A brain tumour refers to an abnormal mass or space occupying lesion, that develops in the brain as a result of uncontrolled cell division. Depending upon the nature of these cells, they are broadly classified as malignant (cancerous) and benign (non-cancerous). Brain tumours can develop in any part of the brain and while some are not very dangerous, others can prove to be life-threatening.
Symptoms of brain tumour
The symptoms of brain tumours vary from one person to another, depending upon various different factors. These include:
- Persistent headaches
- Weakness on one side of the body
- Generalised body weakness and fatigue
- Feeling nauseated
- Problems with vision, hearing, taste or smell
- Problems in speech and comprehension
- Hormonal changes
- Problems with movement and coordination
- Loss of balance and posture
Treatment
Surgery is one of the first steps of all the treatment modalities for Brain Tumour and it focuses on the complete or partial excision of the tumour. The surgical approach is decided based on different factors that are specific to the patient, such as the location, size, nature and grade of the tumour. Craniotomy is the most common surgical modality used in brain tumour excision. It is done by making an incision on the patient’s skull and accessing the tumour by removing a flap of bone to expose the brain underneath. The flap is replaced post-surgery.
Neurovascular surgery
It is an umbrella term, used for a wide gamut of complex surgical interventions, both traditional and minimally invasive, that aim at treating damaged or malformed blood vessels of the brain and spinal cord. If left untreated, such conditions can lead to life-threatening bleeds and problems related to blood circulation in brain & Spine.
Major indications of neurovascular surgery
Various conditions that may call for the need of Neuro vascular surgery include:
- AVM or Arteriovenous Malformations
- Carotid artery stenosis
- Stroke and transient ischemic attack
- Brain aneurysm
- Spinal aneurysm
- Subarachnoid haemorrhage
- Atherosclerosis of the carotid or vertebral artery
- Dural Arteriovenous Malformation
- Cavernous Malformation
Treatment
Neurovascular surgery is broadly classified into three different types:
- Micro neurosurgery: which is performed with the help of an operating microscope, making it possible to work around small blood vessels and very delicate areas of the brain. This includes procedures aneurysm clipping, excision of AVMs etc.
- Endovascular surgery: offers a minimally invasive approach for treating conditions like aneurysm. The procedure uses catheterization technique, thereby ensuring minimal pain and faster recovery. It includes endovascular interventions like coiling, stenting and embolization.
- Radiosurgery: As the name suggests, involves the use of a Gamma Knife, that uses focussed radiation therapy to treat brain disorders. The technique is highly trusted and effective, ensuring high levels of precision and accuracy.
Integrated management of traumatic brain & Spine injury
Integrated management of traumatic brain injury focuses on offering round the clock, robust neuro-interventions for helping patients suffering from complex traumatic injuries involving the brain and spinal cord. In some cases, multiple injuries may have to be dealt with simultaneously. Trauma management is primarily based on precise judgement, priority based treatment, accurate assessment and comprehensive, yet multi-disciplinary approaches. Post-surgery focus is predominantly laid on holistic rehabilitation, aiming at a better quality of life for the patient.
Different types of traumatic brain & spine injuries
- Coup-contrecoup brain injury
- Brain contusion
- Intracranial Haematoma
- Extradural Haematoma
- Subdural Haematoma
- Skull Fractures
- Second impact syndrome
- Shaken baby syndrome
- Penetrating injury
- Vertebral Body Fractures
- Spondylolisthesis
Common causes of traumatic brain & injuries
- Falling or tripping
- Motor vehicle Collison caused in a road traffic accident
- Sports Injuries
- Joint Replacement
- Domestic violence or child abuse
- Explosion, gunshot or blast
- Being hit by a sharp or blunt object
Treatment
The aim of the surgery is to prevent further damage to the brain and make up for the damage already done. Surgical interventions aim at removing hematomas, extracting dead or damaged tissues, reconstructing or replacing damaged parts, repairing skull fractures and relieving intracranial pressure.
Deep brain stimulation for movement disorders & Functional Neurosurgery
Movement disorder is a term used for a variety of neurological ailments and conditions that affect the patients’ movement, which can be both voluntary as well as involuntary. In some cases, the patient’s movement may be increased, whereas in other it may be reduced or slowed down. Such conditions can drastically reduce the quality of the patient's life making it difficult for them to perform normal day to day activities
Types of movement disorders that can be addressed surgically
- Parkinson’s Disease is a neurodegenerative disorder characterized by chronic stiffness and involuntary shaking, which severely impacts our ability to walk around or maintain proper balance or posture. Parkinson’s disease passes through 5 stages and has no permanent cure. Surgical approach by deep brain stimulation helps to greatly improve the quality of the patient’s life.
- Essential tremor is a term used for various neurological disorders marked by involuntary shaking, which can happen in any part of our body, but is more likely to affect our hands. Just like Parkinson's disease, the shaking is evident when we indulge in some activity such as holding a glass of water, using a remote or mobile e.t.c. Although the underlying cause of essential tremor is not known, some the studies suggest that it could be due to communication error between the cerebellum and other parts of the brain.
- Dystonia is a neurological disorder characterized by involuntary muscle contractions, resulting in twisting movements and abnormal postures. It does not affect any particular area of the body but may vary from person to person and may affect a single muscle, a specific muscle group, or various muscles in different parts of the body.
