Neurosurgery
Neurosurgery is the branch of medicine that involves surgical treatment of diseases and injuries to the brain, spinal cord, peripheral nerves and arteries in the neck. Uday Hospital offers a full range of neurosurgical services, including cerebrovascular surgery, radiosurgery, epilepsy treatment, spine and spinal cord surgery, pediatric neurosurgery, brain tumor surgery and the treatment of trigeminal neuralgia and hemifacial spasm. Our team of surgeons, nurse practitioners, support staff and rehabilitation therapists are committed to providing the most technically superb, compassionate and timely care.
Surgery is the first and most common treatment for most patients at uday Hospital Comprehensive Brain Tumor Center. Brain tumor surgery can provide:
The complete removal (resection) of some brain tumors
Partial removal of tumors near sensitive areas of the brain to relieve symptoms and facilitate or increase the effectiveness of other treatments
A biopsy — a surgical procedure to remove a small sample of a brain tumor for examination under a microscope — is usually performed during surgery to remove the tumor. A biopsy enables doctors to confirm the diagnosis and recommend the most appropriate treatment.
Better quality of life: Less pressure within the skull can mean reduced symptoms and improved ability to function (e.g., to think, speak or see better)
The challenge of brain tumor surgery is removing as much of the tumor as possible without severely damaging normal brain tissue, which demands skill and experience, as well as advanced technology and a well-orchestrated team.
Neurosurgeons at udayHospital Comprehensive Brain Tumor Center perform surgery on hundreds of patients with brain tumors every year. They use the latest and most advanced imaging and surgical techniques to precisely plan and perform surgery using the least invasive approach possible.
The Comprehensive Brain Tumor team also works closely with neuroanesthesiologists (doctors who specialize in using pain-blocking techniques or medications during neurosurgery) ensuring that each patient receives the most appropriate type of anesthesia for the specific brain tumor and optimal anesthesia care during the procedure.
Functional Neurosurgery involves providing comprehensive evaluation and treatment for patients with movement disorders such as Parkinson’s disease, essential tremor, dystonia, epilepsy, hemi-facial spasms, medically refractory depression and certain chronic pain syndromes. The majority of patients with these disorders can be effectively treated with medications. However, some patients either don’t respond to medication or initially respond to medication that eventually becomes ineffective. For patients like this, who are medically refractory, deep brain stimulation surgery is a treatment option.
In deep brain stimulation procedures, electrodes are implanted into specific targets in the brain and then connected to a pacemaker device that is implanted underneath the collarbone. This provides continuous electrical stimulation to the affected areas of the brain resulting in improvement in the symptoms of these movement disorders.
The overwhelming majority of patients who undergo deep brain stimulation surgery experience a very significant improvement in their symptoms and a very significant improvement in quality of life. A successful deep brain stimulation program requires the cooperation of numerous different medical specialties including neurosurgery, neurology, neuropsychology, radiology and anesthesiology.
At uday Hospital, our mission is to provide each patient with individualized care in a unique combination of compassion and world-class technical therapy. Working together with a variety of experts, a team approach is utilized in order to meet the needs of each individual patient while providing state of the art surgical treatments.
Epilepsy surgery is a procedure that removes an area of the brain where seizures occur.
Epilepsy surgery is most effective when seizures always occur in a single location in the brain. Epilepsy surgery is not the first line of treatment but is considered when at least two anti-seizure medications have failed to control seizures.
A number of pre-surgical tests are necessary to determine whether you’re eligible for epilepsy surgery and how the procedure is performed. Epilepsy surgery may be an option when medications do not control seizures, a condition known as medically refractory epilepsy or drug-resistant epilepsy. The goal of epilepsy surgery is to stop seizures or limit their severity with or without the use of medications.
Why it’s done
Poorly controlled epilepsy can result in a number of complications and health risks, including the following:
Physical injuries during a seizure.
Drowning, if the seizure occurs during a bath or swimming.
Depression and anxiety.
Developmental delays in children
Sudden death, a rare complication of epilepsy
Worsening memory or other thinking skills
Types of epilepsy surgery
Epileptic seizures result from abnormal activity of certain brain cells (neurons). The type of surgery depends on the location of the neurons that start the seizure and the age of the patient. Types of surgery include the following:
Resective surgery, the most common epilepsy surgery, is the removal of a small portion of the brain. The surgeon cuts out brain tissues in the area of the brain where seizures occur, usually the site of a tumor, brain injury or malformation. Resective surgery is most often performed on one of the temporal lobes, an area that controls visual memory, language comprehension and emotions.
