Neuro Surgery

Neurosurgery, or neurological surgery, is the medical specialty concerned with the prevention, diagnosis, surgical treatment, and rehabilitation of disorders which affect any portion of the nervous system including the brain, spinal cord, peripheral nerves, and cerebrovascular system.

  • Deep Brain Stimulation
  • Brain Tumor Surgeries
  • Pituitary Surgeries
  • Awake Craniotomy
  • Epilepsy Surgery
  • Gamma Knife

Specialized Treatments

Brain Tumor Surgeries

Brain tumor surgeries are of different types and could be done for both benign and malignant tumors. Traditionally, open surgery approach was followed based on the MRI/CT scans, however, our surgeons at IBS Hospitals use Neuro- Navigation to perform real-time intra-operative guidance during brain surgery.

This increases the safety & precision of the surgery. Neuro- Navigation helps the surgeon to precisely localize the tumor and thus, limits the size of skull opening or craniotomy.

In Neuro- Navigation Guided Craniotomy, you will undergo Navigation screening protocol which assists the surgeon in planning tumor resection. Once you are shifted to the operating room, post anesthesia various fiducial markers are taped to the scalp and the orientation of these markers is used to register the computer containing the brain image. Once registration is completed, the computer can show the relationship of the surgical instruments to the imaged brain. In this procedure, either partial or complete removal of a tumor is undertaken.

In some cases, due to a risk of neurological damage, some part of the tumor may be left behind. In either procedure, a sample of the excised tissue is sent for histopathological examination to find out nature and type (Benign vs Malignant, grade) of the tumor. In most cases, the surgeon can tell if the tumor is likely to grow again based on the type of tumor.

Epilepsy Surgery

Epileptic seizures could be as a consequence of temporal lobe epilepsy (about 80%) or due to various brain conditions such as gliosis, low-grade tumors and vascular malformations in the brain. Overall 70 % of the patients respond to medications but for rest, 30% patient’s surgery is the solution.

Epilepsy surgery is a surgical procedure performed in the brain to control seizures due to above-mentioned conditions and improve the overall quality of life. It is usually considered when medications fail to control seizures.

Temporal lobe epilepsy (partial/localized) is the commonest form of epilepsy for which love resection procedure is done. The brain tissues in the lobe area are cut away to remove the seizure focus. Detailed brain mapping is performed prior to the surgery by our neurologist to ensure that only abnormal tissue is removed. In OT sophisticated technologies such as stereotactic implantation of electrodes is done to remove as little as tissue possible, as safely as possible, to eliminate seizures.

To remove the brain tissue from areas outside of temporal lobe, you would need extratemporal resection. In Corpus callosotomy, a doctor cuts the corpus callosum, which connects two halves of the brain. For children smaller than 13 years, the most preferred procedure is in the form of functional hemispherectomy. In this procedure, the hemisphere is left in place but is disconnected from the rest of the brain.

Pituitary Surgeries

In our centers, our surgeons perform pituitary surgery with three different approaches, based on the best possible outcome criteria. Surgeons would employ Endoscopic trans-sphenoidal surgery, Microscopic sublabial or Microscopic trans-nasal methods for pituitary surgery. Very rarely, open skull-based surgeries (craniotomy), such as supraorbital eyebrow may be performed.

Microscopic pituitary surgery is performed through the nose and sphenoid sinus to remove pituitary tumors. In this procedure, small incisions are made along the nasal septum or under the upper lip. Small surgical drills and other instruments are used to open the boney walls of the sphenoid tissues. Small tools guided by microscope are used to remove tumors.

InEndonasal endoscopic transsphenoidal surgery, an endoscope, a thin fiber-optic tube with a tiny camera at the tip is used to help perform surgery. A small incision is made in the back of the nasal septum. Instruments are passed through the nose and the sphenoid sinus. This approach affords a more panoramic and detailed view than the more restricted “tunnel vision” of a microscope.

The surgery usually takes 2-4 hours, in case the tumor is extending further into the intracranial space such as craniopharyngioma, it may take up to 8 hours. Once in an operating room, you would be anesthetized, positioned, and registration on the neuro-navigation system shall be done. The surgeons (sometimes ENT Surgeon), would reach your sphenoid sinus and thereafter the procedure shall include exposure of Sella and tumor removal. During tumor removal, care is taken to protect the critical surroundings structures such as optic nerves, chiasm, carotid arteries, pituitary gland and pituitary stalk. Once a tumor is removed, the tumor resection cavity is inspected thoroughly to confirm that all or maximum amount of tumor has been removed.

