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NEUROSURGICAL DISEASES IN BRIEF AND TREATMENTS

The Neurosurgeons collaborate seamlessly like a single entity. To the patient it means better diagnosis and better treatment. We are renowned for providing specialized care when it comes to stroke, head & spinal injuries, brain tumors, seizure disorders, movement disorders and headaches.

The Neurologists, Neurosurgeons, critical care specialists, nurses and researchers at the Apollo Institute of Neurosciences collaborate seamlessly like a single entity. To the patient it means better diagnosis and better treatment. We are renowned for providing specialized care when it comes to stroke, head & spinal injuries, brain tumors, seizure disorders, movement disorders and headaches.

What Is Epilepsy?

Definition

Epilepsy is a neurological (central nervous system) disorder characterized by seizures and short periods of unusual behaviour, sensations and loss of consciousness at times, due to disruption of the nerve cell activity in the brain.

 

Symptoms

Seizure signs and symptoms are:

  • Involuntary and uncontrollable jerking movements of the limbs

  • Loss of consciousness and awareness of surrounding

  • Psychic symptoms of confusion and staring blankly

 

Risk Factors

Factors which increase the risk of epilepsy are:

  • Age - Usually early childhood and after the age 60 but conditions may appear at any age

  • Family history - Family history of epilepsy

  • Head injuries - In some cases

  • Stroke and other vascular diseases - Any stroke induced brain damage can trigger epilepsy

  • Dementia - Memory loss in older adults

  • Brain infections - Meningitis can cause infection and inflammation in the brain or spinal cord

  • Seizures in childhood - High fevers in childhood can sometimes be associated with seizures

 

Diagnosis

The doctor will do the following:

  • Patient medical history - Review signs and symptoms and medical history

  • Neurological examination and neuro psychological tests - Check behavior, assess thinking, memory and speech skills, motor abilities and mental function to determine the type of epilepsy and area of brain affected

  • Blood tests - To check for infections, genetic conditions associated with seizures

  • Scans - Doctors may run a CT scan, an MRI, a PET scan, a SPECT test and an Electroencephalogram (EEG) test to detect brain abnormalities and seizure epicenter

 

Treatment

Doctors generally treat epilepsy with medication. If medications don't treat the condition, doctors may propose surgery or therapies like vagus nerve stimulation and a ketogenic diet.

Brain & Spine Surgery

Brain Spine Surgery

Neurosurgery, which includes surgery on the brain, spinal cord, skull and the bony spinal column, is a highly advanced super specialty which requires specialized training. With technology becoming the prime driver in most areas of healthcare, tremendous strides have been made in Neuro care. Our hospital is recognized as a leader in acute Neurosurgical care and is ranked among the top hospitals specializing in Neuro care in the world. Ably supported by modern Neuro-radiology service, Neuro-intensive care facility, medical and radiation oncology services, specialists at our Hospitals achieve outcomes matching those of the leading institutions across the globe.

Micro - Neurosurgery

(Surgery performed using an operating microscope)

Neurosurgery often involves reaching into complex areas of the brain, the skull base, or the spinal cord. The objective of Neurosurgery is to treat the disease while keeping the delicate functions of the brain intact, thereby achieving good surgical outcome. This can be done by combining the latest microscopic surgical techniques with the most advanced and up-to-date technical resources. This allows us to reach the surgical target safely while keeping the risk at a minimum.

Micro neurosurgery is a term used to refer to the operating microscope and specific micro-instruments which are deployed to perform a surgery for treating the diseases of brain, spine, and spinal cord. Neurosurgeons are nowadays very adept in Microsurgery and perform several complex delicate operations using the Microscope.

The centers for Neurosurgery at our Hospitals offer the best in micro neurosurgery. Almost all procedures in brain and spine are done under the magnification provided by the microscope. With the use of a microscope, there is less damage to a normal brain or spinal cord surrounding the area of abnormality. Patients have a smooth recovery and lower incidence of surgery induced deficits. The hospital stay is reduced and thus the cost of treatment is lower.

complex Spinal Surgeries & Minimal Access Spine Surgery

(Microsurgery for Disc Prolapses, Stabilization for Spinal Instability and Deformity)

With the increasing rates of high speed vehicular accidents, the incidence of Spinal injuries are on the rise. And if the patients do not receive effective treatment at the earliest, they may be left with debilitation neurological defects (paralysis of hands and legs / inability to control urination and defecation). Complex Spinal stabilization procedures are performed at Apollo Hospitals to achieve a high degree of Spinal stability as rehabilitation often depends on it. Microsurgery (Micro-Discectomy, Corpectomy [removal of vertebral body], Laminectomy, Laminoplasty) is used to treat Spondylosis, where the spine gets degenerated and causes pressure on the Spinal Cord and Spinal Nerves.