Laser interstitial thermal therapy (LITT) is a less invasive surgery that uses a laser to pinpoint and destroy a small portion of brain tissue. Magnetic resonance imaging (MRI) is used to guide the laser the surgeon uses.
Deep brain stimulation is the use of a device — permanently implanted deep inside the brain — to release regularly timed electrical signals that disrupt abnormal, seizure-inducing activity. This procedure is also guided by MRI. The generator sending the electrical pulse is implanted in the chest.
Corpus callosotomy is a surgery to completely or partially remove part of the brain that connects nerves on the right and left sides of the brain (corpus callosum). This is usually used with children who experience abnormal brain activity that spreads from one side of the brain to the other.
Hemispherectomy is a procedure to remove one side (hemisphere) of the folded gray matter of the brain (cerebral cortex). This surgery is generally reserved for children who experience seizures that originate from multiple sites in one hemisphere, usually the result of a condition present at birth or in early infancy.
Functional hemispherectomy is a procedure primarily used in children that removes the connection nerves without removing actual pieces of the brain.
Neuronavigation is a computer assisted technology that enables neurosurgeons to visualize the anatomy of a patient’s brain or spine during surgery. The navigation system, works much like a GPS system guided by infra-red beams. It helps the surgeon by accurately localising important anatomical structures, such as arteries and nerves, which may not be visible directly even under the microscope.
Navigation can also help make approaches through the skull bone safer, enabling the surgeon to plan the surgery sparing important normal brain structures. In approaches to areas where tumour has altered the normal anatomy, navigation can help the neurosurgeon to operate accurately. Ear, nose, and throat (ENT) surgeons can also use navigation as an aid for nasal, paranasal, and operations involving parts of the hearing mechanism in the inner ear.
The use of neuronavigation provides real time guidance to the neurosurgeons during all stages of the surgery – planning the surgery, performing the surgery and confirming adequacy of surgery (confirming that the tumor is removed completely).
Advantage of use of Neuronavigation:
Maximizes the precision and efficacy of surgery
Minimizes the damage to normal structures
Increases the safety profile of the surgery
Reduces the duration of surgery
Enable operation through smaller openings lowering the incidence of wound infections
Minimizes pain and scarring
Shorter hospital stay
More patient comfort
Currently, neuronavigation is used primarily for interventions requiring millimetric precision: surgery for brain tumors in complex regions of the brain and skull base, epilepsy surgery, circulatory abnormalities of the cerebrospinal fluid (fluid within the brain), ENT surgeries and certain interventions on the spine.
At uday Hospital, our neurosurgeons use the most modern Stealth station neuronavigation system which helps in planning a surgical approach to the targeted lesion with precision, confidence and safety, avoiding areas of the brain that directly control function during tumor surgery.
Damaged, injured or malformed blood vessels can cause bleeding or circulation problems that can result in strokes, headaches and other symptoms.
Neurovascular surgery uses open or minimally invasive surgical techniques to treat problems with the blood vessels of the brain or spine and spinal cord.
Uday Hospital is a widely recognized referral center for the treatment of neurovascular disorders. Our team of neurosurgeons, neurologists, diagnostic and interventional neuroradiologists, neurointensivists and neuroanesthesiologists provides highly specialized care from outpatient evaluation, diagnosis and treatment for these disorders.
Conditions that neurovascular surgery evaluates and treats include:
Arteriovenous malformations of the brain and spine
Atherosclerotic disease of the blood vessels of the neck and brain
Brain hemorrhage
Carotid dissection
Carotid stenosis
Cavernous vascular malformations (cavernomas)
Cerebral aneurysm
Dural arteriovenous fistulae
Idiopathic intracranial hypertension
Intracerebral hemorrhage
Pseudotumor cerebri
Spinal aneurysm
Stroke
Subarachnoid hemorrhage
Vasospasm
Our neurovascular surgeons are skilled at managing a variety of complex conditions, including aneurysms, hemorrhagic strokes, vascular malformations of the brain and skull base tumors. Our surgeons have access to the latest technologies and perform the most advanced surgical procedures, to give patients the best care possible. Our specialists believe in multidisciplinary discussion of each patient’s case and to develop a treatment plan based on individual needs. Whenever possible, our surgeons choose minimally-invasive surgery.
