Brain Conditions and treatment
- Brain Tumors
- Pituitary & Skull Base Tumors
- Aneurysm
- AVM
- Craniovertebral Junction
- Craniosynostosis & Craniofacial Anomalies
- Hydrocephalus
- Normal Pressure Hydrocephalus
- Trigeminal Neuralgia
- Facial Pain Syndromes & hemifacial Spasm
- Epilepsy Surgery
- Traumatic Brain Injury
Brain Tumors
A brain tumor is a mass or growth of abnormal cells in the brain. Some brain tumors are noncancerous (benign), while others are cancerous (malignant). Common tumors are glioma, meningioma, schwannoma, metastasis etc. Brain tumor treatment options depend on the type of brain tumor, as well as its size and location.
Procedures commonly performed for brain tumors are:
- craniotomy and removal of tumor
- Awake craniotomy
- computer assisted surgery (Neuronavigation)
- endoscopic tumor removal
- stereotactic surgery
Contact for successfully completing Brain tumor surgery in Chennai with latest technology. Dr. C.V. Shankar Ganesh of NHN clinic is specialized in treating deadly diseases relates to the
- Brain
- Nerves
- Spine
He works as a visiting doctor for famous clinics and hospitals. He had improved his knowledge in the field of Neurosurgery when he worked as a assistant professor at Jawaharlal Institute of Post Graduate Medical Education and Research in Pondicherry.
Pituitary & Skull Base Tumors
Pituitary tumors are abnormal growths that develop in the pituitary gland. The vast majority of pituitary tumors are noncancerous growths (adenomas). Treatment for pituitary tumors involves various options, including removing the tumor, controlling its growth and managing the hormone levels with medications.
Doctors generally use surgery, radiation therapy and medications, either alone or in combination, to treat a pituitary tumor and return hormone production to normal levels. The two main surgical techniques for treating pituitary tumors are:
Endoscopic Transnasal Transsphenoidal Approach
With this approach, a doctor usually can reach and remove the tumor through the nose and sinuses without an external incision. No other part of the brain is affected, and there's no visible scar. However, very large tumors may be difficult to remove with this procedure, especially if a tumor has invaded nearby nerves or brain tissue.
Transcranial Approach (craniotomy)
During this procedure, the tumor is removed through the upper part of the skull by way of an incision in the scalp. It's easier to reach large or more complicated tumors using this procedure.
Aneurysm
An aneurysm (AN-u-rism) is a balloon-like bulge in a blood vessel. A brain aneurysm can leak or rupture, causing bleeding into the brain (subarachnoid hemorrhage). A ruptured aneurysm quickly becomes life-threatening and requires prompt medical treatment. Some aneurysms are detected during tests for other conditions. These are ‘unruptured’ aneurysms.
Treatment options are surgical clipping and endovascular coiling. Surgical clipping is a procedure in which the surgeon opens a portion of the skull and applies a clip across the neck of the aneurysm to prevent leakage of blood. Usually once clipping is done, rebleeding does not occur. Computer assisted surgery is an option to make the procedure safer. Endovascular coiling is another way of treating an aneurysm, where platinum coils are packed into the aneurysm through a small tube (catheter) inserted through a blood vessel in the groin.
AVM
A brain AVM (arteriovenous malformation) is an abnormal connection between arteries and veins (blood vessels). It appears as a tangle of abnormal arteries and veins, can occur in any part of the brain.
Surgical Resection
Surgical treatment of a brain AVM is relatively safe and effective. In this procedure, the neurosurgeon removes the abnormal cluster of blood vessels through small opening in the skull. Once the AVM is completely excised, the chance of hemorrhage and risk for life is eliminated.
Endovascular Embolization
In is a procedure, blood vessels which carry blood to the AVM are occluded by injecting a glue like material, through a small tube (catheter), inserted through a blood vessel in the groin.
Stereotactic Radiosurgery
This treatment uses precisely focused radiation to destroy the AVM. It takes about one to three years for the AVM vessels to obliterate.
The choice of treatment of a AVM depends on its site, size, blood flow characteristics etc. Combination of surgery, embolization and radiosurgery is sometimes employed, to achieve safe and complete obliteration of the AVM
Craniovertebral Junction
The Craniovertebral (or craniocervical) Junction(CVJ) is a collective term that refers to the back side of the head and the upper part of the spine. It is a transition zone between a mobile skull and a relatively rigid spinal column. It encloses important structures like the brain stem, nerves and the spinal cord. Birth defects, developmental defects, trauma, tumors etc can affect this important area in our body.