Surgery for Spinal Cord Tumors

Any tumor or growth on the spine whether cancerous or not, can press upon the nerves, causing pain, neurological defects and sometimes paralysis. Loss of sensation or muscle weakness, especially in the legs, difficulty in walking, sometimes leading to falls and loss of bowel or bladder function are some other symptoms of such tumors.

They are classified according to their location, as follows:

  • Extradural - outside the dura mater lining (most common)

  • Intradural - part of the dura mater lining

  • Intramedullary - inside the spinal cord

  • Extramedullary - inside the dura, but outside the spinal cord

 

Surgeons at our Hospitals treat spinal tumors even in the most inaccessible areas. High-powered microscopes that are used in surgery help remove even delicately placed intradural tumors. Total Spondylectomy - removal of the entire vertebra is done as a definitive cure is also done for some spinal tumors.

Surgery for the Acute Head Injury and Spinal Injuries

Head Injury is a general term used to describe any trauma to the head, and most specifically to the brain itself.

Skull Fracture : A skull fracture is a break in the bone surrounding the brain and other structures within the skull.

Linear Skull Fracture : A common injury, especially in children. A linear skull fracture is a simple break in the skull that follows a relatively straight line. It can occur after seemingly minor head injuries (falls, blows such as being struck by a rock, stick or other object or from motor vehicle accidents). A linear skull fracture is not a serious injury unless there is an additional injury to the brain itself.

Depressed Skull Fracture : This is common after forceful impact by blunt objects most commonly, hammers, rocks, or other heavy but fairly small objects. This injury causes "dents" in the skull bone. If the depth of a depressed fractures is at least equal to the thickness of the surrounding skull bone (about - inch), surgery is often required to elevate the bony pieces and to inspect the brain for evidence of injury.

Minor blunt head injuries : May involve only symptoms of being "dazed" or brief loss of consciousness. They may also result in headaches, blurring of vision or nausea and vomiting.

Severe blunt head trauma : Involves a loss of consciousness lasting from several minutes to many days. Seizures may result. The person may suffer from severe and sometimes permanent neurological damage or may die. Neurological damage from head trauma resemble those seen in stroke and include paralysis, seizures, difficulty in speaking, seeing, hearing, walking, or understanding.

Penetrating trauma : May cause immediate, severe symptoms or only minor symptoms despite a potentially life-threatening injury. Death may follow from the initial injury. Any of the serious blunt head trauma may result.

Emergency personnel should immediately attend to all potentially serious head injuries.

Surgery for Stroke/Stroke Prevention

Definition

A stroke, or brain attack, is caused by the sudden loss of blood flow to the brain or bleeding inside the head. Each can cause brain cells to stop functioning or die. When nerve cells in the brain die, the function of body parts they control is harmed or lost. Depending on the part of the brain affected, people can lose speech, feeling, muscle strength, vision, or memory. Some people recover completely; others are seriously disabled or die.

You can reduce your chances of death or disability if you recognize the signs of stroke and get immediate medical help. Quick medical attention and treatment can save lives. It can also prevent more serious, long-lasting problems. People who are suffering a stroke must get immediate medical care. It is very important they get to a hospital within 60 minutes of the onset of a stroke. Time is of the essence.

 

Risk Factors

Stroke risk increases sharply with age, doubling every decade after the age of 55. However, stroke can occur at any age. About 28 percent of those who have a stroke are under 65 years old. Men have slightly more strokes than women. Strokes claim the lives of more women than breast cancer. And people with a family history of stroke and heart disease have an increased stroke risk.

There are also very important risk factors that often can be controlled:

  • Monitoring and reducing high blood pressure

  • Limiting tobacco use

  • Managing cholesterol levels

  • Maintaining a healthy weight

  • Controlling diabetes

See your doctor for help in addressing these risk factors.