Treatment
Deep brain stimulation is a new and advance technique that involves the implantation of electrodes in specific areas of the brain to generate electrical impulses. The electrodes are connected to a pacemaker like device that is surgically implanted under the skin in the upper chest with the help of a wire.
Functional Neurosurgery
Epilepsy is a disorder of the central nervous system, marked by abnormal electrical activity of brain, which often gives rise to seizures. Some patients suffering from epilepsy may also experience sudden and frequent onset of unusual behaviour and sensations. The problem can affect people of any age group or gender. At present there is no cure for epilepsy however surgery can help to control the seizures in patients who are not improving on medications or those who have a brain lesion causing epilepsy, which can otherwise lead to severe brain damage in the long run.
Treatment
Patients of epilepsy with refractory seizures (meaning seizures which are not getting controlled on medications) are worked up for the possibility of surgical intervention providing relief to the patient. The site in brain from which seizures are originating is meticulously localised with the help of electrophysiological studies and fMRI imaging studies and the that seizurogenic focus is excised from brain by micro neurosurgical techniques. Sometimes a small lesion such as small tumour or a condition called mesial temporal sclerosis is detected on brain imaging studies which is responsible for seizures is detected. Then it is excised with micro neurosurgical techniques. The dosage and number of medications is decreased or the patient does not need medications at all and his quality of life in vastly improved.
Hydrocephalus
Hydrocephalus is a condition marked by the accumulation of CSF (cerebrospinal fluids) in the various cavities present in the brain. These are commonly referred to as ventricles. As a result of this fluid accumulation, the pressure inside the cranial cavity (in which brain resides) starts to increase, resulting in impairments. These may be development or physical, and may affect intellectual growth. Hydrocephalus is more likely to affect children or adults who are above 60 years of age. The condition could possibly be a result of a blockage, excessive production of cerebrospinal fluid or inability of the blood vessels to absorb the same. Sometimes this may also happen in brain tuberculosis or brain tumours.
Symptoms
The signs and symptoms associated with hydrocephalus may vary from person to person depending upon various factors, including the patient's age
- Toddlers may show symptoms like extreme fuzziness, sleepiness, poor feeding, low muscle tone, seizures and abnormal increase in head circumference
- Older children may experience symptoms like muscle spasms, stunted or delayed growth, loss of coordination, bladder incontinence, persistent headache, nausea and seizures
- Adults may experience problems with vision, memory and concentration, bladder incontinence, walking difficulties, loss of coordination and frequent headaches
Treatment
Presently surgery is the only available treatment option for patients suffering from Hydrocephalus. It aims at the implantation of a shunt in the patient's brain, that helps to divert the fluids to other areas, thereby relieving pressure. A shunt basically has three components - collection catheter which is placed in the cerebral ventricles, a valve mechanism for controlling the flow of cerebrospinal fluids, and an exit catheter that serves as the passage for draining the fluids. The valve mechanism can be programmed to different pressure settings in programmable shunt devices.
Stroke management
Stroke is a serious condition marked by disrupted blood supply to the brain which may be due to a blockage or rupturing of a blood vessel. This significantly lowers the amount of oxygen reaching the brain resulting in the death of the brain cells (neurons). A person suffering from a stroke needs immediate medical intervention. Stroke is primarily categorised into three different types:
- Transient ischemic attack which is marked by the formation of a blood clot in the blood vessels that are responsible for supplying oxygenated blood to the brain which is usually relieved in 24 hours.
- Ischemic stroke which is usually a result of clot or plaque formation in the artery. The stroke lasts longer than TIA and may even be permanent
- Haemorrhagic stroke is a result of the rupture of a blood vessels that causes leakage of blood in the brain.
Symptoms
Stroke can affect any part of the brain and signs and symptoms majorly depend upon the area involved. Some of the common symptoms associated with stroke include:
- Partial or complete paralysis
- Numbness or weakness in the limbs and face.
- Inability to speak or understand what is being said
- Confusion and disorientation
- Inability to respond properly
- Abrupt change in behaviour
- Problems with vision and hearing
- Inability to walk or maintain a proper posture
- Light-headedness or dizziness
- Severe and persistent headache
- Nausea and vomiting
- Seizures
Treatment
The surgical intervention usually depends upon the type of stroke. Ischemic stroke and transient ischemic stroke may call for the need of mechanical thrombectomy, which involves the use of a catheter to pull out the clot from the blood vessel. In case the arterial walls of the patients have become weak, stent placement will be recommended.
In haemorragic stroke the need for surgical intervention may arise if there is mass effect in the form of midline shift in brain suggestive of raised pressure inside cranial cavity. In case of ischemic stroke also there may arise a need for surgery if there is rise in intracranial pressure resulting in shift of midline structures inside the brain.
Why choose Accord Superspeciality Hospital?
- Advanced surgical interventions using state of the art modalities to address the most complex cases with utmost perfection
- Dedicated digital operating rooms for uncompromised precision and accuracy
- Real-time imaging modalities to enhance workflow and improve surgical outcomes
- Advanced modular surgical and intensive care units for uncompromised care
- Comprehensive rehabilitation with professional expertise for early mobilization and rehabilitation
- Highly specialized team of surgeons with immense expertise in the field
- Highly qualified and experienced team of doctors of all medical specialities working as a team under one roof
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