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  • Gujarat Brain & Spine Clinic

Endoscopic/Minimally Invasive Neurosurgery


Minimally Invasive Surgery

Non-invasive treatments whenever these techniques can achieve comparable or better results compared to standard open surgical procedures. State-of-the-art, minimally invasive neuronavigation technology minimizes incisions and often allows surgeons to cosmetically hide scars.

Minimally Invasive Procedures

Some of the minimally invasive surgery techniques used by him are listed below:

Microcraniotomy

For certain brain tumors deep under the surface of the brain, a narrow opening (about half an inch in diameter) can be used to reach the tumor.The narrow, minimally invasive surgery opening minimizes damage to normal brain tissue overlying the tumor.In other cases, precise stereotactic neuronavigation may allow very small skin incisions and bony openings (craniotomy) for removal of brain tumors.

Neuroendoscopy

This minimally invasive surgery technique uses specialized endoscopes with high resolution video cameras to perform surgery of the brain. Smaller incisions and bony openings often result in less pain and shorter hospital stays. Many brain tumor operations that previously required a large scalp incision and large bony opening (craniotomy) can be performed as minimally invasive surgery - using smaller incisions and craniotomy openings.

Skull Base Tumors


Skull base tumors grow primarily on the inside of the skull, but occasionally on the outside. Some tumors originate in the skull base, while others spread there from a cancer elsewhere in the body . The many types of skull base tumors and conditions are classified by the type of tumor and its location in the skull base.

Common symptoms of skull base tumors and conditions include:

  • Headaches
  • Difficulty breathing
  • Altered sense of smell
  • Blurred or double vision
  • Trouble swallowing
  • Hearing loss

Diagnosis of skull base tumors and conditions may involve:

A physical exam: This includes questions about the patient's symptoms, and personal and family health history.

A neurological exam: This test checks vision, hearing, balance, coordination, reflexes and ability to think and remember.

Imaging of the brain: Magnetic resonance imaging (MRI) or computed tomography (CT or CAT scan), which use computers to create detailed images of the brain, are the most common scans used to diagnose brain tumors.

Treatment: Treatment for skull base tumors and conditions may include surgery, radiation therapy, chemotherapy and/or observation. The treatment for a skull base tumor or condition depends on many factors, including:

  • The location of the tumor or condition
  • For tumors, the extent of the tumor and whether it is benign or malignant
  • The patient's general health and preferences regarding potential treatment options.

If the patient's tumor is benign and in a part of the skull base where Dr. Patel can safely remove it completely, surgery may be the only treatment needed. Although many tumors are amenable to minimally invasive endonasal endoscopic surgery, there are in fact a variety of approaches to surgery for skull base tumors.

If the patient's tumor is benign and in a part of the skull base where Dr. Patel can safely remove it completely, surgery may be the only treatment needed. Although many tumors are amenable to minimally invasive endonasal endoscopic surgery, there are in fact a variety of approaches to surgery for skull base tumors.

Brain Tumors Including Pituitary Tumors


A brain tumor is a group (or mass) of abnormal cells in your brain. Many different types of brain tumors exist, and their clinical behavior can vary from benign (noncancerous) to malignant (cancerous).

  • acoustic neuromas (vestibular schwannomas)
  • chordomas
  • ependymomas
  • germ cell tumors
  • gliomas (includes glioblastomas, gliosarcomas, astrocytomas, oligodendrogliomas, and oligoastrocytomas)
  • medulloblastomas (includes primitive neuroectodermal tumors, or PNETs)
  • meningiomas
  • pineal-region tumors (includes pineocytomas and pineoblastomas)
  • pituitary tumors (includes pituitary adenomas)
  • schwannomas
  • secondary brain tumors

Treatment for a brain tumor depends on the type, size, and location of the tumor, as well as your overall health and your preferences.