 

The brain is affected by two types of stroke, "ischemic" and "hemorrhagic."

Eighty percent of all strokes are ischemic. Ischemic strokes can be caused by narrowing of the large arteries to the brain. This is also called "atherosclerosis." Ischemic strokes include:

Embolic : Clots travel from the heart or neck blood vessels and lodge in the brain, sometimes due to an irregular heartbeat, called "atrial fibrillation"

Lacunar : Small vessels in the brain are blocked, often due to high blood pressure or diabetes damage

Thrombotic : Clots form in the brain blood vessels, often due to "arteriosclerosis," or hardening of the arteries

When blood cannot get to the brain cells, they die within minutes to a few hours. Doctors call this area of dead cells an "infarct."

The lack of normal blood flow to brain cells sets off a chain reaction called the "ischemic cascade." Over hours, this endangers brain cells in an increasingly larger area of brain where blood supply is reduced but not completely cut off. Quick medical treatment offers the best chance of rescuing this area of brain cells, called the "penumbra."

Hemorrhagic strokes involve bleeding into or around the brain, including:

  • Subarachnoid : Weak spots on brain arteries, called "aneurysms," burst and blood covers the brain.

  • Bleeding into the brain: Blood vessels in the brain break because they have been weakened by damage due to high blood pressure, diabetes, and aging.

Symptoms

Stroke symptoms may not be as dramatic or painful as a heart attack. But the results can be just as life-threatening. Stroke is an emergency. Get medical help immediately and know when the symptoms started. Common symptoms include:

  • Sudden numbness or weakness of face, arm, or leg, especially on one side of the body.

  • Sudden confusion, trouble speaking or understanding speech.

  • Sudden difficulty seeing in one or both eyes.

  • Sudden trouble walking, dizziness, loss of balance or coordination.

  • Sudden severe headache with no known cause.

Call 1066 immediately if you or someone you know experiences any of the above warning signs. Write down the time the symptoms started. Sometimes these warning signs last for only a few minutes and then go away. Even if this happens, or if you think you are getting better, call for help.

Diagnosis

The neurologist or emergency doctor must examine you to understand your condition and find out what caused the stroke. Diagnostic tests to determine treatment could include:

  • Neurologic exam

  • Brain imaging tests (CT, or computerized tomography scan; MRI, or magnetic resonance imaging) to understand the type, location, and extent of the stroke.

  • Tests that show blood flow and bleeding sites (carotid and transcranial ultrasound and angiography).

  • Blood tests for bleeding or clotting disorders.

  • EKG (electrocardiogram) or an ultrasound examination (echo cardiogram) of the heart to identify cardiac sources of blood clots that could travel to the brain.

  • Tests that measure mental function.

 

Treatment

Immediate medical care is important. New treatments work only if given within a few hours after a stroke begins. For example, a clot-busting drug must be given within three hours.

Once the doctor completes the diagnostic tests, the treatment is chosen. For all stroke patients, the aim is to prevent further brain damage. If the stroke is caused by blocked blood flow to the brain, treatment could include:

  • T P A (tissue plasminogen activator), a clot-busting drug that is injected within three hours of the start of a non-bleeding stroke.

  • Drugs that thin the blood, including anticoagulants (warfarin) and antiplatelet medications (aspirin or ticlopidine); a combination of aspirin and sustained release dipyridamole.

  • Surgery that opens the insides of narrowed neck blood vessels (carotid endarterectomy). If bleeding causes the stroke, treatment could include:

    • Drugs that maintain normal blood clotting.

    • Surgery to remove blood in the brain or decrease pressure on the brain.

    • Surgery to fix the broken blood vessels.

    • Blocking off bleeding vessels by inserting a coil.

    • Drugs that prevent or reverse brain swelling.

    • Inserting a tube into a hollow part of the brain to lower pressure.

After a stroke, a person may have some disability. The disability depends on the size and location of the stroke. The right side of the brain controls the left side of the body; in right-handed individuals it is important for attention and visual-spatial skills. The left side of the brain controls the right side of the body; in right-handed individuals (and 50 percent of left-handed people) it controls language speaking and understanding. Language disorders are also called "aphasias."

Rehabilitation

Rehabilitation helps regain functions lost from damage due to stroke. During rehabilitation, most people will get better. However, many do not recover completely. Unlike skin cells, nerve cells that die do not recover and are not replaced by new cells. However, the human brain is adaptable. People can learn new ways of functioning, using undamaged brain cells.

