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Neurology & Neurosurgery

Cerebral Palsy

Cerebral Palsy refers to a range of disorders caused by damage to the developing nervous systems before birth or in early infancy. NeuroPhysiotherapy aims to facilitate and promote postural control and improved function. Early intervention can help prevent deformity and deconditioning. Many children have access to some form of therapy throughout childhood, however with transition into adulthood care and support can become disjointed. NeuroPhysiotherapy can help priorities a physical care plan and provide treatment, strengthening and fitness programs plus education on self-management.

Chronic Regional Pain Syndrome

When pain becomes persistent and chronic it can lead to maladaptive brain and immune responses. This may result in a cluster of other symptoms controlling temperature, blood supply and sweating. In addition altered movement behaviour and fear of movement can re-enforce poor movement and lead to secondary problems such as ongoing pain, weakness and reduced independence. Neuro Physiotherapy involves education, self-management and sensorimotor learning exercises to develop new strategies that aim to gain a greater repertoire of functional movement.

Craniotomy (Excision of brain tumor)

A craniotomy is the surgical removal of part of the bone from the skull to expose the brain. Specialized tools are used to remove the section of bone called the bone flap. The bone flap is temporarily removed, then replaced after the brain surgery has been done.

Some craniotomy procedures may use the guidance of computers and imaging (magnetic resonance imaging [MRI] or computerized tomography [CT] scans) to reach the precise location within the brain that is to be treated. This technique requires the use of a frame placed onto the skull or a frameless system using superficially placed markers or landmarks on the scalp. When either of these imaging procedures is used along with the craniotomy procedure, it is called stereotactic craniotomy.

Scans made of the brain, in conjunction with these computers and localizing frames, provide a three-dimensional image, for example, of a tumor within the brain. It is useful in making the distinction between tumor tissue and healthy tissue and reaching the precise location of the abnormal tissue.

Burr Holes

Burr holes are small holes that a neurosurgeon makes in the skull. Burr holes are used to help relieve pressure on the brain when fluid, such as blood, builds up and starts to compress brain tissue.

A layer of thin tissues called meninges surround and help protect the brain. These meninges contain blood vessels that carry blood to and from the brain. The dura is the outermost of these meninges. A head injury can cause one or more of these blood vessels to tear and bleed. A sudden tear might cause blood to build up very suddenly. With a small tear, the blood might build up more slowly. Blood might start to build up just below the dura mater. This causes something called a subdural hematoma. Tears in different blood vessels may cause blood to build up just above the dura layer, causing an epidural hematoma. A hematoma is when blood collects in an area and causes swelling.

This buildup of blood is dangerous. As the blood builds, it pushes up against the skull and has nowhere to go. If the blood starts to compress the brain, it can lead to symptoms or even death if not treated.

Deep Breath Stimulation Brain Surgery

Deep brain stimulation (DBS) is a neurosurgical procedure involving the implantation of a medical device called a neurostimulator (sometimes referred to as a ‘brain pacemaker’), which sends electrical impulses, through implanted electrodes, to specific targets in the brain (brain nuclei) for the treatment of movement and neuropsychiatric disorders. DBS in select brain regions has provided therapeutic benefits for otherwise-treatment-resistant disorders such as Parkinson’s disease, essential tremor, dystonia, chronic pain, major depression and obsessive–compulsive disorder (OCD).Despite the long history of DBS, its underlying principles and mechanisms are still not clear. DBS directly changes brain activity in a controlled manner, its effects are reversible (unlike those of lesioning techniques), and it is one of only a few neurosurgical methods that allow blinded studies.

Dystonia

Dystonia is a movement disorder characterised by involuntary muscle activity in a specific parts of the body. There are many forms of genetic and idiopathic dystonia which many believe to be caused by some form of maladaptive neuroplasticity either spontaneously over time, or following trauma, and can also occur in professional musicians following years of intense practice. The aim of Neuro Physiotherapy is to establish which muscles are involved, the response to intrinsic and extrinsic stimuli and determine other secondary movement compensations. While botulinum toxin can be helpful for many people with dystonia, learning additional movement strategies and strengthening various, specific muscle synergies can further enhance physical rehabilitation.