Surgery : If the brain tumor is located in a place that makes it accessible for an operation, your neurosurgical oncologist will work to remove as much of your brain tumor as possible.

Radiation therapy : Radiation therapy uses beams of high-energy particles, such as X-rays, to kill tumor cells. Radiation therapy can come from a machine outside your body (external beam radiation), or, in very rare cases, objects that release radiation can be placed inside your body close to your brain tumor (brachytherapy).

Radiosurgery : Stereotactic radiosurgery is not a form of surgery in the traditional sense. Instead, radiosurgery uses multiple beams of radiation to give a highly focused form of radiation treatment to kill the tumor cells in a very small area. By itself, each beam of radiation is not particularly powerful, but at the point where all the beams meet—the brain tumor—a very large dose of radiation is delivered, killing the tumor cells.

Chemotherapy : Chemotherapy uses drugs to kill tumor cells. Chemotherapy drugs can be taken orally in pill form or injected into a vein (intravenously).

Targeted Drug Therapy : Targeted drug treatments focus on specific abnormalities present within cancer cells.

Head Injuries


Brain injury results from an impact to the head that disrupts normal brain function. Brain injury may affect a person’s cognitive abilities, including learning and thinking skills. Falls are the leading cause of traumatic brain injury for all ages.

Doctors classify traumatic brain injury as mild, moderate or severe, depending on whether the injury causes unconsciousness, how long unconsciousness lasts and the severity of symptoms. Although most

traumatic brain injuries are classified as mild because they're not life-threatening, even a mild traumatic brain injury can have serious and long-lasting effects.

If a Head Injury Occurs If you or someone you're with experiences an impact to the head and develops any symptoms of traumatic brain injury, seek medical advice even if symptoms seem mild.

Symptoms of a brain injury include:

  • Unconsciousness
  • Inability to remember the cause of the injury or events that occurred Immediately before or up to 24 hours after
  • Confusion and disorientation
  • Difficulty remembering new information
  • Headache
  • Dizziness
  • Blurry vision
  • Nausea and vomiting
  • Ringing in the ears
  • Trouble speaking coherently

Treatment : The most serious head injuries require specialized hospital care and can require months of inpatient rehabilitation. Most traumatic head injuries are mild and can be managed with either a short hospital stay for observation or at-home monitoring followed by outpatient rehab, if needed.

Initial focus of treating a head injury is to stabilize the injured person in order to minimize secondary complications. As a patient is admitted, initial medical treatment goals include ensuring proper oxygen and blood flow to the brain and body, stabilizing blood pressure, and treating any problems or conditions affecting other parts of the body (besides the brain) that have arisen because of the injury. After individuals with head injury have been stabilized, the treatment plan generally involves rehabilitation efforts to teach patients how to cope with their specific injury-related symptoms.

Each head injury and its recovery is different, and the brain has a remarkable way to adjust after injury. It is critical to know the symptoms and to seek treatment before there is a chance for additional, more serious complications to occur.

Intracerebral Aneurysm


A brain aneurysm is a balloon-like bulge in the wall of a brain artery. If this balloon bursts and bleeds, the surrounding brain cells may be damaged.

What are the causes of a brain aneurysm? A brain aneurysm usually occurs in an artery wall that has a defect or is weak.

It is often associated with the hardening of the arteries.

High blood pressure, heredity factors, or head injury are possible causes that might have led to a brain aneurysm.

What are the symptoms? Most people will not have any symptoms until the aneurysm bleeds.

When the aneurysm bleeds, symptoms experienced include:

  • Severe headache, nausea and vomiting
  • Brief blackout
  • Neck stiffness
  • Vision or speech problems
  • Jerking movements
  • Paralysis or weakness on one side of the body

How do we diagnose a brain aneurysm? Brain aneurysms need to be treated as soon as possible – otherwise, they can be fatal. A fast and accurate diagnosis is essential for recovery. The following tests may be performed:

Cerebral Angiogram o A special dye that is visible on X-ray is injected into an artery that supplies blood to the brain. The dye will show any obstruction and bleeding in the X-ray images taken

MRA o A Magnetic Resonance Angiogram (MRA) is done with the use of an MRI scanner to show the 3-dimensional structure of the blood supply in the brain.

