Neuro Oncology (Brain 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 holds 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 touching the spinal cord. Intramedullary tumours directly affect the spinal cord. In addition to surgical procedures for tumour removal, the doctors may also employ radiation therapy and chemotherapy to treat the cancer.
The word cerebrovascular refers to blood flow in the brain. Conditions that result in irregular blood flow to the brain include strokes, carotid stenosis, vertebral stenosis, intracranial stenosis, brain aneurysms and vascular malformations. The irregular blood flow could be caused by narrowing of blood vessels, formation of clots, blood-vessel blockages or ruptured blood vessels. Lack of sufficient blood flow to the brain could cause a stroke or permanent intellectual deficits. Doctors will determine the surgical course of treatment for the patient based on a series of diagnostic imaging tests to visualise blood flow through the brain.
Movement disorders are characterised by neurological dysfunction associated with co-ordinated movements. This covers the debilitating motor symptoms of Parkinson’s disease, essential tremors, dystonia and focal epilepsy. Deep Brain Stimulation (DBS) is a surgical procedure which has proven effective in the treatment of movement disorders. DBS uses a battery-operated surgical implant called an Implantable Pulse Generator (IPG). The Implantable Pulse Generator is stop-watch size device that delivers electrical stimulation to the brain, similar to the electrical stimulation provided to the heart by a pacemaker. This blocks the abnormal brain signals that cause the movement or tics. Before the procedure, an MRI or CT scan is used to identify and locate the target for surgical intervention in the brain. During the procedure, a thin electrode is inserted into the target location in the brain. The electrode is then attached to an insulated extension cable connecting it to the Implantable Pulse Generator in the collarbone area, chest or abdomen. Once the system is in place, it is tested and activated to help the patient manage their movement disorder.
Epilepsy is a central nervous system disorder characterised by abnormal brain activity resulting in seizures. The symptoms of the seizure can vary in patients, ranging from disorientation and blank staring to full-body twitching and foaming at the mouth. The exact cause of epilepsy is unknown but it is associated with head traumas, strokes and infectious diseases such as AIDS, viral encephalitis and meningitis. Surgical approaches to epilepsy usually involve removal of the part of the brain generating the abnormal electrical activity. Hence surgery is usually only recommended for focal seizures. Surgical treatment for epilepsy is recommended only if drug therapies prove ineffective.
Epilepsy could be treated by a variety of procedures – Multiple Subpial Transections (MST), Laser Interstitial Thermal Therapy (LITT), Resective Surgery, Deep Brain Stimulation, Corpus Callosotomy or Hemispherectomy.
Neurological problems in children are often complex and difficult to treat. The GGHC Paediatric Neurosurgery Program covers a comprehensive range of brain, spine and peripheral nerve disorders. Our doctors are also experienced in treating brain tumours, cerebral palsy, congenital brain malformations, hydrocephalus, skeletal dysplasia, spine bifida, tethered cord syndrome and Chiari malformations.
Spine Surgery/ Peripheral nerve surgery
Spinal and Peripheral Nerve Surgery consists of surgical strategies and procedures to minimise pain and restore maximum range of motion in patients with spinal and peripheral nerve conditions such as degenerative disc disorder, traumatic spinal injury, herniated disc, spinal stenosis (narrowing) and spinal cord tumours. Surgical intervention can help minimise chronic pain, address spinal instability and help improve the patients range of movement and quality of life. Spinal surgery consists of a range of techniques such as decompression, spinal fusion, laminectomy etc. In most cases, these procedures can be performed using open or minimally-invasive technologies.
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.
A head injury is any trauma to the scalp, skull, or brain. Acute head injuries are of the utmost priority and must be given immediate medical attention. Head injuries usually result in internal brain bleeds or hematoma, a possible skull fracture, a concussion or bruises (contusions) on the brain. Common causes of these injuries are road accidents, sports or adventure sports accidents, falls and physical assault. First aid for a person who has had a head injury requires that their airway, breathing and circulation to be checked. The neck and the head are then stabilised, and any bleeding through the skull is brought under control.
The treatment for head injuries depends on the type and the severity of the injury. Minor head injuries can be treated with pain medication alone. In case the head injury has caused a hematoma, excess pressure on the brain or a skull fracture, surgical intervention is required.
Pain relieving surgery
Chronic pain is a difficult symptom to manage and live with. Its effects on the patient’s lifestyle and ability to function is debilitating. Neurological conditions like trigeminal neuralgia, glossopharyngeal neuralgia and carpal tunnel syndrome cause instant, easily-triggered pain that can be frustrating, excruciating and embarrassing. These conditions are usually caused due to a swelling or mass pressing on the nerve, triggering the pain. Surgical intervention is recommended to remove the mass or swelling. Microvascular decompression is a technique that is recommended for this purpose.
Neuro-endoscopy is a set of minimally-invasive surgical procedures that operate on tumours in the brain, skull or spine. Neuro-endoscopy is performed using an endoscope, which is a small camera, and specialised surgical instruments. Using neuro-endoscopy techniques, the surgeon can access and remove tumours inside the skull without harming surrounding tissues or having to open the skull. The use of neuro-endoscopic techniques also reduces patient recovery time, post-operative pain and scarring.
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