Chiari malformation, syringomyelia, basilar invagination, atalanto axial dislocation, fractures and tumors like meningioma and schwannoma are common diagnosis for which people seek treatment. Evidence based, treatment is available for these conditons along with complete rehabilitation.
Craniosynostosis & Craniofacial Anomalies
Craniosynostosis is a birth defect in which one or more of the joints between the bones of an infant’s skull close prematurely, before the brain is fully formed. When a baby has craniosynostosis, his or her brain can't grow in its natural shape and the head is distorted. Craniosynostosis can affect one or more of the joints in the skull. In some cases, craniosynostosis is associated with an underlying brain abnormality that prevents the brain from growing properly.
Treating craniosynostosis usually involves surgery to separate the fused bones. If there is no underlying brain abnormality, the surgery allows the child’s brain adequate space to grow and develop.
Although there is no upper age limit for corrective surgery, the optimal time is between 2 months to one year of age. Endoscopic surgery can be considered for children who have single suture anomaly. Open surgery is done for babies with multiple suture or complex anomalies and for those with facial deformities. Both endoscopic and open procedures generally produce very good cosmetic results with low risk of complications.
Hydrocephalus
Hydrocephalus is the accumulation of fluid (cerebrospinal fluid or CSF) in the ventricles (cavities) deep within the brain. The excess fluid increases the size of the ventricles and puts pressure on the brain. CSF normally flows through cavities in the brain and spinal column. But the pressure of too much cerebrospinal fluid associated with hydrocephalus can damage brain tissues and cause a wide spectrum of disorders in brain function.
Although hydrocephalus can occur at any age, it's more common among infants and older adults. There are various causes for the formation of hydrocephalus like birth defect, infection, tumor, trauma etc.
Surgical treatment for hydrocephalus can restore and maintain normal cerebrospinal fluid levels in the brain. The commonest surgical procedure done for hyderocephalus is ventriculo peritoneal shunt. Endoscopic diversion of the fluid (without placing a shunt tube) can be considered for some patients.
Normal Pressure Hydrocephalus
People with Normal Pressure Hydrocephalus (NPH) have different combinations of gait difficulty, urinary problems and memory impairment, though gait difficulty invariably is a prominent feature. The affected person walks with difficulty - movements are slow, broad-based and shuffling.
Cognitive decline includes memory loss,speech problems, changes in behavior or mood (indifference and withdrawal), difficulties with reasoning, paying attention, or judgment.
Urinary problem manifests as inability to hold urine, frequent urination and urgency to urinate. Inability to hold stool, or feces is less common
The disorder is commonly seen in elderly people. It occurs due to a build-up of cerebrospinal fluid (CSF) in the ventricles of the brain, causing pressure on nerves that control the legs, balance, bladder and cognitive function.
A diagnosis of NPH is based on detailed history of symptoms, physical examination (structured examination of memory, reasoning, problem solving and gait). MRI scan of the brain is done to look for fluid accumulation and to rule out other disease processes.
Management
Lumbar puncture or spinal tap is done. This procedure involves removal of CSF from the area around the spinal cord in the lower back. The CSF pressure is measured, and the fluid that is removed is analyzed for abnormalities that might give a clue as to the problem. In some cases, the person is hospitalized for a few days while fluid is drained slowly through a small tube called a catheter. This is another way of checking whether removing extra fluid will help symptoms. Patients are subjected to detailed examination before and after this test. Improvement of symptoms (it is usually temporary) with lumbar puncture is commonly interpreted as meaning that a surgical shunt would be helpful in that person.
Patients who show good improvement with CSF tap test are good candidates for shunt operation. The treatment in these cases is a shunt operation.
A shunt is a thin tube that is implanted in the brain by a neurosurgeon. The tube is routed under the skin from the head to the lower belly. CSF drains from the brain into the abdomen. Flow is controlled by a valve, hence only excess fluid is drained. Once the fluid reaches the abdominal cavity it is absorbed by the blood stream. Newer shunts tubes have a programmable valve. The quantity of CSF drainage through the valve can be adjusted externally by a devise(Non-invasive method). This enables optimal removal of CSF from the brain in an individual patient, as each patient requires different amount of fluid to be diverted to improve his or her symptoms and also to prevent complications of excessive drainage of CSF. Outcome after surgery is variable. It is often good in patients who are carefully selected based on the above mentioned protocol. Patients should have regular visits with a neurologist or neurosurgeon. These visits allow the doctor to monitor their symptoms. Changes in symptoms may require adjustments in care.