CT Scan o A CT Scan will be able to detect any bleeding in the brain after a burst aneurysm.

What are the treatments available? If the aneurysm has already ruptured, the goal of treatment is to prevent bleeding/another rupture while preserving the artery from which the aneurysm originated.
If the aneurysm has not burst, the goal will be to prevent it from bursting.

Surgery (Microsurgical Clipping of Aneurysm) The neurosurgeon puts a clip on the aneurysm where it bulges from the artery. This prevents the blood from entering the aneurysm. As a result, further bleeding is avoided and the surrounding brain tissue is protected from additional damage.

Occlusion and Bypass It may be best to stop blood flow through the artery leading to the aneurysm. This is called occlusion and is usually done as open surgery.
Sometimes occlusion is done together with a bypass. A bypass re-routes blood around the occlusion. It brings blood to the part of the brain that has been fed by the damaged artery. A small blood vessel is used for the bypass.

Endovascular Procedure An endovascular procedure may be the best option for some aneurysms.
This is done in the X-ray Lab by the interventional Neuroradiologist. During this procedure, a catheter is guided from the groin to the brain arteries. Platinum coils are released into the aneurysm causing a blood clot to form within and sealing it off.

Arterio Venous Malformations


Arteries normally carry oxygenated blood from the heart to the brain while the veins carry de-oxygenated blood away from the brain and back to the heart. An arteriovenous malformation (AVM) is a tangle of blood vessels in the brain which divert blood directly from the arteries to the veins, bypassing the normal brain tissue.

What are the symptoms of a brain AVM? The symptoms of an AVM depend on where it occurs within the brain.
Over 50% of patients with an AVM present with intracranial haemorrhage.

20% - 25% of patients with an AVM have either focal or generalised seizures. Patients may experience localised pain in the head because of increased blood flow around an AVM.

15% of patients may have difficulty with movement, vision, or speech.

What is the best treatment for an AVM? Treatment usually depends on the type of AVM (location and size) and the symptoms that it may be causing.

Medical Therapy If the patient has no symptoms, or if the AVM occurs in a region of the brain that cannot be easily treated, conservative medical management may be necessary. The AVM patient will be advised to avoid blood thinners (Warfarin), and any activities that may excessively raise blood pressure (e.g. carrying heavy things or strenuous exercise).

Surgery If an AVM has bled and/or is in an area that can be easily operated upon, then surgical removal may be recommended. The patient is put to sleep with anaesthesia, a portion of the skull is removed, and the AVM is surgically removed. With the AVM completely removed, there will be no possibility of further bleeding

Stereotactic Radiosurgery (Gamma Knife) An AVM that is not too large, but is in an area that is difficult to reach by regular surgery may be treated by performing Gamma Knife Radiosurgery.

Interventional neuroradiology/endovascular neurosurgery It may be possible to treat part – or all – of the AVM by placing a catheter (small tube) inside the blood vessels that supply the AVM, and blocking off the abnormal blood vessels with a variety of different materials.

Skull Growth Defects, Deformities


The Skull Growth Defects and Deformities typically affect the bone and soft tissue in the head and spine. There are many different types of these malformations. They can vary greatly from mild to severe conditions.

A congenital skull defect usually occurs due to an interruption in the normal growth of the nervous system. When this process is disturbed, it can cause structural defects in the brain and skull. Normal brain function can be impaired even if only the skull’s growth is upset.

Types of Congenital Brain Defects Several types of congenital brain defects are caused by neural tube defects. They are:

Anencephaly: This occurs when the head end of the neural tube fails to close. A major portion of the skull and brain is missing. Existing brain tissue is exposed.

