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Neurosurgery

Brain Surgery

Our expert Neurosurgeons have the expertise and many years of experience in performing complex Neuro surgical procedures and have hands on experience with the latest technological devices used to perform the most sophisticated surgeries.

Our network of hospitals have dedicated state-of-the-art Neurosurgery operation theaters with semi-robotic microscopes, the neuro-navigation facility, cranial and spinal endoscopy, MRI and CT compatible stereotaxy for functional neurosurgery. It assists the surgeons in attaining precision while conducting complex neurosurgeries. Minimal invasive techniques,

There are various medical conditions which necessitate surgery and some of which are:

Stroke/ Brain Attack-

Stroke is the rapidly developing loss of brain function(s) due to disturbance in the blood supply to the brain. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die.

There are three kinds of stroke.

The "Ischemic stroke" which is the more common one, is caused by a blood clot that blocks a blood vessel in the brain.

The "Hemorrhagic stroke" is caused by bleeding of a blood vessel in the brain tissue.

The 'Transient ischemic attacks (TIAs)", occur when the blood supply to the brain is briefly interrupted.

The most common symptoms of a stroke are paralysis of one side of the body, speech and vision impairment, confusion and temporary personality changes.

Surgery is indicated in certain stroke cases either for prevention of future strokes or for repairing damaged or malformed blood vessels.

Brain Aneurysm Surgery

An aneurysm is a localized, blood-filled dilation (balloon-like bulge) of a blood vessel caused by disease or weakening of the vessel wall. It may burst leading to death or stroke and can be corrected by surgery.

Arteriovenous Malformations

Arteriovenous malformations are masses of abnormal blood vessels which grow in the brain. They consist of a blood vessel "nidus" (nest) through which arteries connect directly to veins, instead of through the elaborate collection of very small vessels called capillaries.

Some people are born with the nidus, but as the years go by, it tends to enlarge as the great pressure of the arterial vessels can not be handled by the veins that drain out of it. This causes a large collection of worm-like vessels to develop (malform) into a mass capable of bleeding at some future time.

Carotid stenosis

"Stenosis" means narrowing and Carotid artery supplies blood to the brain. Carotid stenosis is the narrowing of the main carotid artery or its branches supplying the brain It may possibly lead to stroke or a warning 'TIA'

Trigeminal neuralgia

Trigeminal neuralgia is sometimes described as the most excruciating pain known to humanity. The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye. This intense, stabbing, electric shock-like pain is caused by irritation of the trigeminal nerve, which sends branches to the forehead, cheek, and lower jaw. It is usually limited to one side of the face.

Surgery is an effective option for those who become unresponsive to medications.

Hemifacial spasm

Hemifacial spasm is a neuromuscular disorder characterized by frequent, involuntary muscle contractions (tics or spasms) in the face. It usually affects only one side of the face, but in severe cases, tics may occur on both sides. Surgery is often the best cure for this.

Hydrocephalus

The term hydrocephalus is derived from two words: "hydro" meaning water, and "cephalus" referring to the head.

Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles (fluid-containing cavities) of the brain and may increase pressure within the head. Although hydrocephalus is often described as "water in the brain," the "water" is actually CSF, a clear fluid surrounding the brain and spinal cord.

The problem area may be treated directly (by removing the cause of CSF obstruction), or indirectly (by diverting the fluid to somewhere else; typically to another body cavity). Indirect treatment is performed by implanting a device known as a shunt to divert the excess CSF away from the brain

Head injury

A head injury is any trauma that leads to injury of the scalp, skull, or brain. The injuries can range from a minor bump on the skull to serious brain injury. Blood clots ('haematomas') can develop after a head injury and some need to be removed with surgery.

Brain Tumours

Brain tumours can be benign (curable with surgery) or malignant (incurable but controllable with surgery. Although a benign tumour can continue to grow, the cells do not spread from the original site. In a malignant tumour, the cells can invade and destroy surrounding tissue and may spread to other parts of the brain.

