Excision of Cranial and Spinal Arterio-Venous Malformation (AVMs)
These are complex surgeries aimed at removing malformed conglomeration of blood vessels that parasitize the brain’s blood supply. The operation involves meticulous dissection around the tumour like growth of abnormal blood vessels and removal in toto. Similar AVMs in the spinal cord require greater expertise. However the procedure involved in similar to the one described above.
Clipping of aneurysms
Intracranial aneurysms are out -pouchings of blood vessels, similar to a balloon. These may burst causing life threatening sub-arachnoid haemmorage. We are equipped with the facilities to perform ‘clipping’ of these aneurysms in any location in the brain after performing a digital subtraction angiogram (DSA). Clipping means, that the aneurysm is removed from the circulation by application of a clip at its base.
Surgery for giant aneurysms under CPB
For certain aneurysms which are located in exquisite areas or are giant in size, clipping as described above may not be feasible. In such cases, the help of the Cardiac surgery team is sought to perform a Cardio Pulmonary Bypass and temporarily block the blood flow to the site of the aneurysm. This is done by cooling the patient to profound hypothermia conditions and initiating Total Circulatory Arrest. The window of opportunity is around 30 minutes within which the clipping has to be accomplished. This expertise is available in a only a handful of centers around the world.
Dural AV fistula (DAVF)
DAVFs are rare anomalies which may be managed with either open surgery or interventional procedures. At SSSIHMS a variety of operative strategies are employed in an attempt to disconnect the abnormal communication between an artery and a vein.
Excision of Cavernomas
Carvernomas are mulberry shaped overgrowth of intracranial small blood vessels, which may bleed. They may be located in almost any part of the brain or spinal cord. Great care has to be exercised in removal of these lesions which may be small and may be located in eloquent regions of the brain or at great depth. Sophisticated surgical aids like a neuro-navigation system are often employed to reach the lesion and remove it without damaging the surrounding brain tissue.
This is a painful condition involving the face where the patient presents with unbearable, episodic, shooting pain in a particular portion of his/her face. The offending structure is usually a loop of an intracranial blood vessel which irritates the nerve conducting sensation from that portion of the face. Surgery is very gratifying and involves separating these two structures under the operating microscope.
These are brain tumours which may range from benign to malignant high grade tumors(Grade I to grade IV). Depending on its location, size and patient condition, the surgical strategy is planned for tackling each tumor.
Acoustic tumors( Vestibular schwannoma)
These are common tumors arising from the nerve responsible for conducting the sound from the ear. Unfortunately even in this day and age, the patients seen at SSSIHMS present at a late stage with some even losing vision and almost all tumors being extremely large in size.
Meningiomas are benign tumors arising from the covering of the brain and spinal cord. Depending on its location, the surgical approach is planned.
Complex cranial base tumors
Cranial base surgery is a sub specialty in neurosurgery which is oriented towards the approach of lesions located at areas in the brain where routine surgical approach may not be successful.
The pituitary gland which has been described as the master gland in the human body may be home to a variety of tumors some of which may present with mass effect (visual deterioration, neurological symptoms) and others with endocrinological symptoms. Trans-nasal, trans-sphenoidal approach is used commonly to operate these tumors. i.e the surgeon operates on the pituitary gland through the nose. Other larger tumors may require an intracranial approach.
A variety of primary and secondary skull tumors are seen. Surgery involves removal of the tumor and reconstructing the bone defect.
The brain is a common site for the lodging of cancer deposits from primary malignancies elsewhere in the body. Sometimes the location of the primary may elude detection.
The ventricles of the brain are cavities filled with the cerebrospinal fluid. A whole range of tumors from, the most innocuous to the most malignant may be harbored within the ventricles. By virtue of its location, the approach has to be planned in great detail before embarking on surgery.