Encephalocele: This occurs when a portion of the brain bulges through an opening in the skull. It typically is located along the front-to-back midline at the back of the skull.

Spina bifida: This occurs when the neural tube doesn’t close below the level of the brain. This prevents the surrounding vertebrae from fully developing. It leaves the spinal column divided.

Other types of congenital brain defects develop within the structure of the brain.

Hydrocephalus, or fluid on the brain, is an excessive buildup of cerebrospinal fluid (CSF) due to impaired circulation of the CSF. When there is excess fluid, it can put too much pressure on the brain.

Dandy-Walker syndrome is a defect that involves the absence or defective growth of the central section of the cerebellum.

Holoprosencephaly is a condition in which the brain doesn’t divide into two halves, or hemispheres.

Megalencephaly, also called macrencephaly, is a brain that is abnormally large or heavy. Microcephaly, or a small brain, occurs when the brain doesn’t develop to full size

Symptoms Symptoms of congenital brain defects vary. Each defect has a distinct set of symptoms and impairments. Some of these symptoms may not be apparent until after birth when the child exhibits developmental or growth delays.

Treatment Available treatment of congenital brain defects varies according to the type and severity of defect. Anticonvulsant medications can help with seizures. Many defects only can be treated with symptom relief.

Surgical techniques can provide improvement for some conditions. Decompression surgery can create more space for brain and cerebrospinal fluid in conditions where there is not enough space for brain growth. Surgery to correct defective skulls can give the brain space to grow normally. Shunts can be inserted to drain the cerebrospinal fluid that builds up with hydrocephalus.

Hydrocephalus


Shunt operation is generally performed to treat Hydrocephalus. Hydrocephalus is a condition in which excess cerebrospinal fluid (CSF) builds up within the ventricles (fluid-containing cavities) of the brain and may increase pressure within the head. Hydrocephalus can occur at any age, but is most common in infants and adults aged 60 and older.

Shunt Procedure In this procedure, a ventricular catheter is placed in the cerebral ventricles. This allows the bypass and drainage of the excess fluid to other cavities in the body. The fluid may be drained into cavities such as the peritoneal cavity, the right atrium, pleural cavity and gallbladder. A shunt is a tube that is soft and flexible, and is usually made up of plastic or silicone rubber. It contains a valve that allows drainage and a catheter that joins the drainage and deposit sites. A small sensor may be placed near the valve to check pressure levels if the intracranial pressure is high. A ventriculoperitoneal shunt is permanently placed with one end inserted in a ventricle of the brain and another end in the peritoneal cavity. Other drainage sites may be the gall bladder, the heart’s right ventricle and the pleural area surrounding the lungs. According to the location of obstruction, fluid drainage may be done from the subarachnoid space around the brain. The shunt is usually replaced after 10 years in adults. In children, the shunts may need to be replaced sooner.

While there is no permanent cure for hydrocephalus, our doctors is committed to the most comprehensive care for those who come to him. He offers expert treatment of hydrocephalus and can advise patients and their families of the most advanced treatment options.

Craniostenosis


Cransynostosis is the premature closure of one or more of the gaps between the developing bones of the skull. This condition is typically discovered by the pediatrician or parents within the first few months of life. For some babies, this diagnosis can best be determined by a trained craniofacial surgeon.

In this birth defect, some or all of the sutures in the skull close too early, causing problems with normal brain and skull growth--which potentially can result in increased intracranial pressure and the head becoming irregular in shape. The earlier this fusion occurs, the greater its effects.

Craniosynostosis Causes Craniosynostosis is usually an isolated finding in an otherwise normal child. The precise causes vary and are incompletely understood. Most cases of craniosynostosis occur in families with no history of the condition.

Its heredity form has been associated with various genetic disorders. In addition, mutations in several genes have recently been identified in certain forms of craniosynostosis. A geneticist examines all infants and discusses the chances of having another infant with craniosynostosis with each family.