Endovascular Therapy
Sometimes called neurointerventional neurosurgery or interventional neuroradiology, endovascular therapy relies on minimally invasive treatment procedures coupled with advanced imaging techniques to deliver care to the nervous system. Typically catheter-based, these procedures treat aneurysms, stroke and other blood vessel conditions in the head, neck and spine. This minimally invasive approach often offers faster recovery times and lesser risks when compared to open surgery, but it is only appropriate for some conditions.
Endovascular procedures include:
Coiling and/or stenting for cerebral aneurysms
Flow diversion
Endovascular embolization of aneurysms, fistulas or tumors
Embolization of vascular malformations
Carotid stenting with angioplasty
Thrombectomy for acute stroke
Balloon angioplasty
Intraarterial therapy for vasospasm
Embolization for nose bleeds
Open Neurovascular Surgery
Some diseases, including some aneurysms or vascular malformations, require an open surgical approach that allows the surgeon to directly repair the problem. In these cases, open surgery is a safer and more effective method compared to the minimally invasive alternatives.
Common conditions treated with open neurovascular surgery include:
Aneurysm clipping
AVM or fistula resection
Cavernoma resection
EC-IC bypass surgery
Microvascular decompression
Moyamoya
Cerebral revascularization for tumors
Stereotactic neurosurgery involves mapping the brain in a three dimensional coordinate system with the help of MRI and CT scans and 3D computer workstations. Neurosurgeons can then accurately target any area of the brain using its 3D coordinates. Stereotactic neurosurgery broadly is classified into stereotactic biopsy and stereotactic brain surgery.
“Stereotactic biopsy” is a surgical procedure where a thin needle is inserted into the brain by a neurosurgeon to extract a small piece of tissue to examine under a microscope. The goal of this procedure is to diagnose an abnormality seen on an MRI or CT scan. While MRI and CT scans are very good at showing parts of the brain that are abnormal, they can’t yet tell us with 100% certainty what an abnormality represents – a cancerous tumor, a benign tumor, an infection, an inflammatory process, a vascular abnormality, or other pathology. Because the treatments for these abnormalities are so different, it is important to determine what a lesion is so that appropriate treatment can be recommended.
For aframeless biopsy, you will be asked to get a special MRI or CT one or two days before the planned biopsy. This image is imported into a computer system that provides us with a 3-dimensional image of your brain and our biopsy target while we are in the operating room. We use this image, along with a biopsy guidance arm to guide our needle safely into the tumor target.
For aframe based biopsy, we attach a device known as a stereotactic frame to your head before obtaining the MRI or CT scan to be used with the image guidance system (picture). The frame is particularly useful for guiding the biopsy needle to small targets, or targets that are deeper in the brain. Both approaches have the same safety and success record. For both frame and frameless biopsies, a small incision is used and a small hole is drilled in the skull to allow the needle to pass through to the target. At the end of the operation the needle is removed and the incision is sutured or stapled closed. The operation can be done either with general anesthesia where you are asleep or with sedation where you are drowsy, but not fully unconscious.
“Stereotactic brain surgery” is a surgical procedure where lesion, frequently a brain tumor, is removed with assistance of image guidance, that is previously obtained images (usually an MRI) are used to guide the surgeon to the exact location of the lesion to facilitate as accurate a pathway through the brain and safe removal of as much abnormal tissue as possible while leaving normal, healthy brain relatively intact.
The greatest advantage of stereotactic procedures is the millimetric precision with which abnormalities located even deep inside the brain can be targeted using a thin needle. The operation can be done either with general anesthesia or with sedation. Patients are monitored for several hours following the procedure and usually go home within a day.
Uday Hospital is equipped with a state-of-the art CRW stereotactic system, which in combination with the 3.0 Tesla MRI and Multislice CT systems, ensures precision of the highest order during stereotactic procedures
Neuroendoscopy is a minimally-invasive surgical procedure in which the neurosurgeon operates through small holes (of a few millimeter diameter) in the skull or through the mouth or nose. Neuroendoscopy enables neurosurgeons to:
Access areas of the brain that cannot be reached with traditional surgery
Remove the tumor without cutting or harming other parts of the skull
Neuroendoscopy utilizes small, flexible, lighted tubes called endoscopes to visualize various parts of the brain, skull base, or spinal cord through small openings. Endoscopes serve as small microscopes, magnifying critical anatomical structures so the surgeon can easily see the various diseased areas requiring repair, removal, or replacement. The surgery is performed while looking at a monitor which displays magnified real-time video from the endoscope. The rest of the surgery is done with the similar techniques as to open surgery, but requires the use of special instruments and allows for less retraction and chance of injury to the brain.
