FAQs - Neurosurgery

No not every head injury is serious. But when one falls from a speeding vehicle without a HELMET, the impact on the brain and its internal structures is far more serious ( many lead to death) than slipping in one's house or staircase.

• There may be a fracture of skull. The bone may remain only cracked or get displaced and penetrate the brain (depressed fracture).
• There may be bleeding in the brain or its covering
  1. Extradural Hematoma (EDH)– This is bleeding between skull and duramater which is the outermost , tough protective cover of the brain, just below the bone (skull)
  2. Subdural Hematoma – Bleeding between 1st & 2nd layer of brain (below the dura)
  3. Intracerebral bleeding - Bleeding inside the brain
• Concussion -  Vibrational injury to the brain without bleeding This can cause cell death or swelling
• Contusion - When there is direct bruising, swelling or laceration of the brain tissue there may be bleeding, leading to hemorrhagic contusion,

After a detailed clinical examination, C.T. Scan of the brain is the important investigation to find out whether there is bleeding, swelling or fracture.

If the C.T. Scan shows a EDH (Extra dural Hematoma) or SDH (Subdural hematoma) or a large intra cranial bleed TIME IS BRAIN. Immediate surgery to remove the clot and reduce the swelling (decompression) can save a life.

If the fracture is undisplaced and patient is conscious and awake surgery is not required. If the fracture penetrates the brain or its covering (depressed fracture) surgery may be required to remove the bone pieces

When there is abnormal or excessive growth of brain tissue it forms a mass or swelling leading to compression or pressure on the surrounding tissue This is a brain tumor.

No. There are many brain tumors which are non cancerous called Benign brain tumors. Those which are cancers are called Malignant brain tumors.

• Intense, prolonged or continuous headache over days or months.
• Vomiting, squinting of eyes asymmetry of face.
• Paralysis or weakness of one side of the body (Hemiparesis)
• Double vision or Diplopia
• Fits, seizures or convulsions.

Please see your doctor if you have the above symptoms. After clinical exam, a C.T. Scan of brain or MRI scan of brain is performed, which will show   the tumor

• Surgery is the best form of treatment ,where removal of the tumor may be curable.
• If the tumor is very deep seated, advanced surgical techniques like Stereotaxic Surgery, Minimal Invasive Surgery or Endoscopic Surgery, Gaama Knife Surgery are some of the options.
• If the tumor is large or inoperable, Stereotaxic biopsy of the tumor followed by radiotherapy may be an option.
• In some pituitary tumors, a medication called BROMOCRIPTINE, given daily may reduce the size of the tumor considerably.

Hydro means water and cephalum means brain. When there is obstruction to the flow of Cerebro Spinal Fluid (CSF) in the brain, it leads to hrdrocephalus.

• Congenital hydrophalus - When there is obstruction to the flow of CSF from birth, due to blockage of ventricles it leads to congenital hydrocephalus
• Acquired hydrocephalus – When the flow of CSF is obstructed either internally due to infection, tumor or bleed or externally when a tumor or mass presses on the ventricle to obstruct its flow.

• Obstructive or non communicating hydrocephalus – When there is obstruction to the flow of CSF within the ventricles causing swelling or increase in size of ventricles
• Communicating Hydrocephalus - Here there is no obstruction to the flow of CSF within the ventricles, but there is a defect in the absorption of CSF into the veins over the surface of brain.

• Severe headache
• Vomiting
• Sunset sign- Inability to look up. So eyes have a downward gaze, looking like sunset.
• Enlarging size of head in Congenital hydrocephalus
• Enlargement of veins over the skull

• Shunt surgery – A tube is introduced into the ventricles and tunneled down below the skin into the abdomen - peritonum called VP shunt or ventriculo peritoneal shunt. VA shunt or Ventriculo Arterial shunt when the lower end of the shunt is introduced into the heart.
• Third Ventriculostomy - Here the obstruction to the flow from the third and forth ventricle is corrected by endoscopy .

When there is bleeding in the brain without trauma or head injury.

• Hemorrhagic stroke – Seen in 30-60% of hospital admissions due to stroke. High blood pressure (BP) increases the risk of bleed in the brain in stroke patients
• Head Injury
• Rupture of Aneurysm - An aneurysm is a defect in the wall of the artery. As age advances the pressure of the flow blood causes thinning of this wall with an out pouching  of the vessel (aneurysm). When the aneurysm ruptures it leads to Brain Haemorrhage.
• AVM  (Aretrio Venous Malformation) -  There is an abnormal connection between the arteries    and veins. This is usually a defect from birth. Due to this abnormal connection, the pressure in    the arteries is directly transmitted to the veins leading to bleed over a period of time. When the AVM occurs in the brain blood vessels, it leads Brain Hemorrhage.
• Brain tumor bleed  - Some brain tumors are very vascular and may at times spontaneously bleed.
• Disorders of Bleeding and Clotting of Blood - Can cause bleeding anywhere in the body including BRAIN

After a clinical suspicion of Brain Hemorrhage a C.T. Scan of brain will be able to show the Brain haemorrhage which appears as a bright shadow.

First a Brain Angiography is done to confirm the details of Blood vessel
Anerurysm –

• Surgical clipping of the aneurysm - This involves an open surgery of the brain and clipping the base of the aneurysm by a silver clip
• Endovascular coiling – Here a platinum coil is stretched and guided through the femoral artery, under fluroscopic vision. Once the stretched coil enters the aneurysm it is released and it coils in the aneurysm to block the ruptured site and prevent further bleeding. This method is NON INVASIVE and can avoid an open surgery

AVM – The treatment depends on the size and site of the AVM

• Surgery alone
• Embolization alone
• Radiotherapy alone
• Combination of all the above

When there is a natural degeneration of the vertebrae of the neck it leads to Cervical Spondylosis. Some individuals age faster than others so Cervical spondylosis may manifest even at a relatively early age of 35-40 years.

Chronic , dull aching pain in the neck, aggravated by movement. If the spondylosis is very long standing it may lead to inter vertebral disc prolapse or degeneration of disc and patient may have weakness of upper limbs. Tingling and numbness in upper limbs.

• X-ray of cervical spine is good basic investigations
• MRI scan of cervical spine to confirm diagnosis and observe details of degeneration and injury to nerves.

• In early stages using a hard collar to restrict the movement of the neck is the best treatment
• After acute pain subsides supervised physiotherapy to stretch the paravertebal muscles & ligaments.Interferntial therapy (IFT) and ultrasonic therapy (UST)
• Surgery , if the disc prolapse is severe causing compression of nerves.

• Proper posture especially those working on computers and desk job, exercise of neck
• weight control, good physical exercises
• Control of diabetes, obesity and hypertension.