Some benign type of tumours are

Acoustic neuromas

Acoustic Neuromas are a kind of tumour at the base of the brain, related to the hearing nerves.

Astrocytoma

Astrocytoma is a type of tumour that originates within the brain tissue itself. It can vary in its behaviour. Some are slow growing and relatively benign, others are fast, more aggressive and prone to do more damage to surrounding tissues.

Low-grade astrocytic tumours are usually slow-growing and are not likely to spread. Grade 1 astrocytic tumours can be removed with surgery, and are unlikely to come back if they have been completely removed. Grade 2 tumours can sometimes be removed but may come back after surgery.

High-grade astrocytic tumours are more likely to grow faster and to spread to other parts of the brain. It is common for the tumour to come back after initial treatment. This is known as a recurrence. Further treatment will probably then be necessary.

Haemangioblastoma

A haemangioblastoma tumour is formed from cells that line the blood vessels, at an early stage of their development. It is almost always a benign tumour, which may be like a cyst (a fluid-filled area), and more than one tumour may be present.

Haemangioblastomas are usually found in the cerebellum, at the back of the brain. They are commonly slow-growing tumours and do not spread to other parts of the brain.

Meningioma

A meningioma is a tumour of the meninges, which are the protective membranes around the brain and spinal cord. A meningioma can start in any part of the brain or spinal cord, but the most common sites are the cerebral hemispheres of the brain. Most meningiomas are benign. Malignant meningiomas are extremely rare.

There are also various other types of tumours in brain which may include Pineal Tumors Pituitary Tumors or tumours of other parts of the brain.

A few Malignant types of tumours are:

Ependymoma

Within the brain and spinal cord, there are nerve cells and also cells that support and protect the nerve cells. The supporting cells are called glial cells. A tumour of these cells is known as a glioma .

Ependymomas are a rare type of glioma. They develop from the ependymal cells which line the ventricles (fluid-filled spaces in the brain), and from the central canal of the spinal cord. They can be found in any part of the brain or spine, and in children are more common in the cerebellum (see diagram).

Ependymomas may occasionally spread from the brain to the spinal cord in the cerebrospinal fluid (CSF). CSF is the fluid that surrounds and protects the brain and spinal cord.

Medulloblastomas

Medulloblastomas are malignant tumours formed from poorly developed cells at a very early stage of their life. They develop in the cerebellum, in a part of the brain called the posterior fossa, but may spread to other parts of the brain.

Very rarely, medulloblastomas may spread to other parts of the body. If they do spread to other parts of the brain, or to the spinal cord, this is usually through the cerebrospinal fluid (CSF) .

Spine Surgery

Our association with the centers of excellence for Spinal surgery in India helps us offer you the latest in spine surgery. The advanced micro-surgical techniques used at these centers to treat complex Brain & Spine disorders

Some of these are cervical disc replacement and the use of expandable devices for lumbar spine fusion, the latest technique in spine care. Another technique called minimally invasive spine surgery, specifically meant to treat spine deformities. With the help of such services, especially minimally invasive spine surgery, the recovery of a patient is reduced to as less as 24 hours.

Various Spinal Surgeries carried out at our network of centers are:

Microscopic lumbar discectomy or decompression
Microscopic anterior cervical discectomy
Endoscopic discectomy
Spinal decompression with or without fusion
Endoscopic fusion of spine
Percutaneous Endoscopic Lumbar Discectomy
Minimally-invasive spinal fusion and advanced instrumentation
Total disc replacement surgery
Spinal deformity correction and stabilization
Endoscopic fusion of spine
Percutaneous Endoscopic Lumbar Discectomy
Vertebroplasty
Kyphoplasty
Posterior spinal instrumentation
Thoracoscopic deformity correction
Posterior correction of Scoliosis or Kyphosis with instrumentation
Thoracoscopic Spinal Surgery with Para spinal abscess drainage
Spine Tumor Surgery
Spine Trauma

Spine and Various Spinal Disorders

The spine is made up of individual bones called vertebrae, which provide support for the spine. These vertebrae are connected in the front of the spine by intervertebral discs that help support the spine and also allow it to move. The many ligaments and muscles that are attached to the back of the spine provide the power for movement.