Because the use of endoscopes is much less intrusive into these anatomical structures than is conventional surgery, endoscopic neurosurgery is referred to as minimally invasive neurosurgery. For example, endoscopic neurosurgery in general does not require large incisions on the scalp or skull, or extensive dissection through brain tissue. The result is a faster and simpler procedure with greatly reduced post-operative complications, faster recovery, and less pain and scarring. The actual removal or repair of the problem is done as effectively, safely, and completely as with conventional “open” surgery.
Intracranial Surgery: In intracranial surgery, endoscopes are introduced into the brain through very small skull openings, following which tiny instruments may be placed through the same opening for the purpose of performing endoscopic tumor biopsy, colloid cyst resection, and endoscopic cyst fenestration, as well as to treat hydrocephalus. Operations can last from about 15 minutes to an hour, and patients are typically discharged the next day from the hospital.
Endonasal Neurosurgery: Endonasal (through the nose) neurosurgery is frequently performed to treat a range of conditions, included among which are pituitary tumors, meningiomas and chordomas. The surgeon is able to maneuver the endoscope to different areas, which allows treatment of brain tumors in different locations. The surgeon can also direct the endoscope downward and clearly see the palate and the back of the throat to operate on the top of the spine and base of the skull. Patients are typically discharged between two and four days after surgery, depending on size of the tumor and overall functioning.
Advantages of Neuroendoscopic Surgery:
While each patient’s medical history, age, condition and other factors play a role in the outcome of endoscopic brain surgery, here are some of common benefits associated with the procedure:
Minimally invasive (results in less pain for the patient)
Faster recovery time than open brain surgery
Reduced risk of brain trauma
Reduced risk of side effects
Reduced hospital stay
Conditions treated by neuroendoscopy include:
Obstructive Hydrocephalus
Intraventricular tumors
Pituitary tumors
Rathke’s cleft cysts
Skull base tumors
Pineal region tumors
Stereotactic radiosurgery (SRS) is a highly precise form of radiation therapy. It uses sophisticated 3D imaging technology to target a narrow X-ray beam for delivery of a highly concentrated dose of radiation to the affected area. It fundamentally works in the same way as other forms of radiation treatment. It does not actually remove the tumor; but, damages the tumor cells. As a result, these cells lose their ability to reproduce. Following treatment, benign tumors usually shrink over a period of 18 months to two years. Many tumors will remain stable and inactive without any change. Since the aim is to prevent tumor growth, this is considered a success. When treated with SRS, arteriovenous malformations (AVMs) may begin to thicken and close off slowly over a period of several years following treatment.
Despite its name, SRS is a non-surgical procedure and does not involve incisions (cuts) on the body. The radiation dose is delivered with accuracy of a few millimetres. The high precision of the technology permits delivery of maximum radiation dose to the target area in lesser number of sessions, while minimizing dose to the surrounding healthy tissue. The goal is to deliver doses that will destroy the tumor and achieve permanent local control, while minimizing the side effects of radiation on the normal brain. Radiosurgery treatments are similar to having an x-ray. The patient will not be able to see, feel or hear the x-rays. In most cases, radiosurgery patients can resume all of their normal activities within one or two days.
Uday Center partners with the CyberKnife system at Omega Hospitals to provide the best technology and clinical protocols into stereotactic radiotherapy services for its patients. The CyberKnife System is a unique, robotic system designed to deliver high-precision radiosurgical procedures. It is the only fully robotic radiation delivery system. The robotic design, coupled with real-time imaging, enable the CyberKnife System to deliver a maximum dose of radiation directly to the tumor from many different angles with sub-millimeter precision. The CyberKnife System does this by tracking and automatically adjusting for tumor or patient movement during treatment to minimize radiation exposure to healthy organs and tissues.
This technology makes it possible for neurosurgeons to reach the deepest recesses of the brain and correct disorders not treatable with conventional surgery. Since there is no incision, surgical risks such as infection are not an issue, and there is little discomfort. Adult patients may be lightly sedated but are awake throughout the procedure. Hospitalization is short and at most, requires an overnight stay. The majority of patients are treated on an outpatient basis. As a result, patients experience less discomfort and have much shorter recovery periods than having undergone conventional surgery.