This rehabilitation period is often a challenge. The patient and family work with a team of physical, occupational, and speech therapists, along with nurses and doctors. Most of the improvement will take place in the first three to six months of the process. But some people can make excellent progress over longer periods.

Skull Base Surgery

(Complex procedures at the base of the brain involving the bone and blood vessels)

Tumors of the skull base are often the most difficult to treat. Surgery is complex due to the critical location of the tumor in terms of proximity to vital blood vessels, nerves and requires a team of surgeons - Neurosurgeon, Head & Neck surgeon, Plastic surgeon and Vascular surgeon. With the latest in high-speed drills and saws, we are indeed well equipped for these procedures.

Surgery for Parkinson's disease

Parkinson's disease is a progressive disorder of the nervous system that affects voluntary movement.

Symptoms vary person to person and typically affect one side of the body first , even as they worsen. Traditionally total cure was never possible and patients were put on medications to manage their worsening symptoms.

Parkinson’s disease can progressively affect quality of life , with symtomps such as:

Tremor - Tremor in a limb, often in the hand or fingers at rest, a back-and-forth rubbing of your thumb and forefinger, known as "pill-rolling"

Slowed voluntary movement (bradykinesia) - Reduced ability to move and walk, and dragging feet with smaller steps as well as difficulty in rising from sitting/getting out of a bed/chair

Orthostatic hypotension - Lightheadedness or dizzy when standing

Rigid muscles - Muscle stiffness and abnormal tone in the body limiting your motion and causing pain

Impaired posture and balance - Stooped posture, unsteady balance

Loss of automatic movements - Decreased facial movement like blinking, smiling or swinging your arms when you walk

Dysarthria - Difficulty in speaking and speech-related problems like speaking softly, quickly, with a slur or hesitation, monotonous without inflections

Dysphagia - Difficulty in swallowing

Writing changes - Difficulty to write, and writing may appear small.

Surgery for Parkinson’s disease

Our Hospitals has been in the forefront for surgery of Parkinson's disease from as early as the '60s and '70s. It has brought the latest in surgery for Parkinson's disease - Sub Thalamic Nucleus (STN) Deep Brain Stimulation (DBS) to India. Similar to a Cardiac Pacemaker, here also a pacemaker is implanted into the brain. The procedure is done under local anesthesia. The results are visible immediately and are sustained.

 

What is DBS?

Deep brain stimulation (DBS) is a surgical procedure used to treat a variety of neurological symptoms-most commonly the symptoms of Parkinson’s disease (PD), such as tremor, rigidity, stiffness, slowed movement, and walking problems. The procedure is also used to treat essential tremor, a common neurological movement disorder. DBS does not damage healthy brain tissue by destroying nerve cells. Instead the procedure blocks electrical signals from targeted areas in the brain.

DBS is often described as a pacemaker for the brain. It works much like a pacemaker, sending electrical signals to the brain instead of the heart. It is primarily utilized for patients who have Parkinson’s disease, dystonia, or essential tremor (ET), and who can’t adequately control their disease with medication.

For those with Parkinson’s, DBS can reduce tremors and significantly improve slowness and stiffness; and make tremors disappear for those with ET. DBS can help relax muscles and improve abnormal postures caused by muscle contractions for those with dystonia. In all cases, DBS can help enhance quality of life.

It’s important to understand that DBS does not offer a cure for your disease, but a way to manage it more effectively. It can offer many benefits, including the need to take less medication and therefore experience fewer medication side effects.

FAQS about DBS

When is a good time to consider DBS? Am I a good candidate?

There are somewhat different criteria for determining if DBS is a good option for you based on your diagnosis and condition. For Parkinson’s disease, DBS is typically helpful if you experience motor fluctuations or tremors that interfere with activities that are not already adequately managed by medication, are not improved by changes in medication, or you experience side effects that prevent you from taking higher doses. For ET, DBS may be considered if you have tremors that interfere with your quality of life and cannot be controlled adequately with medications. Other key factors considered are age in combination with general health, a solid support system of family and friends, absence of dementia or an active psychiatric illness such as severe depression, and realistic expectations for treatment outcomes.