Few of the common spinal disorders are:

Disc Herniation

Herniation of the nucleus pulposus (HNP) occurs when the nucleus pulposus (gel-like substance) breaks through the anulus fibrosus (tire-like structure) of an intervertebral disc (spinal shock absorber). A herniated disc occurs most often in the lumbar region of the spine especially at the L4-L5 and L5-S1 levels (L = Lumbar, S = Sacral). This is because the lumbar spine carries most of the body's weight. People between the ages of 30 and 50 appear to be vulnerable because the elasticity and water content of the nucleus decreases with age.

Pain resulting from herniation may be combined with a radiculopathy, which means neurological deficit. The deficit may include sensory changes (i.e. tingling, numbness) and/or motor changes (i.e. weakness, reflex loss). These changes are caused by nerve compression created by pressure from interior disc material.

Many patients with back pain, leg pain, or weakness of the lower extremity muscles are diagnosed with a herniated disc. When a disc herniation occurs, the cushion that sits between the spinal vertebra is pushed outside its normal position.

Spondylolisthesis

Spondylolisthesis occurs when one vertebra slips forward in relation to an adjacent vertebra, usually in the lumbar spine. The symptoms that accompany a spondylolisthesis include pain in the low back, thighs, and/or legs, muscle spasms, weakness, and/or tight hamstring muscles. Some people are symptom free and find the disorder exists when revealed on an x-ray. In advanced cases, the patient may appear swayback with a protruding abdomen, exhibit a shortened torso, and present with a waddling gait. Spondylolisthesis can be congenital (present at birth) or develop during childhood or later in life. The disorder may result from the physical stresses to the spine from carrying heavy things, weightlifting, football, gymnastics, trauma, and general wear and tear. As the vertebral components degenerate the spine's integrity is compromised.

Another type of spondylolisthesis is degenerative spondylolisthesis, occurring usually after age 50. This may create a narrowing of the spinal canal (spinal stenosis). This condition is frequently treated by surgery.

Degenerative Disc Disease

The spine is made up of number of vertebral bones stacked one on top of the other. In between the vertebrae are discs which lend mobility to the spine and act as shock absorbers. On the back side, there are two small joints at each levels - called facet joints. This type of structure allows one to bend and rotate in different directions. When the discs wear out, the spine at that particular level does not function normally and the back becomes painful. The degeneration of disc leads to a condition called Degenerative Disc Disease. Whereas large majority of such patients can be treated with painkillers, braces, physical therapy, small percentage of such patients do not respond to non-operative treatment and need surgery.

There are two options in such conditions:

Spinal Fusion

Disc Replacement

In spinal fusion surgery, the disc (which is a soft material between two vertebrae) is removed and the space is packed with bone graft. In due course of time, the bone creates a solid bony bridge across the two vertebrae. By doing away with movement, previously painful segment is made pain free. However, the disadvantage of this procedure is that not only does this takes away normal movements of spine at that particular level but also ultimately leads to degeneration of higher level of spine which were uninvolved earlier on. This thus leads to pain in uninvolved segment over the course of time. Modern innovative operative treatment for Degenerative Disc Disease is - Disc Replacement. After removing the disc, it is replaced by an artificial disc which thus restores movements in that particular segment and also does not make higher motion segment of vertebral column painful in the longer run.

The Artificial Disc is an alternative to spinal fusion for patients who have one or two degenerated, painful discs usually between L4/L5 and L5/S1.

Spinal stenosis

Spinal stenosis is a narrowing of the spinal canal, which places pressure on the spinal cord. If the stenosis is located on the lower part of the spinal cord it is called lumbar spinal stenosis. Stenosis in the upper part of the spinal cord is called cervical spinal stenosis. While spinal stenosis can be found in any part of the spine, the lumbar and cervical areas are the most commonly affected.

