The brain and spinal cord together form the central nervous system. This complex system is part of everything we do. It controls the things we choose to do, Thus a small disorder can be of grave danger to one’s life. Neurosurgery is considered the special realm of some of the world’s most respected surgeons.
Disorders of the nervous system such as dementia, epilepsy, movement disorders, chronic pains, sleep disorders, headaches, multiple sclerosis and various other neuro-muscular diseases are effectively handled here
Surface Brain Tumor Neurosurgery
Meningiomas or surface brain tumors are the second most common primary tumors affecting the central nervous system. Meningiomas grow from cells of the middle layer of the meninges (the three membranes enveloping and protecting the brain and spinal cord). They often are found at the surface of the brain near the top of the head, at the base of the skull, and along the spinal cord.
Common symptoms include: Headache, Nausea and/or vomiting, seizures, muscle weakness, loss of movement or sensation in a specific area, confusion, changes in mood and sleep, vision problems like blurriness or double-vision, hearing loss and slurred speech
Diagnosis is by MRI and neuro vascular angiography. Sometimes a CT scan is obtained to evaluate whether there is any bone (skull) involvement, or if the tumor is calcified.
Treatment plans involve observation and neurosurgery. In some patient where tumors are very small and asymptomatic or where patient’s age is advanced and surgery is risky doctor may choose to observe and provide symptomatic treatment for pains and seizures.
Neurosurgery for meningiomas may vary from relatively straightforward to highly complex, sometimes requiring multiple surgeons from different specialties. In neurosurgery, the ease of removal depends upon both their accessibility and the skill of the neurosurgeon.
Arteries carry blood containing oxygen from the heart to the brain, and veins carry blood with less oxygen away from the brain and back to the heart. When an arteriovenous malformation (AVM) occurs, a tangle of blood vessels in the brain or on its surface bypasses normal brain tissue and directly diverts blood from the arteries to the veins.
Symptoms may vary depending on where the AVM is located and may cause Intracranial haemorrhage, Focal or generalised seizures, Localised pain in the head due to increased blood flow around an AVM.
Most AVMs are detected with either a computed tomography (CT) brain scan or a magnetic resonance imaging (MRI) brain scan.
If patient is asymptomatic or if the AVM is in an area of the brain that can’t be easily treated, medical management may be indicated and no surgical intervention may be required. If an AVM has bled and/or is in an area that can be easily operated upon, then surgical removal may be recommended. It may be possible to treat part or all of the AVM by placing a catheter inside the blood vessels that supply the AVM and blocking off the abnormal blood vessels with various materials and this is called endovascular neurosurgery. Vascular neurosurgeons specialize in surgically removing brain AVMs
Aneurysms may be caused due to high blood pressure and atherosclerosis, trauma, heredity, and abnormal blood flow at the junction where arteries come together.
A brain aneurysm may be diagnosed by doing a CT Scan or cerebral angiogram.
In most cases aneurysms are observed without any surgical intervention. However if the doctor sees significant risk of rupture the aneurysm bay be treated by embolisation or surgical clipping. Embolisation involves inserting a small tube into the affected artery and placing it near the aneurysm. Soft metal coil or a mesh is then moved into the tube reducing the risk of rupture of the artery. Clipping involves placing a small metal clip around the base of the aneurysm decreasing the pressure and hence reducing the risk of rupture. Both these procedure should be done in a large hospital for neurosurgery in India where many procedures like these are done.