Before any patient is considered for DBS surgery, they are evaluated by the U-M Surgical Therapies Improving Movement (STIM) multidisciplinary team, which has extensive training in DBS. The STIM team includes a neurosurgeon, neurologist, clinical neuropsychologist, speech pathologist, social worker, and other team members who ensure that you and your family understand the procedure and discuss your expectations and concerns.

 

What does DBS feel like when the device is on?

During the initial programming of the DBS, individuals may experience a slight, temporary shock or tingling as placement and levels are adjusted. Identifying the best placement and level enables you to receive the greatest benefit possible based on your unique condition and needs.

 

Does the DBS procedure need to be done with MRI? I have a pacemaker and cannot get an MRI.

The MRI provides the clearest and most detailed picture of the brain. This is the preferred method to make sure the best outcomes are achieved. However, DBS surgery can be performed using CT guidance. CT, or computed tomography, is a way of imaging the brain, but the detail in the pictures is not as good as with MRI. This may lead to suboptimal outcomes. CT-guided DBS is easier with ventralis intermedius (VIM) nucleus placement (done with essential tremor), as the VIM nucleus (a part of the thalamus section of the brain) is a bigger structure and not as deep. CT-guided DBS is much more technically difficult if the neurosurgeon is trying to place a lead in the subthalamic nucleus (STN), a part of the basal ganglia section of the brain, but it can be done. If you have a pacemaker, this will be discussed as part of your surgical planning.

Where would you put the DBS stimulator if I already have a pacemaker?

Pacemakers are typically placed in the same pocket in the chest where DBS stimulators are placed. Because pacemakers are placed on the left side of the chest, the DBS stimulator could be placed on the right side of the chest. Another alternative would be to place the DBS stimulator just under the skin of the abdomen. The extension wires from the leads to the stimulator would be longer, which would put it at higher risk for lead fracture, but there is generally more “padding” in the abdomen, so the stimulator does not stick out as much.

What if the stimulator battery runs out? What will happen?

If the stimulator battery runs out, if you have Parkinson’s you should contact your neurosurgeon or the STIM team as soon as possible. They may tell you to go into the emergency room, and an urgent battery replacement will be scheduled. If you have dystonia, the symptoms of your dystonia may come back over days to weeks. Again, this will be more of an urgent issue, and you should contact the DBS neurosurgeon or STIM team as soon as possible. Following up with your DBS team for regular monitoring of your battery will greatly reduce the chances of your battery running out unexpectedly.

 

Will others be able to see my DBS device?

Once you are healed, there is very little evidence that can be seen. At some centers, a small amount of hair is shaved above your forehead on the top of your head at the time of Stage I. Most women and some men are able to style their hair in such a way that this is not very noticeable. However, if you have short hair, or no hair, the incisions are likely to be visible to others until you are healed. If your DBS center shaves the entire head, then the incisions will certainly be visible until they heal and your hair grows back. There will be a 2- to 4-inch incision in the scalp on the top of the head and a smaller incision behind the ear. Once healed, the incisions will leave scars that will be visible on balding heads but are well-covered when hair grows back.

The scalp will have bumps where the holes were drilled. The holes are filled with plastic caps that sit just under the scalp, leaving a small raised area. Again, in those with hair, this is not visible. In balding men, the raised areas on the scalp are more visible. The extension wire that runs from the lead(s) in the brain to the stimulator is tunneled in the fatty tissue just under the skin. For most, the track of the extension wire is not visible. However, for those that are thin, it may appear as a large vein would, just under the skin.

The stimulator lies under the skin, just below the collar bone. Once healed, there will be a 3- to 5-inch scar from the incision. The stimulator site will be slightly raised. This is more noticeable in those that are thin. It may be noticeable if one is wearing a bathing suit or low cut blouse. However, this generally is not seen through clothing.

 

I need tremor control in both of my hands to perform my job. Can I have DBS for both hands?

If you have Parkinson’s disease, you are likely to have bilateral surgery with placement of leads in the subthalamic nucleus (STN) or globus pallidus interna (GPi) and experience tremor control in both hands. If you have essential tremor (ET), lead placement occurs in the ventralis intermedius (VIM) nucleus of the thalamus, but often only on one side. This is done to see if there is enough benefit with tremor control in one hand.

How do I know when to use my DBS?

