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Neurosurgery
 
Our nervous system is a complex network that coordinates movement, sensory perception and thought processing. Medical conditions that affect any part of the nervous system can be extremely dangerous, crippling and painful; these conditions can only be diagnosed and cured by a highly skilled neurosurgeon. Thankfully, Holy Family Hospital's neurology department is well prepared for the diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the brain, spinal column, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.

Modern neurosurgery uses neuroradiology methods (such as CT scans, MRIs and MEG ie. magnetoencephalography) for imaging and diagnosis, and stereotactic surgery (using the Gamma knife or the CyberKnife) for treatment of nervous tissue that is inoperable though conventional methods. Neurosurgery overlaps with ENT in terms of minimally invasive endoscopic surgery and with cardiology in terms or neuro-interventions, where techniques such as angioplasty, stenting, clot retrieval, embolization, and diagnostic angiography are utilized. Neurosurgeons today, use methods such as Gamma knife and Cyberknife to perform Gamma Surgery.

About Gamma Surgery
Spinal tissue, brain tissue and other tissues of the nervous system are too sensitive and delicate to be operated through conventional surgery, which could result in damage and infection. However, these tissues may become diseased or develop tumors and require surgery. In such cases, a gamma knife is used. The Gamma Knife (sometimes known as the Leksell Gamma Knife) is not really a knife, it is instead a non-invasive procedure that allows neurosurgeons to operate on inoperable brain and spinal tissue by focusing high intensity gamma radiation, over a small volume.

To perform this surgery, the patient wears a helmet like device, which has 201 metal cylinders called collimators, that focus individual beams of ionized cobalt 60 to a particular spot. Thus, powerful doses of radiation can be used to target and treat diseased tissue while leaving surrounding tissue intact. This state-of-the art technology allows physicians to operate on brain lesions often considered inoperable; giving new hope to patients with brain tumors, vascular malformations and functional disorders.

Commonly treated conditions are:
  • Chiari Malformations
  • Spinal disc herniation
  • Spinal stenosis
  • Hydrocephalus
  • Head trauma (brain hemorrhages, skull fractures, etc.)
  • Spinal cord trauma
  • Traumatic injuries of peripheral nerves
  • Brain tumors
  • Infections and infestations
  • Tumors of the spine, spinal cord and peripheral nerves
  • Cerebral aneurysms
  • Stroke, including hemorrhagic stroke and ischemic stroke
  • Intracerebral hemorrhage, such as subarachnoid hemorrhage, intraparenchymal, and intraventricular hemorrhages
  • Pharmacologically resistant epilepsy
  • Movement disorders (advanced Parkinson's disease, chorea) this involves the use of specially developed minimally invasive stereotactic techniques (functional, stereotactic neurosurgery) such as ablative surgery and deep brain stimulation surgery )
  • Intractable pain of cancer or trauma patients and cranial/peripheral nerve pain
  • Malformations of the nervous system
  • Carotid artery stenosis
  • Vascular malformations (i.e., arteriovenous malformations, venous angiomas, cavernous angiomas, capillary telangectasias) of the brain and spinal cord
  • Peripheral neuropathies such as Carpal Tunnel Syndrome and ulnar neuropathy
  • Congenital malformations of the nervous system, including Spina bifida and Craniosynostosis
Interesting Case Studies

Three complex and interesting cases were operated at Holy Family Hospital. All the patients have done well following the surgery.

  1. Ten year old boy with a giant brain tumour (brainstem glloma)
  2. One of the rare cases at Holy Family Hospital, neurosurgeons removed a large brain tumour from a ten year old child. The tumour was located in a complex place (the brainstem). This boy presented with headache, vomiting and imbalance while walking. The tumour was removed with the aid of a microscope. Biopsy has been reported as pilocytic astrocytoma that carries a favourable prognosis. Thank you to those who prayed, child has made an excellent recovery.

    Neurosurgery

  3. Fourteen year old boy with paraplegia and tuberculosis of spine
  4. This boy presented with severe excruciating back pain and diagnosed to have lesion in the thoracic spine. CT guided biopsy was done and showed features of tuberculosis. However, he developed weakness of both legs and became bed bound. The boy was operated the next day, during which decompression of the spine followed by fixation was done. The child has made significant improvement and is able to walk independently.

    Neurosurgery

  5. Fifty year old lady with severe facial pain - Trigeminal Neuralgia
  6. The lady presented with severe right side facial pain that was so debilitating that she was not able to smile, eat, drink and sleep. Despite being on medication, her pain persisted.

    A detailed workup showed trigeminal neuralgia, an extremely painful condition which occurs due to anamolus position of an artery in the brain with respect to the nerve that carries sensations to the face (trigeminal nerve). After comprehensive discussion and considering various options, minimally invasive keyhole surgery was offered. She underwent microvascular decompression, following which she had 'instantaneous' relief from the pain. Surgery lasted two hours and involved fine handling of extremely delicate nerves and arteries.

    She was back to her smiling self and discharged in absolute painless condition.

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