Deep Brain Stimulation

Deep brain stimulation is a surgical process of implanting one or more electrodes in specific regions in the brain to deliver continuous high-frequency electrical impulses to the brain. These electrodes produce impulses which regulate abnormal impulses. The strength of the stimulation, length of each pulse and the number of the pulses per second may be adjusted to individualize the stimulation so that you achieve best results possible. Each electrode is attached to an extension wire that runs under the skin behind the ear and down the neck to an implantable pulse generator (IPG/ pacemaker) which is usually placed under the skin of the upper chest.

Deep brain stimulation is indicated for Parkinson's disease, OCD, and Dystonia. It is performed while you are awake, reducing the risk of damaging critical brain areas that control speech and other skills.

DBS for Parkinson's Disease

Before the procedure, neuro-navigation MRI protocol is done and the same is used to identify the concerned area of the brain to be stimulated.

You would be given local anesthetic on the scalp and thereafter a stereotactic frame is placed on a skull. You would then go to the CT scanner with the doctor with a frame being in place. From there you would be shifted to OT for the procedure.

What symptoms of PD are treated through DBS

  • DBS helps to improve the motor symptoms of PD such as Tremors, rigidity, and bradykinesia.
  • DBS also helps to relive the motor complications of the PD, often related to medications: Dyskinesia, Dystonia and “On/Off” fluctuations
  • DBS will also help in non-motor functions such as Mood, energy level and the general sense of well-being.

Are you a candidate for DBS? Yes if you have:-

  • Had PD for at least 5 years
  • “On /off” fluctuations, with or without dyskinesia
  • Good response to levodopa (though the duration of response is insufficient)
  • Tried various PD medications –without beneficial results.
  • PD symptoms that interfere with daily activities.

Awake Craniotomy

Awake craniotomy is a brain surgery performed while you are awake, reducing the risk of damaging critical brain areas that control speech and other skills. The procedure is generally performed to treat various brain conditions, including some brain tumors, epileptic seizures etc.

Neuro-navigation is used to determine the exact position of incision and exposure of brain. After exposing the brain, speech areas are mapped. While the brain area to be excised is exposed, your surgeon may ask you questions and monitor the activity in your brain as you respond.

The tumor or the culprit area is then removed while the speech test continues. After the tumor or the culprit brain area has been removed, all bleeding is stopped and the thick membrane surrounding the brain is closed with sutures. The bone flap is then replaced with three mini plates.

What Conditions are treated through Awake Craniotomy?

  • Epileptic Seizures
  • Tumors in the speech / vision / motor area of the brain

Complications

  • Bleeding
  • Brain Swelling
  • Infection
  • Seizures
  • Muscle weakness

Gamma Knife

Gamma knife is well established non-invasive treatment method used to treat brain tumors and other conditions of the brain. It is an alternative to traditional brain surgery for the treatment of certain complex brain conditions.

Prior to the actual procedure, a lightweight stereotactic frame is attached to your head and certain MRI/CT imaging is done to pinpoint the target.

Once your imaging has been studied and accurate and very precise individual treatment plan is devised, you are sifted to a treatment room, where you would lie on a bed that slides into the Gamma Knife machine. The machine directs precisely focused beams of radiation to the problem area while sparing healthy tissue. These beams of radiation are positioned in a hemisphere so that all the beams can converge on a single point. The shape and the dose of the radiation are optimized to hit the target tissue and spare the healthy one.

The procedure is silent and painless. You would remain awake during the procedure and would be able to communicate with the doctor and the nurse. The treatment may last from few minutes to an hour depending upon the size of your tumor. Additional medications may be given to you to improve your level of comfort.

Once the treatment is complete your head frame shall be removed.

WHY IBS HOSPITALS

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About IBS Hospitals

Established in the year 2011, IBS Hospitals have managed to create a niche in providing advanced medical care in the field of neurosciences. The Hospital specializes in advanced neurology, neurosurgery, spine surgery and joint replacement surgeries. Our rehabilitation department offers post-surgical and other treatments wherein out rehab team ensures your speedy and healthy recovery.

We also have a separate department for International patients to take care of you throughout your medical journey, we offer various pre-visit services over emails and telephone such as specialists opinion, visa assistance and travel assistance.

With world class infrastructure, dedicated team of specialists, qualified and considerate staff, at IBS you will not only get immediate medical attention but we will also make you feel at home. A smile on our patients’ face while leaving our premises is a reflection of our success.