Individuals with Parkinson’s disease or dystonia will be instructed to leave the stimulator on continuously. There is no need to turn off the stimulators, unless undergoing a medical procedure. Those with essential tremor who have leads placed in the ventralis intermedius (VIM) nucleus can turn the stimulator on or off, depending on when tremor control is needed. Many people turn the stimulator on in the morning upon waking and off at bedtime.

Can I do my own programming?

Finding the correct contact on your DBS lead can only be done by the DBS neurologist or nurse who does the initial programming. However, some of the newer stimulators on the market allow the DBS neurologist to set different programs. For example, they could set it so you would be able turn your stimulator voltage up to a pre-set level, or switch your settings back to the same settings you had at the previous visit.

I have essential tremor that affects my voice. Will DBS help the tremor in my voice?

Although DBS is excellent for helping the tremor that is experienced in the hands and arms due to essential tremor, it is unlikely that DBS will help your voice with just a unilateral lead.

Why would you choose the subthalamic nucleus (STN) as a site for Parkinson’s disease? It seems that it is associated with more problems than the globus pallidus interna (GPi)?

In a recent large DBS trial comparing STN to GPi DBS for Parkinson’s disease, there was not much difference in the effect on motor symptoms. STN had a slight advantage in that people were able to reduce their medications more. In other studies, GPi is reported to have less depression and fewer problems with cognition after surgery, but in the large DBS trial, there really were not any clinically significant differences in outcome with respect to depression or cognition.

Neuro-Endoscopic Surgery for Pituitary Tumors and CSF Leaks

This procedure has reduced the hospital stay of the patients and has helped in quicker recovery from hormonal problems. Patients who have a leak of the brain fluid through the nose can also be treated by this relatively less invasive technique. Neuroendoscopy Equipments are also used routinely for minimally invasive endoscopic removal of certain tumors (eg. intraventricular and pituitary tumors), third ventriculostomy in the treatment of hydrocephalus, drainage of brain abscesses and cysts.

 

Endovascular Coiling of Aneurysms and Vascular Malformations

With the help of a dedicated Cath lab and a full time Neuro-interventional Radiologist, Apollo Hospitals has to its credit for having treated numerous aneurysms, Carotico-cavernous fistulae, Dural AV fistulae, AVM's of brain and spinal cord. Therapeutic embolisations of Brain tumors and tumors of the spine are done routinely

 

Paediatric Neurosurgery

(For anomalies and tumors of the brain and spinal cord in infants and children)

For children born with anomalies of the brain, spinal cord, skull deformities and spinal deformities, Apollo Hospitals offers the best care, in the form of programmable shunts for hydrocephalus, repair of meningo-myeloceles, correction of cranio-synostosis (early, abnormal closure of skull bones) and correction of spinal deformities. Children with tumors of the brain and eyes are also treated.

 

Vertebroplasty

Vertebroplasty is an image-guided, minimally invasive, nonsurgical therapy used to strengthen the vertebra (spinal bone) weakened by osteoporosis, or cancer. Vertebroplasty can increase the patient's functional abilities, allowing them to return to the previous level of activity, and prevent further vertebral collapse. It is usually successful at alleviating the pain. Performed as an outpatient procedure, vertebroplasty is accomplished by injecting a bone cement mixture through a needle into the fractured bone.

Goals

The goals of vertebroplasty, as a surgical procedure, are to stabilize the spinal fracture and alleviate pain caused by the fracture. This is a minimally invasive procedure as it accomplished by doing a small puncture in the patient's skin.

What to expect

A typical vertebroplasty involves the following steps:

  • The patient is treated with local anesthesia or light sedation sometimes.

  • A biopsy needle is guided into the fractured vertebra, under X-ray guidance, through a small puncture in the patient's skin.

  • Specially formulated acrylic bone cement is injected under pressure directly into the fractured a, filling the spaces within the bone. This makes a type of internal cast (a cast within the vertebra) to stabilize the vertebral bone.

  • The needle is removed and the cement hardens quickly (within 10 minutes), congealing the fragments of the fractured vertebra and stabilizing the bone.

  • The small skin puncture is covered with a bandage.

  • Shortly after the cement has hardened, the patient is free to leave the medical facility and can go home the same day.

 

Stereotactic Radiosurgery

Stereotactic radiosurgery (SRS) uses diverse, precisely focused radiation beams to treat tumors and diseases in the brain, neck, etc.