Trigeminal Neuralgia
Trigeminal Neuralgia is a condition that is characterized by repeated, intermittent, shooting pain in the face. It is usually experienced on one side of the face. This excruciating pain is triggered by activities like brushing the teeth, chewing, talking, drinking hot or cold liquids, touching, talking, shaving, washing the face or even by feeling a breeze. Frequency and severity of pain increases over a period of time and can become distressing and intolerable. some people have remission of pain for several months or years before the next episode. This facial pain is believed to be caused by compression of the nerve (Trigeminal nerve) carrying sensations from the face to the brain. The nerve is usually compressed by a blood vessel at its entry into the brain stem. Rarely, a tumor or an abnormal cluster of blood vessels (AVM) or a disease within the nerve itself (multiple sclerosis)can affect the nerve and cause facial pain.
Diagnosis of trigeminal neuralgia is made by a clinician, based on the detailed history of a person’s pain characteristics like duration of the symptom, how did it start, activities that triggers the pain, where exactly is the pain felt, frequency of pain episodes etc. MRI scan of the brain is done to look for compression of the nerve and also to rule out other causes like tumors or AVMs.
The first line of treatment is medical management. A course of medicine is started eg. carbamazepine, gabapentine etc. Medical therapy is effective and give adequate pain relief in most patients. However, over time, some people with the condition may stop responding to medications, or they may experience unpleasant side effects.
Microvascular decompression (MVD) of trigeminal nerve is a surgical procedure. It is performed through a small hole in the skull, behind the ear. Blood vessels which are in contact with the trigeminal nerve are relocated and a patch of teflon is placed in between them. This procedure is successful in most of the patients.
Glycerol injection is a non-surgical procedure. A needle is inserted through the face into an opening in the base of the skull. The needle guided near the branches of the trigeminal nerve. Sterile glycerol is injected, which causes pain relief. This procedure is effective in most of the patients.
Radiosurgery (eg. cyberknife)is another non-surgical treatment option for trigeminal neuralgia. A focussed beam of radiation directed at the trigeminal nerve. Radiation damages the nerve and causes pain relief. If pain recurs the procedure can be repeated.
Facial Pain Syndromes & hemifacial Spasm
Glossopharyngeal neuralgia is a condition which is similar to trigeminal neuralgia. A person affected by this disorder experiences severe stabbing or shock like episodic pain in the throat, back of tongue or ear. During episodes of pain, about 10% of people experience heart irregularities like slowing of pulse, low blood pressure, fainting and seizures.
The cause is often unknown. It is usually associated with compression of the glossopharyngeal nerve (9th cranial nerve) by a blood vessel. Pain responds well to medicines. Microvascular decompression of the nerve or radiosurgery are considered for those who don’t get adequate pain relief with medicines.
Hemifacial spasm is an involuntary twitching or contraction of the facial muscles on one side of the face. It may be caused by a blood vessel touching a facial nerve, a facial nerve injury or a tumor involving the facial nerve.
Medications give good relief in most patients. Injection of botulinum toxin or microvascular decompression of the facial nerve are considered for patients who don’t respond to medicines
Epilepsy Surgery
Drugs can control seizures in most people. But about a third of people with epilepsy continue to have seizures inspite of being on several medicines. Surgery is an alternative for some people who continue to have seizures even after adequate trials of anti-epileptic drugs. Epilepsy surgery is an altenative for such people. There are various crietria to select candidates for this procedure.Aim of the surgery is to control seizures and improve the person's quality of life. The effectiveness of surgery depends on the underlying cause, type of surgery performed etc.
Traumatic Brain Injury
Traumatic brain injury (TBI) or head injury is caused by a blow to the head due to traffic accidents, falls, sports injuries and assaults. TBI may be classified as mild, moderate and severe. CT scan is usually done to evaluate the extent of brain injury. It can reveal fracture of the skull, blood clots in the brain, brain tissue damage and swelling. Depending upon the conscious level of the patient and the CT scan findings, the course of treatment is planned in the hospital. Usually, large blood clot in the brain, would require surgical evacuation. Those with severe brain swelling would require removal of a part of the skull (decompressive craniectomy) to reduce pressure on the brain. Outcome depends on various factors like age of the patient, mechanism of injury and severity of brain injury etc.