Potential benefits of the CyberKnife system include:
No need for immobilization
No incision
No pain
No anesthesia or hospitalization
Greater comfort (patient can breathe normally during treatment)
Little or no recovery time
Immediate return to normal activities
Stereotactic radiosurgery may be used for selected cases of benign brain tumors (such as acoustic neuromas, meningiomas, pineal tumors, pituitary tumors), malignant brain tumors (such as astrocytomas), metastatic brain tumors, brain vascular malformations, trigeminal neuralgia and other functional procedures.
Minimal Invasive Spine Surgery(MISS) is a group of techniques for effective spine surgery, without the large surgical incisions associated with traditional open spine surgery. In MISS specialized instruments called as tubular retractors are used to access the spine through small incisions. The tubular retractor is inserted through the skin, soft tissue and muscle down to the spinal column.
Despite its name, SRS is a non-surgical procedure and does not involve incisions (cuts) on the body. The radiation dose is delivered with accuracy of a few millimetres. The high precision of the technology permits delivery of maximum radiation dose to the target area in lesser number of sessions, while minimizing dose to the surrounding healthy tissue. The goal is to deliver doses that will destroy the tumor and achieve permanent local control, while minimizing the side effects of radiation on the normal brain. Radiosurgery treatments are similar to having an x-ray. The patient will not be able to see, feel or hear the x-rays. In most cases, radiosurgery patients can resume all of their normal activities within one or two days.
This creates a tunnel right down to the area where the problem is with minimal injury to normal tissue and muscle and negligible blood loss as compared to the traditional open spine surgery. Any bone or disc material removed exits through the retractor, and any device necessary for the fusion such as screws and rods are inserted through the retractor. At the end of the procedure, the tubular retractor is removed and the muscles return to their original position as before. As there is less trauma to the normal tissue there is less pain after the surgery and faster complete recovery.
These surgeries can be done under local anaesthesia in the awake and alert patient. It is very safe, injures no normal structures and is almost scarless. The patient can walk very early after the surgery and most often can go home even the same day of surgery.
Minimally invasive surgery is available for a number of spinal disorders, ranging from degenerative diseases to spinal tumors. State-of-the-art instrumentation designed specifically for these procedures allow for improve visualization and safe surgical access.
Advantages of MISS include:
The neurosurgeons at uday Hospital have extensive training and experience in non-surgical and surgical treatments, as well as minimally invasive spinal techniques, which have the potential to greatly benefit patients.
Minimal Invasive Spine Surgery(MISS) is a group of techniques for effective spine surgery, without the large surgical incisions associated with traditional open spine surgery. In MISS specialized instruments called as tubular retractors are used to access the spine through small incisions. The tubular retractor is inserted through the skin, soft tissue and muscle down to the spinal column.
Maintaining the health and proper interaction of the spine, spinal cord and nerves are critical to leading a normal life. Unfortunately, spinal disorders are extremely common. Whether it is a backache or pinched nerve, nearly everyone will experience a spinal condition at some point in their life.
At Citi Neuro Centre, we are dedicated to helping people with spinal disorders, lead pain free and healthy lives again. We provide comprehensive spine and neck surgery and spine care, from initial diagnosis through medical and non operative treatments, surgery, post-treatment and rehabilitation.
We treat all types of back, neck, spine, and spine-related disorders—from the more common to the most complex. We specialize in upper, mid, and lower back pain; spinal deformity; and scoliosis. We also have experts that treat spine fractures, spinal cord injuries, and tumors of the spine.
Our neurosurgeons offer the full menu of advanced treatment options to treat the entire range of spinal conditions, including:
Degenerative disc conditions, including osteoarthritis
Degenerative spine conditions
Spinal stenosis
Spondylolisthesis
Tumors of the spine
Cervical compressive myelopathy
Disc herniation of back or neck
Failed back syndrome
Infections of the spine
Osteoporosis and fractures
Scoliosis
Trauma of the spine
Vascular problems of the spine
Spinal congenital anomalies
Neurofibromatosis of the spine
Our spine surgery team frequently works side by side with other specialists, including orthopaedic surgeons, pain management specialists and neurologists, to achieve the best possible outcome for each patient. Our team also offers endoscopic and computer-assisted surgery to improve the safety and precision of spine surgery.