It is not a surgery in the traditional sense because there is no incision. Instead, SRS uses 3-D imaging to target high doses of radiation towards the affected area with minimal impact on the surrounding healthy tissue.

Like other forms of radiation, stereotactic radiosurgery works by destroying the DNA of the targeted cells. The affected cells then lose the ability to reproduce, which causes tumors to shrink.

When doctors use stereotactic radiosurgery to treat tumors in areas of the body other than the brain, it's sometimes called stereotactic body radiotherapy (SRBT) or stereotactic ablative radiotherapy (SABR).

 

Types of stereotactic radiosurgery

Three types of technology are used to deliver radiation during stereotactic radiosurgery.

Linear accelerator (LINAC) machines use X-rays (photons) to treat cancerous and noncancerous abnormalities in the brain and other parts of the body. LINAC machines are also known by the brand name of the manufacturer, such as CyberKnife, Axesse, Novalis Tx, TrueBeam and XKnife. These machines can perform SRS in a single session or over three to five sessions for larger tumors, which is called fractionated stereotactic radiotherapy.

Gamma Knife machines use 192 or 201 small beams of gamma rays to target and treat cancerous and noncancerous brain abnormalities. Gamma Knife machines are less common than LINAC machines and are used primarily for small to medium tumors and lesions in the brain associated with a variety of conditions.

Proton beam (charged particle radiosurgery) is the newest type of stereotactic radiosurgery; it is available only at a few centers in the world. Apollo Hospitals is the first to bring it to India. It can treat brain cancers in a single session using stereotactic radiosurgery or use fractionated stereotactic radiotherapy to treat body tumors over several sessions.

How it works

All types of stereotactic radiosurgery and radiotherapy work in a similar manner.

The specialized equipment focuses many small beams of radiation on a tumor or other target. Each beam has very little effect on the tissue it passes through, but a targeted dose of radiation is delivered to the site where all the beams intersect.

The high dose of radiation delivered to the affected area causes the tumors to shrink and blood vessels to close off over time following treatment, robbing the tumor of its blood supply.

The precision of stereotactic radiosurgery means there's minimal damage to the healthy surrounding tissues. In most cases, radiosurgery has a lower risk of side effects compared to other types of traditional surgery or radiation therapy.

Stereotactic Biopsy /aspiration

Stereotactic biopsy/aspiration involves no opening of the skull and is suitable for small, deep seated tumors. It is performed under a CT / MRI scan guidance having precise computer calculations. Over 1000 stereotactic biopsies and craniotomies (open surgeries with precise localisation of the tumor by stereotaxy) have been performed.

Cyberknife

Ushering in another new era in healthcare, the our Hospitals Group has introduced the most advanced CyberKnife® Robotic Radio Surgery System in the Asia Pacific. The world's first and only robotic radiosurgery system is designed to treat tumors anywhere in the body with sub-millimeter accuracy. An innovation in the treatment of cancer, a breakthrough technology, a non-invasive alternative to surgery, the CyberKnife® brings an unparalleled approach to treating inoperable tumors. Patients who previously had no options or only high-risk options for treatment now have a safer alternative.

Robotic Neuro rehabilitation

we have tie up with kokilaben and thunga hospital.

Neurological disorders leave most with devastating disabilities such as the loss of movement in an arm or leg, and the accompanying loss of freedom of movement. Initially, these disabilities were considered incurable and therapy often focused on training people to use their "good side."

Fortunately research shows that the concept of "task-specific learning", in Neuro rehabilitation based on neuro plasticity, suggests that activities of daily living may be trained and improved through continuous repetition in neurological patients. Robotic therapy meets this demand and enables intensive functional locomotion therapy with augmented feedback.

"Robotics is the intelligent connection of perception to action." Michael Brady (~1985)

Robotics has come a long way in the past few years, and while we're not yet creating bionic men and women, we can at least claim to make people "better, stronger, and faster."

Robotics can compensate for the patient's inadequate strength or motor control at speeds individually calibrated on the residual motor functions, while continuous feedback provides the patient with subjective perception of improvement. These characteristics make robotics a potential support in the rehabilitation domain for both trainers and patients, whose role remains central to the process. Robotic Neuro rehabilitation is attractive because of its potential for easy deployment, its applicability across of a wide range of motor impairment, and its high measurement reliability.