Epilepsy Surgery

Epilepsy surgery involves a neurosurgical procedure where an area of the brain involved in seizures is either resected, disconnected or stimulated. The goal is to eliminate seizures or significantly reduce seizure burden. Approximately 60% of all people with epilepsy (0.4% of the population of industrialized countries) have focal epilepsy syndromes. In 15 to 20% of these patients, the condition is not adequately controlled with anticonvulsive drugs. Such patients are potential candidates for surgical epilepsy treatment.
First line therapy for epilepsy involves treatment with anticonvulsive drugs, also called antiepileptic drugs. Most patients will respond to one or two different medication trials. The goal of this treatment is the elimination of seizures, since uncontrolled seizures carry significant risks, including injury and sudden death. However, in up to one third of patients with epilepsy, medications alone do not eliminate seizures, and/or cause adverse effects. In these patients, epilepsy surgery is considered as an alternate treatment method to medications.

Multiple sclerosis

Multiple sclerosis (MS) involves an immune-mediated process in which an abnormal response of the body’s immune system is directed against the central nervous system (CNS), which is made up of the brain, spinal cord and optic nerves. The exact antigen — or target that the immune cells are sensitized to attack — remains unknown, which is why MS is considered by many experts to be “immune-mediated” rather than “autoimmune.”
  • Within the CNS, the immune system attacks myelin – the fatty substance that surrounds and insulates the nerve fibres -as well as the nerve fibres themselves.
  • The damaged myelin forms scar tissue (sclerosis), which gives the disease its name.
  • When any part of the myelin sheath or nerve fibre is damaged or destroyed, nerve impulses traveling to and from the brain and spinal cord are distorted or interrupted, producing a wide variety of symptoms.
  • The disease is thought to be triggered in a genetically susceptible individual by a combination of one or more environmental factors.
  • People with MS typically experience one of four disease courses, which can be mild, moderate or severe.

Neurosurgical Oncology

The specialty of Neurosurgical Oncology employs a comprehensive approach, incorporating the talents of specialists from various disciplines and state-of–the-art technology, in the treatment of benign and malignant tumors of the brain and spine. Working with specialists in the areas of neurological surgery, neurology, radiation oncology, neuroradiology, neuropathology, neuroendocrinology, physiatry and psychiatry, every neuro-oncology case is discussed in a formal case management conference and a treatment decision rendered.

Parkinson’s Disease

  • Parkinson’s disease (PD) is a neurodegenerative disorder that affects predominately dopamine-producing (“dopaminergic”) neurons in a specific area of the brain called substantia nigra.
  • Symptoms generally develop slowly over years. The progression of symptoms is often a bit different from one person to another due to the diversity of the disease. People with PD may experience:
  • Tremor, mainly at rest and described as pill rolling tremor in hands. Other forms of tremor are possible
  • Slowness of movements (bradykinesia)
  • Limb rigidity
  • Gait and balance problems

Stroke

A stroke is a “brain attack”. It can happen to anyone at any time. It occurs when blood flow to an area of brain is cut off. When this happens, brain cells are deprived of oxygen and begin to die. When brain cells die during a stroke, abilities controlled by that area of the brain such as memory and muscle control are lost.

Vascular and Endovascular Neurosurgery

Vascular lesions of the central nervous system such as aneurysms, arteriovenous malformations, tumours, and fistulas are responsible for the majority of intracranial haemorrhages Micro neurosurgical techniques have enabled neurosurgeons to effectively manage the majority of these lesions.
Microcatheter based treatment modalities have evolved which permit access of the distal intracranial and spinal circulation by percutaneous cannulation of the femoral artery or vein. Technologic developments in polymer science and advances in hydrophilic coatings have produced microcatheters less than 1 mm in diameter capable of reaching deep within the nidus of arteriovenous malformations or into the body of a cerebral aneurysm.

Numerous thrombogenic devices are available that can be delivered through microcatheters to permanently occlude cerebral vascular abnormalities. Catheter technology perfected in the coronary circulation for the management of atherosclerotic disease has been used to treat similar lesions of the extracranial and intracranial cerebral circulation.

Cerebral circulation angioplasty for vasospasm has become an accepted technique, and superselective drug delivery is growing in popularity. This chapter reviews the recent literature in vascular and endovascular neurosurgery in an attempt to familiarize the reader with recent advances in the management of cerebrovascular disease

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DR. NITIN SETHI

Consultant – Neurologist

Neurologist

MBBS, DNB – General Medicine, Diplomate of American Board of Psychiatry and Neurology

Aashlok Hospital

Years Of Experience : 26

DR. ATUL PRASAD

Consultant – Neurologist

Neurologist

MBBS, DM – Neurology

BLK-Max Super Speciality Hospital

Years Of Experience : 40

DR. RAJIV ANAND

Senior Consultant – Neurologist

Neurologist

MBBS, MD – Medicine, DM – Neurology

BLK-Max Super Speciality Hospital

Years Of Experience : 46

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