1. Who is a neurosurgeon?

A surgeon who is trained in the prevention, diagnosis, treatment and rehabilitation of disorders that affect the spine, brain, nervous system and peripheral nerves is called a neurosurgeon. They are trained for five to six years after completion of their basic medical degree in this aspect. They examine, investigate, diagnose and operate if necessary on disease of skull, brain, intra cranial vessels, tumors of pituitary gland, infections of spine, injury of spine, disc disorders cord and head injuries. Neurosurgeons also perform surgery on the carotid arteries in the neck in patients who suffer from stroke of brain. They treat all types of head injuries. In pediatric patients they treat congenital and birth related problems of both the brain and spine

2. What is a craniotomy?

Craniotomy is a surgical procedure on head performed by a neurosurgeon. It is done for conditions like head injury, brain tumors, vascular abnormalities of brain or even the defects in the skull bone. The procedure involves incising the skin, cutting open the skull bone at required site, opening the coverings of the brain, locating the lesion, exposing the brain matter carefully, removing the abnormalities. Similarly after the procedure the operated portion of the head is sutured back.

3. What is an aneurysm?

Aneurysm is ballooning of the portion of the blood vessel inside the brain. They are mostly due to birth defects, can also be caused due to infections or injuries. They cause bleeding in the surface of brain, which is an emergency and called sub arachnoid hemorrhage. Patients present with severe headache, unconsciousness or paralysis of limbs. CT Scan, angiogram of blood vessels of brain is done to confirm the diagnosis. Once aneurysm is diagnosed, the person needs to undergo surgery and clipping of the aneurysm to prevent further bleeding. Sometimes it can be treated without surgery wherein catheter is guided to the aneurysm and coils are placed in the aneurysm to block it.

4. What is a post-concussive syndrome?

A post-concussive syndrome consists of symptoms of headache, confusion, memory and mental problems that follow a moderate-degree of head trauma. The severity of the post-concussive syndrome is directly related to that amount of time a person is unconscious following the injury (concussion). There also is no anatomic damage to the brain seen on MRI or CT scanning.

Symptoms may last up to six months and in the most severe cases even up to a year. There is no surgical or medical treatment for this other than mild analgesics, which are usually non-narcotic, for headaches.

5. What are brain tumours?

Tumours are abnormal growth of tissues in the body. They can be cancerous (malignant) or non cancerous (benign).
The cancerous tumours grow very fast, so the person develops symptoms very quickly. The non-cancerous tumours grow very slowly, that is the reason they come to a doctor later. CT Scan and MRI confirm the presence of tumor. Any tumor, which causes pressure on the surrounding brain tissue, needs to be removed. As far as possible it is removed totally and it is sent for biopsy to correctly diagnose the type of tumour. Sometimes due to location of the tumour near vital structures of brain it is not possible to remove the tumour totally. Cancerous tumours require radiotherapy and chemotherapy depending on the report from biopsy. Sometimes the tumour may be thrown into brain from cancerous tumour in other parts of body like lungs, intestine or breast. The cancer cells travel in the blood and lodge themselves in brain. In that case the primary source has to be treated.


6. What is hydrocephalus?

Brain floats in a watery fluid called CSF. It also has reservoirs inside the brain matter called ventricles, which contains the same fluid. This fluid is always in state of circulation. The old fluid is replaced by new one formed in the brain. The old fluid is absorbed back into the blood and excreted out. At any stage of the pathway, this fluid can be blocked due to various reasons. As the production of the fluid continues to take place but drainage stops the fluid and tends to get accumulated in the brain and pressure in the brain increases. Patients complain of headache and blurring of vision if the intra cranial pressure rises. They may also have persistent vomiting. A neurosurgeon performs a surgery called CSF diversion or shunt. The CSF from the ventricle is drained in a regulated manner into other body cavities from where it is absorbed.

7. What is a laminectomy or laminotomy?

Laminectomy or laminotomy is removal of all or part of the posterior portion of the spine. This operation is done primarily for compression of the spinal cord due to arthritis, tumors or infection. Laminectomy consists of complete removal of the posterior elements (spinous process, lamina and part of the facet joint) of the spine. Laminotomy is only partial removal of the lamina with part of the facet joint.

8. What is an anterior cervical discectomy?

An anterior cervical discectomy is the most common approach to treat paretic and disc problems in the cervical spine. It consists of making an incision in the front of the neck, exposing the anterior (front) portion of the spine and then removing the disc itself. If necessary, two or more discs can be removed along with an entire vertebral body (corpectomy).

In most cases, the disc itself is fused using bone from the patient or bone from a bone bank. This can also be supplemented with a cervical plate to provide immediate stability and enhance the rate of bone fusion.

9. What is a lumbar fusion?

A lumbar fusion is a procedure in which bone is placed either between the vertebral bodies or between the transverse processes of the spine in an attempt to grow a new bone. This new bone will ultimately provide stability for the spine.

In most cases today, this bone fusion is supplemented by instrumentation. This includes plates, rods, and screws attached to the pedicle (which connects the front and back parts of the spine) to keep it from moving. Age can also lead to collapse of the space between each of the vertebrae. In some cases, pieces of bone or metal cages filled with bone can be placed between the vertebral bodies in order to increase the separation between these structures.

Lumbar fusion can be performed solely from the front (anterior interbody lumbar fusion), the back (posterior lateral or posterior lumbar interbody fusion) of the spine or both (global fusion).

