Neurosurgery

SPECIALITIES

The Institute of Neurosurgery at Srikamatchi Medical Centre in Thanjavur is renowned for its highly-skilled neurosurgeons, qualified to perform complex surgical procedures on the brain and nervous system. Our team of surgeons includes internationally reputed Neurosurgery experts, who direct the department towards global standards of medical practice, focusing on the use of minimally invasive techniques and advanced cutting-edge therapies. The hospital is committed to advancing life-changing research in neural disorders and helping the patients who suffer from these conditions. Our comprehensive neurosurgical treatment facilities help us deliver better outcomes and lower recovery time, in addition to the expert use of minimally-invasive techniques. We provide integrated neurosurgical care, and are available on-call 24×7

BRAIN AND SPINE TRAUMA

  • The treatment of brain trauma includes surgery to evacuate the hematoma and removing bone flap to give space for the brain to expand due to edema caused in brain injury. Depending upon the extent of injury, the prognosis of the patient is determined. In Spine trauma, procedures such as stabilization and decompression are done to maintain the spine alignment and to relieve pressure if there are neural structure compression

BRAIN AND SPINE TUMOURS

  • The treatment of brain and spinal tumours has developed greatly in recent years. There are a range of minimally-invasive techniques developed to treat brain and spinal tumours and also promote quicker and less painful recovery. Spinal tumours are of 2 types – Extradural tumours and intradural tumours. Extradural tumours are located outside the Dural sac which covers the spinal cord and fluid. These are usually easier to remove as they are not enmeshed with the spinal cord, hence the surgeon can achieve clean resection margins. Intradural tumours are of two types – Extramedullary and intramedullary. Extramedullary tumours are found inside the dura, but not involving the spinal cord. Intramedullary tumours directly involve the spinal cord. In addition to surgical procedures for tumour removal, the doctors may also employ radiation therapy and chemotherapy to treat the cancer in selective cases.

CRANIOTOMY AND EXCISION OF ALL TYPES OF BRAIN TUMOURS

  • A craniotomy is a surgical procedure to remove a portion of the skull to access the brain. Specialised tools are used to cut a bone flap from the skull. After the brain surgery, the skull flap is replaced and the surgical incision is closed. Craniotomies vary in size and complexity. For endoscopic tumour removal, a small hole called a burr or keyhole is drilled in the skull through which instruments and cameras are inserted. More complex tumour removal procedures may require larger bone flaps to be removed. These could require some skull reconstruction surgery.

BRAIN TUMOUR BIOPSY

  • A brain tumour biopsy is the procedure of extracting a sample of the brain tumour tissue for further laboratory testing. The biopsy helps diagnose the type and grade of brain tumour, which will decide the course of treatment. Most brain tumour biopsies can be done through a small hole drilled in the skull. This is known as a burr hole biopsy. The biopsy extraction takes about an hour or two, after which the sample is sent to the lab for analysis. The lab may take 1-2 days to process the sample and release the results. The biopsy may be performed as an outpatient procedure depending upon the type of brain tumour.
  • Cardiovascular diseases
  • Respiratory diseases
  • Gastrointestinal diseases
  • Disorders of immune system
  • Neurologic disorders
  • Diseases of kidney and urinary tract
  • Disorders of connective tissue and joints

SKULL BASE SURGERY

  • The base of the skull is a sensitive zone, where the skull meets the neck. It houses the cerebellum, an important part of the brain. Tumours in this area could affect a range of functions including balance, hearing, facial paralysis and speech impairment. If the cervical spine is immobilised, traction could be effective in reducing and re-aligning the neck. If traction is ineffective, surgical decompression may be recommended, to relieve pain and reduce pressure. This may be done via an anterior or posterior approach, depending on the specifics of the case. At this time, fusion surgery, with a bone graft or an interbody device may also be done.

