Brain is affected in a variety of pathological conditions requiring intervention by a neurosurgeon. These include:
1. Traumatic brain injury:
India has one of the highest incidence of road traffic accidents and head injuries constitutes one of the largest subgroups of these patients. Head injury requires timely investigation and prompt intervention. Treatment includes measures to reduce the intra-cranial tension, to reduce the edema in the brain, to monitor the ICP and to remove a hematoma (blood clot) if it is large enough to cause pressure on the normal and vital areas of brain. Prompt intervention and timing is of essence in managing these patients. Undue delay of even a few precious moments can affect the outcomes.
2. Vacular neurosurgery:
Brain hemorrhage presents as a catastrophic event for the patient and the family. Most common causes are uncontrolled hypertension, vascular anomalies as aneurysms, arterio-venous malformations and tumors with hemorrhage. Investigation methods include CT, MRI, and angiography. Treatment in those with aneurysms include clipping, coiling.
3. Brain tumor:
Any tumor in brain presents with features of raised pressure as headache, vomitting, seizures and focal deficits. Treatment options include surgery using microscopic and endoscopic methods. Additional aids in managing these include Neuronavigation, Ultrasonic ablation (CUSA), Stereotaxy, Neurosurgical drills. At Bansal hospital, all these intra-operative aids are available which results in better outcomes.
4. Critical care:
a well equipped ICU is very essential for appropriate and close neurologicalmonitoring, detecting early deteriorations, and prompt interventions. ICP monitoring in severe head injuries is routinely performed.
5. Functional Neurosurgery:
some neurological conditions as epilepsy, chronic pain, spasticity, and movement disorders like Parkinsonism affect the quality of life and impair independance of the patient. Functional neurosurgery deals with this aspect. It includes various procedures as Baclofen pump, spinal cord stimulator, Deep Brain Stimulation, Phrenic nerve stimulator.
6. Pediatric Neurosurgery:
Variety of neurological conditions as brain tumors, congenital conditions as spinal dysraphism, hydrocephalus, tethering of the cord affect the pediatric age group. These require a team of pediatric neurologist and a well equipped ICU. Children of varying age from 3 months to teenagers with brain tumors have been managed routinely in this department.
Abnormal accumulation of fluid in the ventricles results in hydrocephalus. Various causes include obstructive as aqueductal stenosis, fourth ventricular outlet obstruction, intraventricular lesions as colloid cysts and periventricular tumors. Non-obstructive causes include infections as tubercular meningitis, post meningitic hydrocephalus, post hemorrhagic hydrocephalus.
Variety of infections affect brain as tuberculosis, fungal infections, pyogenic abscesses and neurocysticercosis. Various modalities apart from medical management include surgical excision, stereotactic biopsy, stereotactic / navigated drainage of the abscess and endoscopic excision of the intraventricular lesions as cysticercal cyst can be excised using these methods