It may occur because of spinal degeneration with aging or because of spinal disc herniation, osteoporosis or a tumour. Spinal stenosis may affect the cervical vertebrae|cervical spine, the lumbar vertebra /lumbar spine or both.

Lumbar spinal stenosis results in low back pain as well as pain or abnormal sensations in the legs, thighs, feet or buttocks, or loss of bladder and bowel control.

This can be fairly corrected through the surgery of spine. Various types of surgeries to correct Stenosis are:

Laminectomy - removal of the entire bony lamina, a portion of the enlarged facet joints, and the thickened ligaments overlying the spinal cord and nerves. .
Laminotomy - a small portion of the lamina and ligaments, usually on one side. Using this method the natural support of the lamina is left in place, decreasing the chance of postoperative spinal instability.
Foraminectomy - when the foramin (the area where the nerve roots exit the spinal canal) is removed to increase space over a nerve canal. This surgery can be done alone or along with a laminectomy.
Foraminotomy - removal of bone around the neural foramen - the space between vertebrae where the nerve root exits the spinal canal. This method is used when disc degeneration has caused the height of the foramen to collapse, resulting in a pinched nerve. It can be performed with a laminectomy or laminotomy.
Medial Facetectomy - part of the facet (a bony structure in the spinal canal) is removed to increase the space
Anterior Cervical Discectomy and Fusion - the cervical spine is reached through a small incision in the front of the neck. The intervertebral disc is removed and replaced with a small plug of bone, which in time will fuse the vertebrae.
Cervical Corpectomy - a portion of the vertebra and adjacent intervertebral discs are removed for decompression of the cervical spinal cord and spinal nerves. A bone graft, and in some cases a metal plate and screws, is used to stabilize the spine.
Laminoplasty - a posterior approach in which the cervical spine is reached from the back of the neck and involves the surgical reconstruction of the posterior elements of the cervical spine to make more room for the spinal canal.

Sciatica

The term sciatica is commonly used to describe pain traveling in the distribution of the sciatic nerve Sciatica is a set of symptoms including pain caused by general compression and/or irritation of one of five nerve roots that give rise to the sciatic nerve , or by compression or irritation of the sciatic nerve itself. Sciatica is a symptom caused by a disorder occurring in the lumbar spine.

The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, there may be numbness, muscular weakness, and difficulty in moving or controlling the leg. Typically, the symptoms are only felt on one side of the body.

Spinal cord injury

Spinal Cord Injury refers to an injury of the spinal tissue. Spinal cord injury can occur from many causes, including:

Trauma such as automobile accidents , falls , gunshots , diving accidents , war injuries , etc.
Tumor such as meningiomas, ependymomas, astrocytomas, and metastatic cancer.
Ischemia resulting from occlusion of spinal blood vessels, including dissecting aortic aneurysms , emboli , arteriosclerosis .
Developmental disorders , such as spina bifida , meningomyolcoele , and other.
Neurodegenerative diseases , such as Friedreich's ataxia , spinocerebellar ataxia , etc.
Demyelinative diseases , such as MultipleSclerosis .
Transverse myelitis , resulting from spinal cord stroke , inflammation , or other causes.
Vascular malformations , such as arteriovenous malformation (AVM), dural arteriovenous fistula (AVF), spinal hemangioma , cavernous angioma and aneurysm .

Lumbar Laminectomy

Lumbar laminectomy is a surgical procedure most often performed to treat leg pain related to herniated discs, spinal stenosis, and other related conditions. Stenosis occurs as people age and the ligaments of the spine thicken and harden, discs bulge, bones and joints enlarge, and bone spurs (called osteophytes) form. Spondylolisthesis (the slipping of one vertebra onto another) can also lead to compression. The goal of a laminectomy is to relieve pressure on the spinal cord or spinal nerve by widening the spinal canal. This is done by removing or trimming the lamina (roof) of the vertebrae to create more space for the nerves. A surgeon may perform a laminectomy with or without fusing vertebrae or removing part of a disc. Various devices (like screws or rods) may be used to enhance the ability to obtain a solid fusion and support unstable areas of the spine.