Several non-genetic factors have also been implicated in the origins of craniosynostosis, including fertility treatments, paternal profession and such environmental exposures as maternal smoking and certain drugs (sodium valproate).

Craniosynostosis Treatment Most cases require early surgery to prevent distortion of other craniofacial structures. However, mild degrees of craniosynostosis may not require surgery. Early diagnosis and treatment can have a great impact on the outcome of the child's brain development and vision development.

Stroke


A stroke occurs when blood supply to a part of the brain is disrupted. As a result, the brain cells are starved of oxygen, causing some to die, and damaging others.

What are the types of stroke and how do they occur? There are two types of strokes:

Ischemic Strokes are caused by the blockage of arteries supplying blood to the brain (e.g. due to High Cholesterol)

Hemorrhagic Strokes are caused by the rupturing of blood vessels in the brain (e.g. due to High Blood Pressure)

What are the risk factors?

  • Old Age
  • High Blood Pressure
  • Smoking
  • Diabetes Mellitus
  • High Cholesterol

How do we diagnose stroke? The following tests may be performed:

  • CT/MRI Scan of the brain to check the location of the blockage or bleeding in the brain, so as to determine the type of stroke the patient has suffered
  • Blood Test to check for the presence risk factors (e.g. High Cholesterol and Diabetes Mellitus)
  • Chest X-Ray/EEG to check for heart diseases
  • Ultrasound studies, such as a Carotid Ultrasound, may be done to check for the narrowing of blood vessels in the neck area
  • Angiogram, where an X –Ray of the blood supply in the brain is performed, so as to get information on the location and severity of the blockage or bleeding
  • What are the treatments available for stroke?
    Patients suffering stroke will be closely monitored, with special attention paid to their blood pressure, blood sugar and cholesterol levels.

    Blood thinners like Aspirin may be used for Ischemic Stroke patients to allow for easier blood flow, while surgery may be needed for Hemorrhagic stroke patients. The next phase of treatment is rehabilitation, which involves the help of a Physiotherapist/Speech Therapist. They will help train stroke patients to be independent in their daily activities.

    Cranial Nerve Lesions Including Trigeminal Neuralgia And Hemifacial Spasm


    Your entire body is powered by nerves, but those nerves can be damaged by injury or an illness such as diabetes. Nerve damage can affect your ability to feel and move. The cranial nerves are those that arise directly from your brain or brainstem and often affect areas like the face and eyes.Your entire body is powered by nerves, but those nerves can be damaged by injury or an illness such as diabetes. Nerve damage can affect your ability to feel and move. The cranial nerves are those that arise directly from your brain or brainstem and often affect areas like the face and eyes.

    The most common Cranial Nerve Lesions are Trigeminal Neuralgias and Hemifacial Spasm.

    Hemifacial spasm is a neuromuscular disorder characterized by frequent involuntary contractions (spasms) of the muscles on one side (hemi-) of the face (facial). The first symptom is usually an intermittent twitching of the eyelid muscle that can lead to forced closure of the eye. The spasm may then gradually spread to involve the muscles of the lower face, which may cause the mouth to be pulled to one side. Eventually the spasms involve all of the muscles on one side of the face almost continuously.

    Both conditions may be caused by a nerve injury, or a tumor or it may have no apparent cause. Most often hemifacial spasm and trigeminal neuralgia are caused by a blood vessel pressing on a nerve at the place where it exits the brainstem.

    Both conditions can be surgically treated through a procedure called Microvascular Decompression (MVD). MVD involves microsurgical exposure of either the trigeminal nerve root or facial nerve root, identification of a blood vessel that may be compressing the nerve, and gentle displacement of it away from the point of compression. “Decompression" may allow the nerve to recover. This often results in pain relief (trigeminal neuralgia) or resolution of spasm (hemifacial spasm).