At our hospitals we provide robotic Neuro rehabilitation, a scientific innovation, helping our patients on their way to recovery and a better quality of life. Apollo Hospitals is the only institution in the country to have the latest technology and equipment in robotic neuro rehabilitation:

  • LOKOMAT for intensive locomotion therapy

  • ARMEO for functional therapy of the upper extremities

  • ERIGO for early rehabilitation and patient mobilization

 

LOKOMAT

While two-thirds of people who suffer from a neurological condition regain ambulatory function, the resulting gait pattern is typically asymmetrical, slow, and metabolically inefficient, mostly associated with difficulty in advancing and bearing weight through the more affected limb, leading to instability, along with increased risk of falls. Secondary impairments, including muscle disuse and reduced cardiorespiratory capacity, often contribute to further functional declines in gait. Hence, improved walking is one of the most frequently articulated goals of rehabilitation and interventions that effectively enhance locomotor function. They are essential in the rehabilitation of neurological patients following stroke, spinal cord injury, and traumatic brain injury, as well as in patients with multiple sclerosis, cerebral palsy or other neurological disorders.

Lokomat consists of a driven robotic gait orthosis that guides the patient's legs on a treadmill offering a wide range of training possibilities and has a pre-programmed gait pattern facilitating a bilaterally symmetrical gait pattern as the individual actively attempts to advance each limb while walking on the treadmill. The pre-programmed walking pattern corresponds with normal gait kinematics including: gait cycle timing (i.e. stance vs. swing phase), inter-limb and inter-joint coordination, appropriate limb loading, and afferent signalling. Lokomat can be used in both adult and paediatric population likewise.

Lokomat entails the following benefits:

  • Faster progress through longer and more intensive functional training sessions compared to manual treadmill training with adjustable level of difficulty and intensity according to the cognitive abilities and the specific needs of each patient

  • Patient walking activity is easily supervised and assessed

  • Gait pattern and guidance force are individually adjustable to the patient's needs to optimize the functional training

  • Improved patient motivation through visualized performance feedback offering various engaging virtual environments

  • Assessment tools allow easy and reproducible measurements of the patient's progress

  • If needed - easily switch from automated to manual therapy

  • An integrated biofeedback system monitors the patient's gait and provides real-time visual performance feedback to motivate the patient for active participation.

 

ERIGO

Accelerates early rehabilitation and minimizes complications of debilitated/bedridden and neurologically impaired patients

Patients confined to prolonged bed rest endure reduced cardiac output, reduced oxygen uptake, muscle atrophy and skeletal demineralization, and the risk of injury when eventually elevated.

The Erigo combines a continuously adjustable tilt table with a robotic stepping mechanism, enabling early, intensive therapy.

  • Combines three established therapies in one - verticalization, leg movement, and cyclic loading and unloading of lower extremities.

  • Supports and facilitates patient mobilization

  • Provides intensive afferent sensory stimulation

  • Activates the cardiovascular system

  • Repetitive physical motion reduces spasticity in some patients

  • May reduce risk of secondary complications caused by immobility

  • May improve alertness in vegetative state patients

 

ARMEO

The Armeo Therapy Concept improves the efficiency of therapy treatments because the exercises are self-initiated, self-directed, functional and intense. Even severely impaired patients can practice independently, without the constant presence of a therapist, allowing patients to explore their full potential for recovery.

The Armeo's purpose is to support functional therapy for patients who have lost the function of or have restricted function in their upper extremities caused by cerebral, neurogenic, spinal, muscular or bone-related disorders.

The Augmented Feedback provided by the shared software platform:

  • Encourages and motivates patients to achieve a higher number of repetitions, and this leads to better, faster results and improved long-term outcomes.

  • Provides adjustable difficulty levels according to the patient's needs and progress

  • Provides adjustable workspace according to the patients' changing abilities The "Continuum of Rehabilitation", from immediate post-injury to long-term recovery, requires a range of therapies to address the changing needs of the recovering patient. Hence, at our Hospitals, we offer various rehabilitation and physiotherapy services tailored to every individual patient and their condition.

  • Neuro-Radiology Services

  • Integrated Neuro-Physiology Laboratory

  • Neuro-Intensive Care

C3/3, Gr flr, shree manek nagar CHS, panjabi lane, opp yes bank, Borivali (W).

Tel: 022 2895 5363