One of the most significant specialities in medicine is neurosurgery. It is associated with diagnosis, surgical treatment, prevention & rehabilitation of clinical disorders related to any portion of the nervous system which includes the brain, spinal cord, central & peripheral nervous system, and cerebral vascular system. Neurosurgery is a complicated process, but with the best neurosurgery hospitals in Bangalore, the treatment has become extremely efficient.
METHODS ARE DIFFERENT
Neurosurgery is performed in different methods like conventional open surgery, microsurgery, stereotactic radiosurgery, minimally invasive endoscopic surgery, etc., depending on the clinical scenario, expected progress, and any other existing ailments of the patient. It is important that you consult with only the reputed doctors like Wilson Asfora for the treatment.
In conventional open surgery, the neurosurgeon accesses the brain by creating a large opening in the skull through a process called a craniotomy. This technique is still used in trauma & emergency situations.
Microsurgery is used in vascular-related treatments like the clipping of an aneurysm, EC-IC bypass surgery, and even in some microscope/endoscope utilised minimally invasive spine surgeries like microdiscectomy, artificial disc replacement & laminectomy.
Stereotactic surgery involves a minimally invasive type of surgical intervention that locates small targets inside the body using a three-dimensional coordinate system. It is used to implant electrodes in functional neurosurgery, where a high level of accuracy is mandatory in cases involving Parkinson’s or Alzheimer’s disease.
As a distinct neurological discipline, stereotactic radiosurgery (SRS) makes use of external ionising radiation to necrose defined tumours without the need for a surgical incision. It is systematically optimised to treat patients with the highest possible accuracy & precision in diagnoses like primary /secondary tumours, meningiomas, pituitary adenoma, and many other indications.
Minimally invasive endoscopic surgery has many advantages. It minimises the tissue injury, trauma & post-operative pain management, which are vital for any patient’s betterment from spine surgery. It includes a small incision, tubular systems & an endoscope in combination to aid in the visualisation of the surgical field. Great advancement in medical imaging, particularly magnetic resonance imaging (MRI) makes it easier to diagnose the culprit disc, which is degenerated and even discography assists in identifying the pain-generating disc correctly.
Other common minimally invasive procedures that are carried with fluoroscopic guidance include percutaneous endoscopic lumbar discectomy via transforaminal and interlaminar routes, percutaneous endoscopic cervical discectomy, percutaneous endoscopic posterior cervical foraminotomy, and percutaneous endoscopic thoracic discectomy. But general contraindications related to these procedures are severe cord compression, narrowed or hard and calcified disc.
Head & spine injuries account for a vast segment of emergency neurosurgeries as they involve high mortality & morbidity & quick assessment is required to prevent secondary brain damage involving hypoxia & hypotension. One main parameter is intracranial pressure (ICP) which holds a key role in brain injury, and every neurosurgical evaluation begins with the determination of the GCS (Glasgow coma scale) score.
Skull fractures are characterised by skull x-ray or coronal CT of the head. They are of two types – a closed fracture which is covered by intact skin, whereas an open fracture is related to the disrupted overlying skin. These fracture lines may be linear or multiple. Open fractures are treated by repairing the scalp followed by craniotomy for operative debridement. Skull base fractures are common & they bring notable impact which is presented in the form of pneumocephalus, hemotympanum, cranial nerve deficits (loss of hearing, injury to the facial nerve), and cerebrospinal fluid (CSF) leaks.
Brain injury following trauma may be focal or diffuse. Diffuse injury causes damage to axons as a result of rotational acceleration or deceleration, and focal lesions cause midline shift & herniation. The main cause of herniation in trauma patients is cerebral oedema, EDH & SDH. Epidural hematoma (EDH) is caused by the blood accumulated between the skull & dura mater, which are mostly caused by disruption of the middle meningeal artery.
Subdural hematoma (SDH) involves the collection of blood due to damaged bridging veins between the arachnoid & dura mater. Clinical prognosis is a little worse in SDH compared to EDH because it is associated with neural parenchyma & open craniotomy may be needed. ICH / intracerebral haemorrhage occurs when vessels in the brain rupture, which is an impact of counter-coup injury.
Spinal emergencies involve acute compression of nerve roots, disc herniations & sometimes urgent surgical decompression is done for stabilisation. The primary goal in brain & spine trauma is to avoid a probable secondary insult through early diagnosis and proper treatment as they prevent certain morbidities in the form of permanent disability.
PAEDIATRIC NEUROSURGERY –
It is concerned with neurosurgical care for children with congenital or acquired clinical conditions like Chiari malformation, congenital malformations of the brain and spine, craniofacial syndromes, craniosynostosis, arachnoid cysts, brachial plexus injury, epilepsy, arteriovenous malformation, brain tumours (meningiomas), hydrocephalus, etc. It is a crucial point that the outcome in pediatric neurosurgery patients is feasibly more complex and multifaceted. The best neurosurgery hospitals in Bangalore have an excellent facility for neurosurgical child care.
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