10. What is Stereotactic radiosurgery?

Stereotactic radiosurgery (Gamma Knife) is the use of focused radiation directed at a lesion within the brain. The accuracy of this treatment is very precise, and can work on an area of the brain as small as a few millimeters. This "surgery without a scalpel is an alternative treatment for small intercranial arteriovenous malformations and tumours that are located in very sensitive or difficult to reach areas of the brain and skull base. It is also an option for recurrent brain tumours or when more than one metastases (tumours from a separate organ, or organs, outside the nervous system) is present in the brain.

More recently, it has been investigated as a possible treatment for pain and movement disorder syndromes.

11. What is a pinched nerve?

A pinched nerve represents essentially radiculopathy. This is a condition in which the nerve root exiting from the spinal cord is compressed either in the spinal canal or as it exits the spine in one of the nerve openings (foramen). Symptoms resulting from this include pain in the cervical region of the spine that radiates into the extremity, numbness in the same pattern as the pain, and weakness of various muscles.

Causes of a pinched nerve include a herniated disc (also known as a slipped disc, extruded disc, or severely bulging disc), spondylosis (arthritis, bone spurs, or calcium deposits) of the spine, or can be due to a tumour, infection or haemorrhage.

12. What is a herniated disc?

Spinal discs are located between nearly all spinal vertebrae, the exceptions being at the top of the cervical spine (to allow rotation), and in the sacrum and coccyx, at the bottom of the back. They perform a cushioning function between each vertebral body.

The disc is made up of two components; the inner potion, a soft nucleus and a very fibrous annulus surrounding it. Disc herniation occurs when the fibers of the annulus weaken, allowing the nucleus to protrude through. Disc material can then press on the spinal cord or nerve roots resulting in myelopathy or radiculopathy respectively.

There are various grades of disc problems. These include degeneration in which both the nucleus and annulus wear down leading to collapse of the disc, without any protrusion of disc material into the spinal canal (degenerative disc disease). The disc can bulge due to weak annular fibers and push out into the spinal canal (disc bulge). A herniated disc can occur when the disc material pierces through the annular fibers and is sits separate from the disc space and annulus within in the spinal canal.

13. What is an MRI Scan?

An MRI Scan is a scan that measures the amount of energy released by hydrogen molecules (the component that makes up 2/3 of water {H₂0} which comprises 70% of your body) when they rotate back and forth through magnetic fields. The energy is measured by sensors and then sent to a computer to reconstruct images of the body.

MRI scanning can look at any part of the nervous system. The area studied can be 'sliced' in all directions (coronal, sagittal and axial) to obtain the best information possible.

Dye (not the same dye as other radiographic studies, so there is no problem in patients sensitive to iodine) is used to further study any abnormal tissue. It also is used to selectively look at the blood vessels of the brain (MR Angiogram). MR angiography is useful to screen individuals for aneurysms or arteriovenous malformations, especially if a close family member had one of these lesions.

14. Are lasers used in brain or spine surgery?

Until about 10 years ago, lasers had a limited role in both brain and spine surgery. Today however, lasers are used on some endoscopic spine procedures. Even these procedures are not performed routinely throughout the world. Other surgical techniques have been developed that are safer and more accurate than those using the lasers.

The main problems with lasers are that they are difficult to focus. If the length of the laser beam is not measured correctly, it can shoot through the desired tissue and damage normal brain and spinal structures.

15. Bad backs run in my family, will I develop one?

The most common cause of spine problems is injury to the spine, being overweight, overuse at work or with recreation. Certain spine diseases do have some genetic relationship, but these are rare. Other more common conditions that can run 'loosely' in families include congenital lumbar stenosis, congenital cervical stenosis, and spondylolisthesis due to a congenital pars defect.

16. How can you operate in the brain and not cause any new symptoms?

The goal of Neurosurgery is to perform this type of surgery without any new deficits at all. Some operations actually do not enter the brain tissue. The brain is lifted or retracted and the operation proceeds outside. If the brain tissue has to be entered, we do know the general areas of motor and sensation, speech, vision and the function of the nerves (cranial nerves) leaving the bottom of the brain at the brainstem. Neurosurgeons also know where blood vessels going in and out of the brain travel. These areas are avoided if possible, and operations in the brain are done in 'silent areas', of which we know have little or no obvious function.

17. Whenever I walk or exert myself, my legs become numb, weak and "crampy"...Why?

The symptoms described above are suggestive of claudication. Claudication is caused by a lack of blood supply to the legs (Vascular Claudication) as well as to the nerves going to the legs (Neurogenic Claudication). Vascular claudication is treated by identifying where the blocked vessels are and re-opening them with surgery or angioplasty (placing a balloon in the vessel and dilating it).

Neurogenic claudication is caused by the lack of blood flow to the nerves going to the legs, while they are still within the spinal canal (cauda equina). (See picture) The poor blood supply is due to physical compression of the nerves (and the blood vessels running with them). In the elderly, this is due to overgrowth of arthritic bone (Lumbar Stenosis and Spondylosis). In younger patients, neurogenic claudication can be due to congenital narrowing of the spinal canal (Congenital Lumbar Stenosis) or a slippage of vertebrae themselves (Lumbar Spondylolithesis). This condition can occur suddenly due to a herniated lumbar disc or fracture (Cauda Equina Syndrome).

18. Do the patients need to bring their actual films with them to their scheduled appointment?

Yes! Before reaching a decision to recommend surgery, we need to personally review all pertinent radiology studies. For this reason, if patients arrive without their actual films, they may need to be rescheduled.

19. How can we prevent seizures?

1. Protect person from injury by placing pillow, jacket or something soft under head and clearing area.
2. Do not place anything in mouth.
3. Do not try to restrict arm and leg movement.
4. Call the ambulance, if seizures lasts more than 5 minutes, recurs without return to consciousness or if person has no past history of seizures.

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