to treat any underlying problem, reduce pain and control symptoms.

    Sugeries Include:

  • Surgery of brachial plexus and other peripheral nerves
  • All type of traumatic, neo plastic, entrapment disorders of nerves
  • Carpal tunnel syndrome

Interventional Neuroradiology

Interventional neuroradiology is an evolving specialty for minimally-invasive percutaneous and endovascular treatment of brain and spine diseases. It uses advanced cross-sectional and three dimensional imaging. All these procedures show great promise for improved diagnosis and clinical outcomes.

  • Coiling of aneurysms
  • Embolisation of intracranial and spinal AVMs
  • AV fistulas
  • Embolisation of tumors

Stenting of intra or extra-cranial vessels:

Extracranial vascular disease refers to carotid or vertebral stenosis outside the skull.

Intracranial vascular disease involves the arteries within the skull or at the base of the Skull.

Intra- and extra-cranial stents are placed in stenotic vessels in order to open up and allow free- flow of blood. Atherosclerosis (the hardening and narrowing of the walls of these vessels due to deposits of fats that form plaques within the arteries) is the most common cause of extracranial and intracranial vascular disease. As the plaque deposits gradually enlarge, they interfere with blood flow. Atherosclerosis can affect any large-to-medium-sized artery in the body and cause serious health problems. Surgeries Include:

  • Carotid angioplasty
  • Cerebral
  • Spinal angiography
  • Head and Spine injuries
  • Strokes
  • Aneurysm
  • AV malformations
  • Congenital Disorders like Hydrocephalus
  • Spinal Dysraphisms
  • Spinal Tumors
  • Disc Disorders
  • Treatment of Trigeminal Neuralgias
  • Parkinson's disease
  • Aneurysm coiling
  • Carotid Stenting
  • Angioplasty
  • Neuroendoscopic System

Pain and Spasticity Surgery

Spasticity – it is a muscle control disorder characterized by tight or stiff muscles and the inability to control those muscles. In addition, reflexes may persist for too long and may be too strong (hyperactive reflexes). Imbalance of signals from the central nervous system (brain and spinal cord) to the muscles is the cause of spasticity. This imbalance is often found in people with cerebral palsy, traumatic brain injury, stroke, multiple sclerosis, and spinal cord injury.

  • Radio frequency ablation for trigeminal neuralgia
  • Microvascular decompression for trigeminal neuralgia and glossopharyngeal neuralgia