SPINE SURGERY

  • Spine surgery indication includes cervical, thoracic, lumbar, sacral and coccygeal spine disorders. The treatment option can either be decompression or fixation. If the spine is immobilised using fixation techniques, traction could be effective in reducing and re-aligning the neck. If traction is ineffective, surgical decompression may be recommended, to relieve pain and reduce pressure. This may be done via an anterior or posterior approach, depending on the specifics of the case. At this time, fusion surgery, with a bone graft or an inter-body device may also be done.

CRANIOVERTEBRAL JUNCTION ANOMALIES

  • The craniovertebral junction consists of the occiput, the foramen magnum and the first two cervical vertebrae that are part of the neck. Craniovertebral junction anomalies can be congenital, developmental or as a secondary symptom of an acquired disease. These abnormalities can cause neck pain, neurological deficits associated with the spinal cord, cerebellum and the lower cranial nerves, and vertebrobasilar ischemia.
  • If the neural structures of the spine are compressed, the neck is immobilised and then reduced with traction. This helps re-align the cranio-cervical junction and reduce pressure on the neck. Surgical interventions for craniovertebral junction anomalies are recommended if traction is ineffective. The surgery aims to relieve neural pressure and realign the vertebrae correctly. The decompression is usually done via an anterior (front) or posterior (back) approach. If the instability persists after decompression, further stabilisation with implants, like rods, screws etc., are used to correct the junction.

VESTIBULAR SCHWANNOMA

  • A Vestibular Schwannoma, also known as an Acoustic Neuroma, is a non-cancerous tumour that develops on the vestibular nerve, connecting the inner ear to the brain. It is usually a slow growing tumour that primarily affects hearing and balance. The tumour is formed due to an overgrowth of Schwann cells, which make up the protective, insulating sheath of the vestibular nerve. Vestibular schwannoma can also affect the facial nerves and cause paralysis on the side of the tumour. As the tumour grows, it may begin to press on the cerebellum and the brain stem and turn fatal. The vestibular schwannoma can be treated with radiosurgery (the “gamma” knife) or with surgical removal of the tumour. If the tumour is small, it may be easier to remove the tumour whilst preserving hearing abilities, balance and normal facial control. As the tumour grows, removal becomes more complicated and could end up resulting in neurological deficits. Early diagnosis is key to a good outcome with surgery. Alternatively, radiosurgery may be used to shrink the tumour. This could make it easier to operate.

MENINGIOMAS

  • A Meningioma is a tumour that forms on the three meninges or membranes surrounding the brain matter and spinal cord, just within the bony structures of the skull and the vertebral column. They usually grow slowly and are non-cancerous. Sometimes meningiomas cause no symptoms and they require no treatment. However, the growth of benign meningiomas can still be dangerous, as they compress various parts of the brain and begin to affect normal neurological function. They can cause seizures, numbness, headaches, blurred vision and speech impairments.
  • A craniotomy procedure is usually performed to remove a symptomatic meningioma. A piece of the skull is opened and the tumour is partially or completely removed. The location of the meningioma will determine the surgical approach taken. If the tumour cannot be reached surgically, it may be treated with radiation therapy. In case of partial surgical removal of the tumour, radiation therapy could be used to stop the remaining portion of the tumour from growing back.

CRANIOPHARYNGIOMA

  • A Craniopharyngioma is a rare brain tumour that occurs near the pituitary gland. The pituitary gland secretes hormones that control key bodily functions and the craniopharyngioma affects these functions. The tumour may occur at any age but is most common in children and geriatric adults. Patients with craniopharyngioma may experience dizziness, headaches, fatigue, excessive urination and changes in vision.
  • Surgical intervention to remove all or most of the tumour is usually recommended for most patients with craniopharyngioma. Total tumour removal is desirable; however, due to the presence of important structures adjacent to the pituitary, this may not always be possible. The procedure may be performed using the open craniotomy technique or a minimally-invasive transsphenoidal (via the nose) technique. Radiation therapy and chemo therapy may also be used, in case of partial removal of the tumour, to kill any remaining tumour cells.

SPECIALITIES